Dr Mel Siff Blog

Further to my earlier mail on treating knee stability problems, here is some
more discussion that I have been sharing with the person who is the
unfortunate victim of those problem. He added this information:

<< Causes of my knee problems:

1. I have a hyperlordosis problem that might be related to having tight psoas
2. I seem to have a tendency to round my back at the bottom of the squat
3. There was something to do with my vastus lateralis coming into play
before my vastus medialis while I squat which contributed to my knee
instability ( note that I did not hurt my knee squatting)
4. I think there were some slight rotation problems with my shoulders
5. I think I had a slight tilt that brought my right shoulder up and my left
hip >>

***None of those tests would be considered to be scientifically definitive.
For example, while psoas ‘tightness’ may have something to do with excessive
‘hollowing’ of the lumbar spine, that is one of several possible explanations
for significant lordosis.

Anyway, tightness of psoas would tend to counteract your tendency to round
the back during the squat. Rounding of the lower spine generally has more to
do with limited flexibility in the ankle and knee joints than the psoas. In
addition, it can simply be due to ‘bad’ neuromotor habits accumulated over
prolonged periods of uncorrected training. Very often, the use of a few
hands-on kinaesthetic ‘tricks’ that I mentioned in my last letter, improve
the situation markedly in a few minutes.

If your back tends to round too much near the deepest part of your squat,
then simply squat as far as you can go with good form and gradually increase
the depth of squatting over a period of a few weeks and the rounding problem
quite happily will resolve itself.

How did they ascertain if one of the vastus muscles was ‘firing’ before the
other without using an EMG? How did they conclude that the way in which your
muscles came into play are not appropriate for your individual structure and
characteristics? It is well known that all muscles contribute to different
degrees with different timing, so what a muscle test reveals under static or
short range conditions may be totally irrelevant to what happens under full
range movement in a given sporting action. There is no set universal pattern
which applies to all of us.

Probably what had more effect on your squatting than anything else is the
fact that knee injuries are notorious for producing reflex inhibition of the
quadriceps. The body innately knows that the ability to produce very
forceful contraction, so it somehow activates inhibitory nervous processes
which counteract your ability to contract muscles that operate the injured
joint. Very often, if you have an injured knee, you will tend to become more
of a “back squatter” with a marked forward lean and you will often tilt your
injured knee in such a way as to minimise the stress on it. This will lead
to tilting of the hip, rotation of the trunk and other such problems. No
need to look for mystical causes in vasti , psoas or pyriformis muscles, or
in “muscle imbalance” – the problem may simply lie in reflexive protective
processes.

<<I thought I had been balanced by another therapist, so I’m thinking that
the tilt might have been related to the pain in my knee. >>

***Your diagnosis is probably as accurate as any therapist is going to make -
your intuitive diagnosis agrees with my above analysis based upon a knowledge
of motor control. Far too often, impressive sounding jargon is used to
justify a model of the injury and healing process, when the truth is that the
diagnosticians don’t really know. However, a diagnosis couched in
pseudoscientific language sounds a lot more convincing to the client and the
therapist – remember that both people involved in the healing situation need
to satisfy psychological needs.

The only way in which one can avoid this situation is to list several
possible causes and, by harmless trial and error (guided by movement patterns
and perception of pain), narrow them down to a short list of the most likely
causes. Of course, genuine medical examination such as radiological scans of
the area should be used to rule out the possibility of really serious
pathology, if this may be of any concern.

Dr Mel C Siff

Recently I described the old Olympic Standing Press on several discussion
groups (because of its special effectiveness as a ballistic training method for
the abdominal musculature in particular) and remarked that:

“Never relax the glutes or allow the lumbar spine to straighten or flex at
any stage of the lift, because of the risk of injury. The ballistic part of
the upward drive relies on carefully timed pretensing of the abdomen, the
characteristic double dipping action and pretensing of the shoulder girdle”

Someone asked for this description to be explained more simply. My added
comments may alos be of interest here.

