As many of you already know, I am lucky enough to be able to speak all over the world on topics such as biomechanics, manual therapy, functional rehabilitation and strength training. Last month I was able to speak at a world famous strength and conditioning conference called SWIS (short for Strength and Weightlifting ??????), oddly enough held right here in Columbus at the Hilton in Easton. The topic was relevant to a many of you, so I thought I would give a quick recap. This is Dr. Ulm by the way. I forgot to mention that.
The topic on which I spoke was “Mastering the Brace for Maximal Performance & Longevity”. Whether you are a world class Powerlifter (of which there were many at SWIS) or an inactive barista at a coffee shop, how you brace has a tremendous impact on the likelihood that you do or do not get injury and on the quality of your life. In my talk I discussed two bracing strategies - one compensatory strategy and another that I will call the optimal stabilizing strategy.
While there are more than a few compensatory stabilizing strategies out there, the one that is by far the most common, particularly in the strength training population, is what I call an Extension/Compression Stabilizing Strategy (ECSS). As the name indicates, this strategy uses extension and compression of the spine to stabilize it. Not the most creative of names, I know, but it get’s the point across. This strategy is one with imbalanced activity between the back muscles (aka the posterior chain) and the abdominal muscles. Here, the back muscles overpower the abdominal muscles, resulting in hyperextension of the lower back (lumbar spine). The pelvis is pulled into what we call an anterior pelvic tilt and the ribcage is elevated. (See image 1)
In this position, the main force used to stabilize the spine is, you guessed it, compression. In this hyperextended position, the overactive back muscles apply a massive and pathological compressive force to the spine. This compression and hyperextended position increase one’s risk of injury to the lower back in 4 main ways.
First, the hyperextended position places a constant load on the back part of the vertebrae called the neural arch. (See image 2) The neural arch is designed to protect the spine, a sight for muscle attachment, and to block excessive motion of the spine. What it is NOT designed for is to handle constant load. As you probably can guess, the thick part of the bone know as the vertebral body is where the load should traverse. Placing a chronic load on the neural arch causes pathological adaptation we would broadly call arthritis.
Second, the hyperextended position alters one’s available hip range of motion for squatting. With the pelvis tilted forward, your available range of motion for hip flexion is reduced. This makes it more likely that you will round your back over when you squat down, which in turn, increases your risk for injury to the disc - flexion being the most common mechanism of injury for the disc. The more often you squat, the more weight with which you squat, and the more your back rounds over at the bottom of the squat, the more likely you are to injure it. Therefore, the more pronounced you ECSS, the more likely you are to injury your disc.
Thirdly, the massive increase in compressive force applied to the spine increases the pressure within the disc. The greater the pressure within the disc, the greater the likelihood the disc gets injured. Discs function much like a water balloon with a rubber band wrapped around it. The more you squish the water balloon, the more it pushes the water outward, increasing the stretch in the rubber band. In this analogy the water balloon is the nucleus pulpous and the rubber band is the annulus fibrosis. (See image 3). Just so you know, disc herniations in all of there varieties result when the annulus fibrosis (rubber band) over-stretches.
The final way an ECSS causes lower back pain/injury is by preventing optimal movement of the spine, namely when you bend forward. When you bend forward, say to put a leash around your adorable standard poodle’s neck (#PoodlesAreTheBest) (see image 4), your lower back should flex or what you might call round over. During this motion, the front part of the joint (or what we call anterior) approximate and the back part of the joint (or what we call posterior) separate. (See image 5). This is normal, health movement of the lumbar spine. If you are sporting an ECSS, the front part of the joint still approximates, but because of the hyperactive back muscles, the back part of the joint does not separate. (See image 6) This produces a massive spike in the pressure within the disc, increasing the likelihood that you experience pain or you injury your disc.
If you would like to avoid the aforementioned causes of lower back pain, then you need to make sure that you are bracing properly during your lifting - whether at home or in the gym. To do this, you need to learn how to generate a force essential to the stabilizing process called Intra-Abdominal Pressure (IAP). With an optimal stabilizing strategy, IAP is maximally leveraged so that minimal activity of the back muscles are necessary to stabilize the lower back. Remember, the ECSS is when the back muscles are overactive.
IAP is an outward-pushing force within the abdomen that is produced by the diaphragm - a horizontally oriented, dome shaped muscle, separating the thoracic cavity from the abdominal cavity. (See image 7) The diaphragm plays a crucial roll in both stabilization and respiration. When it contracts, as it would on a proper brace or during an inhale, the diaphragm is pulled downward towards the pelvis. This produces a compressive load on the abdominal contents, pushing them outward against the abdominal wall, downward into the pelvic floor, and backwards against the lumbar spine. This outward pushing force directly and indirectly stabilizes the lumbar spine. It contributes directly by its pushing backwards into the lumbar spine. IAP is the only force that has the capability to stabilize the spine from the front - not the abdominal wall as is often thought. Indirectly it contributes to stabilization by synchronizing the torso muscles (specifically the abdominal wall and pelvic floor). With the torso muscles synchronized, one is able to maximally stabilize their spine for whatever they are doing, thereby, reducing the risk of injury.
To learn how to brace correctly, you first need to create this outward-pushing force - how to consciously contract the diaphragm. The easiest portion to learn this is a position that looks a lot like the yoga position, child’s pose. (See image 8). In this position, practice pushing your belly outward against your thighs. When you do it correctly, you will feel an outward pushing force in the abdomen pushing forward against the belly and backwards against the lower back. Practice this in this position until you’ve got it down. For many of you, this will be surprisingly challenging. Stick with it, because learning it will be a useful skill.
Once you have learned how to create the outward-pushing force in the abdomen in child’s pose, you need to learn how to do it standing and when lifting. Next, stand up and try to reproduce the sensation of that outward-pushing force. Again, this may take a bit. Once you’ve “mastered”, you’ve learned how to brace. Now try and see if you can hold that brace while you lift. I think the easiest movement to which to apply the brace is a kettlebell deadlift. When you lift the bell, focus on feeling the pressure in the abdomen and see if you can maintain the pressure for the duration of the lift. From here, you just need to practice applying to brace to all of your movements - pressing, pulling, bending, twisting, lunging, etc.
A quick hack to learning how to brace correctly, that’s admittedly a little silly, pulls from the martial arts world. While standing, place your hands just above your hip bones on the soft part of your abdomen. Then execute a full throated kia…like you are Bruce Lee executing a 1” punch. If you give it your all, you will feel a quick burst of the outward-pushing we’re looking for. The kia is a quick contraction of the diaphragm and results in a quick brace. Now that everyone in the gym is looking at you, do a second full-throated kai, but this time hold the brace for a few seconds. Holding the kia is the same as holding a brace. All you have to do now is learn how to reproduce the motion of the kia without the sound and you’ve got it…unless you want to do a kia every time you brace, which would be epic!
Whether you use the first or second method to learn a brace, it will take a few days, even weeks, to be able to successfully apply it to your lifts, but you will benefit tremendously from your efforts.
I have to give a huge shout-out and genuine thanks to long time patient, awesome human, and incredible athlete Jessica Budd. She is an elite, nationally competitive powerlifter who was nice enough to take time out of her day to come in and help demo proper bracing for heavy lifts during my presentation. (See image 9) Without her generosity, the presentation would not have been so well received. Thanks Jess!
I hope you found this email useful and are able to successfully apply it to your everyday lives.
Richard Ulm, DC