In this issue:
Kettlebells and Lower Cross Syndrome
Vladimir Janda was one of the most influential physical medicine physicians in the world in the late 20th century. A pioneer in the field of “low tech” rehabilitation, he honed his skills in communist Czechoslovakia. While western physicians were producing “human wreckage” (Waddell, G. 1992), with surgical techniques for the lumbar spine, Janda consistently produced outstanding results in rehabilitating the same types of cases using wobble boards, sticks, exercise balls, (probably kettlebells) and most importantly his hands. After the fall of the Soviet Union and the formation of the Czech Republic, Janda and his colleagues became more accessible. In the early nineties, a group of progressive thinking chiropractors and physical therapists began teaching Janda’s techniques in the West, and changed the way most of us looked at physical medicine.
One of the more basic (but essential) Janda concepts, is the Lower Cross Syndrome. Lower Cross Syndrome is epidemic in western society because most people spend a large percentage of their time sitting. This can cause tightness and hyperactivity in the hip flexor group (iliopsoas etc.) Through a process known as reciprocal inhibition (defined as the contraction or activity of one muscle group inhibiting the contraction or activity of the antagonist muscle group), the hyperactive or tight hip flexor group can actually inhibit the hip extensor group, most importantly, the gluteus maximus. This imbalance then produces a secondary effect during walking. Since these people are unable to produce hip flexion with the gluteus maximus, they begin to substitute the low back extensors. They in turn become tight and hypertonic and through reciprocal inhibition inhibit the abdominal muscles. Thereby producing a “big gut, no butt” scenario (usually aided by poor diet and no exercise). Lifting and walking using primarily the low back extensors cause an increase in biomechanical stress in the lumbar spine producing chronic pain, osteoarthritic degeneration, and disc herniation.
A key challenge to anyone treating low back pain is how to permanently correct this dysfunctional pattern. In my previous life (before kettlebells), I would use wobble boards, exercise balls and other “low tech” solutions. While effective, the exercises tended to be complicated (as well as boring) for the patient and more than one tool would often be necessary. When I started learning about kettlebells, I was excited at how such simple movements (the swing, clean, press and snatch) in addition to being amazing cardiovascular and strength conditioning exercises, actually corrected many of the movement pattern disorders I had been trained to identify. The most common of these being the Lower Cross Syndrome. What is amazing is that it seems as if the swing was specifically designed to correct this pattern. Proper swing technique involves lowering the kettlbell via lumbar spine neutral hip flexion and then producing power via lumbar spine neutral hip extension (aka the hip snap). This simultaneously stretches and relaxes the hip flexors, activates and strengthens the hip extensors (particularly the gluteus maximus), and teaches lumbar spine control. Additionally, the secondary part of the swing, abdominal contraction at the apex of the swing facilitates and strengthens the abdominals and relaxes and stretches the lumbar paraspinal musculature; a fantastic win/win scenario!!
In summary, performing or teaching the swing exercise not only gets you or a client/patient in shape, it also has a corrective effect on one of the most common dysfunctional lifestyle patterns of the western world!!
Case Study
History and Examination
A 35 year old male presents with complaint of lower back pain of at least one year’s duration. Patient sits and travels for a living. No significant history of trauma or major back injury. Pain is present most days and limits activity, particularly cycling, which had been the patient’s exercise of choice. Current exercise level is minimal due to pain. There are no significant complicating factors. MRI was negative for significant structural abnormality (no disc herniation, disc bulge, or osteoarthritis)
Examination reveals pain arising from the lumbar spine. Movement pattern evaluation reveals significant altered hip extension pattern, i.e. substitution of lumbar extensor muscles for primary hip extension.
Strategy
Decrease pain level and correct local musculoskeletal dysfunction using various techniques (chiropractic adjustment, cold laser, soft tissue percussion, etc.)
Refer patient to Anthony DiLuglio for Kettlebell Training Regimen
Kettlebell Training
Day One:
Swings (two handed) 24kg
Swings (one handed 24kg
Swings (hand to hand) 24kg
Cleans (ladder 5-4-3-2-1) 24kg
Chest Press (ladder 5-4-3-2-1) 24kg
Renegade Row (ladder 5-4-3-2-1) 16kg
Three Months Later:
Double Alternating Press x5 24kg
High-Pull from floor x5 32kg
Double Overhead Lunge x10 12kg
Halos/Side Bend x8 24kg/12kg
Behind the neck squat x10 24kg
(No break between exercises, repeat 3-5x)
No increase in lumbar spine pain following initial workout or any subsequent workouts
Follow Up
Patient continues with kettlebell workouts (AOS: Providence, Newport, and Firepower) on his own, and he was released from active care with full resolution of symptoms. He was able to resume cycling (over 40 miles, multiple times per week) and now participates with no ill effects.
Notes
- Patient was referred for kettlebell training while still symptomatic. On several occasions remarked that any pain he felt prior to beginning the workout would be relieved by the workout.
- Significant structural abnormalities such as disc bulges and osteoarthritis do not disqualify kettlebell training from the treatment strategy. They may, however, cause a modification of the training sequence and/or exercises.
Want more information on dealing with common injuries and/or pain?
Stay tuned for AOS: RX
Video of the week:
Jeff Waters Says Goodbye
Most of you know me as the Minute of Strength Chief Editor and Creative Director for Art of Strength and Punch Kettlebell Gym. It is with a heavy heart that I announce my departure from this fine organization. Over the past two years, I’ve been proud to bring you 44 Minute of Strength issues like clockwork every two weeks.
Your response to this work has kept me motivated to produce the highest quality information. The thousands of emails you’ve sent to mos@artofstrength.com have landed first on my desk. I read every single one of them and was continually amazed at the reach our little publication achieved. I heard inspiring stories from middle-aged housewives in Kentucky and Scandinavian Olympic Teams. There was the young British “bloke” who got in great shape, took some of Anthony’s fashion advice, and developed the self esteem to chat up and date a fashion model in a local bar. I heard a dozen stories of high level business executives who bought extra kettlebells to keep next to their office desks… guys who took great pleasure in the strange looks from their subordinates. I’ve heard from people in every walk of life you can imagine.
I am also extremely proud of our DVD series. Several years ago, there weren’t many kettlebell videos on the market. We noticed that most of the available titles featured poor production quality and simply regurgitated the same old instruction on how to “do” kettlebell drills. But the question we kept hearing over and over again was “ok… now what do I do?” We set out to answer that question by bringing the proven “follow-along” workouts from Punch Kettlebell Gym into customers’ homes on DVD. I spent a tremendous amount of effort teaching myself how to professionally film and edit well enough to bring our vision to life. Our series raised the bar on kettlebell training DVDs and set a new standard.
I am stepping down from my posts at Art of Strength for a variety of reasons. As the business has grown, the workload has gone beyond what I can handle with 3 kids under 6 and a full-time career in the technology sector. I might pop into the AOS online forum down the road and say hello. Until then, I wish you all health and strength. You have all made this one of the most rewarding experiences of my life.
Best,
Jeff Waters
PS: For those of you who know me from the forum. I normally have a full head of hair. My forum picture was taken during the 3 day weekend a couple years ago after goofing around with some clippers!