*** The Olympic Press:

1. Hold the bar firmly on the front of the shoulders, using an action that
seems like bending the bar over the shoulders while tensing the glutes and
pretensing the musculature of the front of the body, especially the abs.
Keep the quads tightly contracted and lock the knees.

2. Slowly commence the layback by allowing the whole body to produce a
marked arch between the shoulders and the ankles, so that the entire body
becomes like a bow ready to project the bar upwards. (Wait for the chief
referee’s clap!)

3. Terminate this layback with a short, sharp ballistic action and thrust as
powerfully as possible upwards by using the prestretch and allowing a strong
body sway to propel the bar off the chest. Don’t lay back by flexing the
lower spine, bending the knees or dropping the shoulders.

4. As the upward movement of the bar provided by the initial ballistic
thrust and the pressing action slows down, once again lay back by pushing
against the bar and arching the body into a pronounced arc between shoulders
and ankles. Do not relax the glutes or round the lower spine while doing this.

5. Continue pressing upwards with all your might until the bar is locked
firmly overhead. (Wait for the chief ref’s signal to lower the bar!).

In the non-ballistic press and the military press, you do not dip backwards
ballistically or use two distinct laybacks during the execution of the
movement – one simply tries to press the bar straight upwards, using just
enough back bend to prevent the bar from colliding with the chin or nose on
the way up, much as you do in seated presses with the bar in front of the
head. A well-executed Olympic Press is almost as fast as the Olympic Jerk.

Refer to the following website:

http://www.olympus.net/personal/cablebar/PRESS.htm

The first single photograph, showing the Russian Kanygin pressing, exemplifies
what would often be considered as excessive backbend by officials. The second
series of photographs of Russ Knipp give an outstanding example of what a
well-executed Olympic Press should look like. Note that Russ started very
strictly in the first layback position. In practice, many lifters started
more upright and then very gradually sank into the prescribed pretensed
layback position, thereby producing a more dynamic (quasi-isometric)
pretensing start (as described in steps 1 and 2 above).

With that added ’sneaky’ action, I could add something like an extra 5kg to
my usual Press of about 120-125kg (264-275 lbs) in the 90kg division – it was
really very disappointing when the IOC discontinued the Press in 1971,
because quite a few of us were aiming at that imaginary 300lb barrier in the
sub-superheavy classes and 400lb in the superheavy class. Ah, well – we can
now but dream of those bygone times and continue to use privately the beloved
Press in our current training!

Paradoxically, many of us experienced more backache or minor lumbar injuries
while jerking, but rarely while pressing, because we were very well aware
that sloppy pressing habits could be dangerous. During jerking, however, one
would sometimes force the body into some unwise postures to correct for a
poorly executed thrusts overhead, some of which involved spinal rotation,
ballistic loading of the lumbar spine or lateral tilting of the pelvis.

Dr Mel C Siff

In one of my earlier posts, I commented on the fallacy that the Olympic
Weightlifting Press is a significant cause of back pain and dysfunction. An
extract from that mail read as follows:

> I added that it is even doubtful if frequent back bending is a major cause
> of the problem, because spondylolysis was not at all common among Olympic
> weightlifters who performed the Olympic Press with a marked backbend under
> heavy loads (weights exceeding 300lbs or 140kg were commonplace).

Someone from another group commented thus:

<<….Kotani, 1970 found an incidence of 30.7 percent in weightlifters who
complained of back pain. They were doing the press back then. Rossi
1990 looked at “athletes suffering from low back problems” from 1962-
1988 (most of those years included the press) and found weightlifters
3rd on a list of 30 sports with an incidence of spondylolysis of 22.68
percent… >>

Mel Siff:

*** It is interesting how much these figures differ from a study whose
results were reported by the International Weightlifting Federation in its
publication, “World Weightlifting” during the late 60s or early 1970s. The
researchers involved stated that back injuries accounted for something like 8
percent of all injuries experienced by Weightlifters, but did not give the
breakdown for the different types of back disorder. Another study like this
of American weightlifters appeared in Bob Hise’s “International Olympic
Lifter” around the same period and the incidence back injuries were similar.
Knee and shoulder injuries were far more common.

