IOL Strength and Conditioning

When I saw Anthony Carey was presenting at the IDEA convention, I knew in advance it would be a real highlight for me. His book, The Pain-Free Program, is an outstanding contribution to corrective exercise self-help, and really had an impact on my early steps in getting to pain-free movement. I was eager to hear him in person and to watch him interact with the crowd.

Snipped off the top of his session handout, we find,

“Limitations and dysfunctions of the hip joint result in a transfer of responsibility to the lumbar spine. The lumbar spine is not designed to work the way the hips do, so the outcome is often lower back pain. Recognizing the contribution of the hips is key to long-term function and back pain prevention.”

I think most of us are starting to get the hint, but let’s get a little deeper into the material. Here are the bullet points from my notes, in no particular order.

• Functional anatomy is more complicated than cadaver anatomy, ie Gray’s. The way the body actually works is different than it appears. For example, the hamstring curls the leg up, but functionally its purpose is much more useful.

• The maximum rotation in the lumbar spine is 8-10%.

• Hip flexion equals lumbar flexion; lifting the leg (hip flexion) causes posterior tilt. Hip extension equals lumbar extension.

• Hip ABduction equals ipsilateral lumbar flexion. Hip ADduction equals contralateral lumbar flexion. Hip AB-ADduction is excessive frontal plane movement—frontal plane hip tilt.

• A normal pelvis rests in 5-10% anterior rotation (toward the front). Sagittal plane deviations are excessive anterior rotation (more than 10%), posterior rotation (to the back) and asymmetrical rotation, meaning one side rotates forward, one side rotates back. Asymmetrical rotation doesn’t dissipate force on impact.

• Frontal plane deviations include hip adduction (elevated) and leg length discrepancy.

• Hip internal rotation equals lumbar rotation toward the involved hip. Hip external rotation equals the opposite (away from the involved hip). This is rotation on the transverse/horizontal plane.

• Corrective exercises for sagittal, frontal or transverse plane deviations should work the planes that need attention, establishing normal range of motion in all three planes. Additionally, train stability of the hip musculature at all ranges of motion and stabilize the lumbar spine when the hip is moving. Include in the program foam rolling, static stretches and dynamic stretches.

• 85% of disc bulges are posterior lateral, meaning they bulge to the back of the spine, not the front, and to the outside.

• When you have a sciatic nerve problem, don’t stretch the hamstring. That makes it worse.

• The sciatic nerve passes under, over or thru the piriformis muscle under the glute maximus.

• Tight hip flexors decrease hip extension and pulls on the lumbar spine during walking, contributing to pain for even the sedentary person who walks 2,000-3,000 steps per day on average.

• If a person has an elevated hip, look for a low shoulder. You’ll also find a short waist on the high-hip side.

• When a hip is in internal rotation, the knee is internally rotated and the foot is pronated; in external hip rotation the knee would point out, with the foot supinated.

• Hips need mobility and stability equally. Don’t just think mobility.

• Average hip rotational range of motion on a clinical testing table is 90 degrees of external rotation and 70 degrees of internal rotation. This is completely different than useful range of motion, which depends not only on mobility, but also on stability.

• When working on joint mobility, look for quality of movement and don’t over-fatigue. Stop before you’re exhausted with the movement.

• Bonus: If the arms are pulled forward in the overhead squat, look for tight lats.

• Bonus # 2: In cases of fibromyalgia, work on posture. That will help with the pain.

Again let me recommend Anthony’s The Pain-Free Program to anyone with recurring back pain or who has determined he or she has problems in the hips. It’s exceptional in helping the reader discover where to start and how to progress. The exercises are well explained, with photos to pull the whole thing together. Exceptional book, grab a copy… read it… then DO THE EXERCISES. That’s the only way it works, eh?