The researchers remarked that the back trauma appeared to be experienced most
often during the catch and early rising phases of the clean, where rounding
of the lumbar spine is quite common. It did not appear to be at all common
during any stage of the snatch because the fixation posture with the bar
overhead and further to the back tended to counteract any tendency of the
pelvis to tilt posteriorly.

None of those studies, including the ones cited by Chad showed that the
Press, as opposed to the Snatch and Clean & Jerk, showed that it was the
Press which was the primary offender in causing skeletal back injuries.

However, as a lifter who competed in the Press for many years and met some of
the world’s most competent pressers such as Russ Knipp, Serge Reding, Alexei
Medvedev & Arkady Vorobyev, I became very aware of pressing techniques that
certainly could put the lumbar spine at risk.

Both my coach at the time, Roelf van der Berg, who held the S African record
of 142.5 kg press in the 82.5kg division at a time when the world record was
held by the great Tommy Kono (153kg in the same division) and the Belgian,
Serge Reding (my coach for a few weeks in S Africa), who held the world
superheavy Press record of 228kg when I met him, stressed that you should
never relax the glutes or allow the lumbar spine to straighten or flex at any
stage of the lift, because of the risk of injury. The ballistic part of the
upward drive was to rely on carefully timed pretensing of the abdomen, that
characteristic double dipping action and pretensing of the shoulder girdle.
While the American Russ Knipp (world record Press of 158.5 in the 75kg div)
was visiting S Africa, he spent time with me at my former university and also
gave me much the same advice on Pressing.

Unfortunately, attempts to push the Press to even greater weights by invoking
increasingly ballistic actions of many parts of the kinetic chain (knees,
back and shoulders) sometimes resulted in lifters doing precisely what my
various coaches warned against. Instead of arching the body like a pulled
bow and pretensing the abdominal and shoulder musculature, lifters executed a
type of bastardised jerk or ‘cheat Press’ which flexed the lumbar spine
during the first dipping movement and sometimes even during the second dip.
Others indulged in excessive back bending during the second dip or layback
and executed what almost looked like a standing bench press, a type of
lifting which may well traumatise the lumbar spine.

Now, it is well known that heavy loading, especially vibratory or ballistic
loading (see Chaffin & Andersson “Occupational Biomechanics”) is especially
harmful to the lumbar spine, a situation which is exacerbated by any spinal
twisting, something that also happened during attempts to press as rapidly as
possible with a flexed spine.

This is precisely why I stressed in my original letter to this group that
technical execution of the Press was of great importance, as it is with all
heavy Olympic and Power lifts. So, if the groups of lifters studied did
experience spondylolysis to the extent reported in those studies – and if the
Press played a contributory role – then I would not be at all surprised if
the less strict form of ‘cheat’ pressing constituted a significant part of
the aetiology.

As we have noted so often before, it is often inappropriate to universally
condemn any exercise as being dangerous – it is not the exercise which
necessarily causes the major problems, but the manner in which it is executed.

Dr Mel C Siff

Some years ago I seem to recall an article which concluded that loaded
hyperextension of the spine was potentially less harmful to the lumbar spine
than unloaded hyperextension such as that encountered in throwing and jumping
sports. Possibly someone else can locate that reference. This might explain
why the incidence of hyperextension injuries in Olympic weightlifting appear
to be far less common than in sports such as cricket and gymnastics.

Many have militated against all spinal hyperextension, but they seem to
forget that McKenzie techniques (as variants of the ancient yoga Cobra asana)
actually comprise controlled forced hyperextension of the spine in a posture
which does not allow the lower body to sway and dissipate stress as in the
standing Olympic Press. Sure, we have pointers such as the
peripheralisation or centralisation of pain symptoms to guide us to the
suitability of McKenzie, but why are many folk adamant about avoiding all
forms of hyperextension, irrespective of such guidelines?

Then, we also must distinguish between the strictly controlled hyperextension
of the spine in the sagittal plane during the Olympic Press, compared with
the complex lumbar hyperextension, trunk rotation, lateral pelvic tilting and
asymmetric foot impact actions involved in cricket bowling, tennis serving,
gymnastics and so forth. Are we justified in comparing simple hyperextension
in one plane with complex trunk actions in several planes?

All too often, it seems to be forgotten that even small torque about the
vertebrae can produce more strain in the peripheral annulus of the disk than
far more extensive flexion or extension. This tends to reflect itself in
training and rehabilitation programs drawn up for athletes and workers – the
(often machines-controlled) movements and stretches very rarely involve
significant use of rotatory actions, especially under progressively
increasing conditions of resistance and range. Yet, all physical therapists
have been exposed to the well-known patterns, pacing, procedures and
principles of PNF with all of its emphasis on the regular use of spiral and
diagonal patterns.

This may well explain why the incidence of injuries associated with forceful,
sudden, ballistic or large range rotation of joints may be so rife in sport -
witness for instance, the mainstays of sports therapy with its epidemic of
rotator cuff, ACL and similar injuries. Machine training and even free
weight training seems to concentrate largely on linear or uniplanar actions,
and if rotation is involved in training, it takes place only in the sport
itself or in the gym via the use of gentle yoga-like stretches and warmups.

It is not only exposure to a stressful action that can cause injury, but also
religious avoidance of so-called dangerous actions (which might occur during
actual sporting conditions). One cannot expect the body to cope with the
immense structural and functional demands placed on the body in sport unless
one methodically conditions the body to cope with progressively greater
structural and functional stresses.

Dr Mel C Siff

This following reference should make some interesting reading for those who
are vehemently opposed to the idea of plyometric training on the basis of it
“causing injuries”. In fact, this article indicates that properly prescribed
plyometric exercises can offer significant benefits over normal sporting
activities.

——————————————-

Witzke KA & Snow CM Effects of plyometric jump training on bone mass in
adolescent girls. Med Sci Sports Exerc 2000 Jun; 32(6):1051-7

PURPOSE: The purpose of this study was to investigate the effects of 9 months
of plyometric jump training on bone mineral content (BMC), lower extremity
performance, and static balance in adolescent girls METHODS: Exercisers
trained 30-45 min, three times per week, performing various exercises using
weighted vests (squats, lunges, calf raises) and plyometrics (hopping,
jumping, bounding, and box depth jumps). The program was designed to load the
lower extremities. Control subjects, matched to exercisers for age and months
past menarche, maintained their usual activities. The following were assessed
at baseline and 9 months: BMC, strength by isokinetic dynamometry, power
(Wingate test), and static balance. . . .

RESULTS: ….Both groups experienced a significant increase in percent change
in bone mass compared to zero, for the whole body (mean: 3.7% for exercisers,
3.6% for controls), femoral neck (4.5% vs 2.4%), lumbar spine (L2-4) (6.6% vs
5.3%), and femoral shaft (3.4% vs 2.3%), but only the exercisers improved BMC
of the greater trochanter (3.1% vs 1.9%). Furthermore, the exercise group
significantly improved knee extensor strength (14.7% vs 7.3%) and
medial/lateral balance (38.1% vs 9.5%), whereas the control group
demonstrated no changes. The variety of lateral movement activities performed
by the exercise group may have contributed to the differences observed
between groups for greater trochanter bone mineral density (BMD), leg
strength, and medial/lateral balance.

CONCLUSION: The trends observed in bone mass between groups suggest that
plyometric jump training continued over a longer period of time during
adolescent growth may increase peak bone mass.

—————————

Dr Mel C Siff
Denver, USA