Do you experience pain in your wrists while doing exercises like bench presses or planks? If so, then read on!
As I've mentioned 1,000 times (and you're probably sick of me saying it already), we always have to look distally (farther away) from the area in question. Think of your entire arms as a train. If the shoulder isn't working properly, you bet that you're gonna have elbow and wrist problems too. Take a look at the photo on the right from Thomas Myers' Anatomy Trains. You can see here that the pecs of the chest will influence the structures all of the way down to the fingers.
The number one complaint I hear from clients when doing the front squat is that their wrists hurt them. While the wrist pain is the symptom, the cause typically arises with poor shoulder mobility. If your front rack position is sub-par, your wrists now have to bear the brunt of that load. The lower your elbows are, the more wrist extension you need to compensate. In this instance, you need to work on opening up the pecs and lats to ease the stress on your wrists.
Because of this horrendous shoulder mobility, his wrists suffer.
I see similar problems arise in pressing movements. In the bench press or the overhead press, clients occasionally lack the necessary strength in their forearm flexors, so they fall into a hyperextended wrist position throughout the lift. A more "neutral" wrist position can save them a lot of discomfort. In these cases, the problem might not be mobility, but grip strength. I would have these people do exercises like hangs from the pull-up bar, plate pinches, or farmer walks to combat this. Sometimes, cueing alone can also go a long way to correct this issue.
This image from Liftbigeatbig explains different wrist positions. We never
want significant extension in pressing movements.
Ultimately, if you feel pain in your wrists you have to check out how your shoulders are moving to properly assess the issue. Shoulder instability can manifest itself in a variety of different ways. Continuing to address your wrist alone will have little to no effect. I see a lot of people working to stretch their forearms to alleviate wrist pain, but rarely do they address other possible contributing factors like shoulder stability or grip strength. Global corrections will stimulate an entire chain reaction of positive effects.
It is common for a lifter to seek boulder shoulder status. While having protruding, rounded shoulders certainly looks nice, the shoulders are very vulnerable to injury. The demands of a sedentary, desk-ridden society already makes our shoulders unhappy, and if you translate this dysfunction into the gym, you're gonna have a bad time.
I have dealt with my own shoulder issues in the past, and I know just how aggravating it can be to have to modify workouts or avoid certain movements. Ultimately, I had to learn the hard way what exercises provoked my shoulder pain. Many common-place shoulder exercises can be effective for deltoid and pectoralis hypertrophy, but they also promote instability and compensation. For both myself and my clients, there are four main exercises that I avoid for the sake of sparing their shoulders:
Pec flies. Regardless of whether you're using cables, dumbbells, or even the pec-deck machine, you're most likely better off without them. With this movement, many lifters tend to go well beyond the necessary range of motion to isolate the pectoralis muscles in transverse shoulder flexion. You also run the risk of sufficiently irritating your biceps tendons. Instead, they end up stretching the hell out of their anterior deltoids and forcing their shoulders into a yucky internally rotated position that makes me cringe. For chest development, I prefer to have clients do reverse grip bench press, neutral grip dumbbell bench press (with a slow eccentric focus), and Spoon presses. If you're hell-bent on keeping pec flies in your workout routine, try to minimize the range of motion so that your arms only go slightly above parallel, and make sure you maintain a slight bend in your elbows.
Behind-the-neck lat pull-downs. I've addressed my feelings about behind-the-neck exercises previously, so to save you from a redundant rant, I'll give you the abridged version: these movements (especially in lat pull-downs) encourage you into flexed cervical spine and often reinforce poor shoulder movement. Very few people possess adequate shoulder and thoracic mobility to perform these. If you really want wings, stay away from these. Instead, try rowing variations, pull-ups (you add weight or go chest-to-bar if you want a greater challenge), straight arm pull-downs, and maybe the occasional Red Bull. (I couldn't resist...)
Yikes!
Box dips. In a recent Instagram video, I mentioned that I stray away from programming dips on a bench or a box. Effectively, this variation places unnecessary stress on the anterior capsule and tendons of the shoulder. To perform these, a client must flare the elbows out excessively, while the shoulder again shifts into a precarious position. You will see this as well on bar dips, but to a lesser degree, because the athlete's shoulder and elbows are closer to his center of mass. The ideal way to do dips, in my opinion, though, is on the rings. The rings force the athlete to properly adduct his shoulder, and his arms are closest to his center of mass (thus resulting in a more mechanically advantageous position. If you're currently unable to do ring dips, stick to push-ups on the rings, and then slowly progress to a full ring dip.
Upright rows. I'm sure you've heard trainers shun this exercise before. While I think it can be helpful for developing the shoulders for the right client, there are always other options. I've found that they cause more harm than good for most people, as usually the anterior deltoids are the strongest part of the shoulder. Instead, many people would benefit from training the posterior or rear deltoids with back flies to balance out the omnipresent imbalance from front to back.
In general, gym goers can benefit from fewer pushing exercises and more pulling exercises. I usually propose a 2:1 ratio for upper body pulling:pushing days. By this, I mean that you should only spend about one day per week doing bench press, push press, etc. (or at least with those movements as your primary focus), and two days with a pulling/rowing focus. The anterior deltoids and pectoralis tend to run the show (especially in men), and, thus, can cause a lot of pathologies and mobility restrictions. Your rhomboids, rear deltoids, lats, and lower trapezius can always benefit from some more love and attention.
There are plenty of safe and effective exercises that will still give you strong shoulders, such as those that I've listed in this article. You can be smart about your upper body training and avoid nagging injuries that will keep you sidelined for weeks at-a-time. Make these changes to your routine, and your shoulders will be happier in the long run!
The quadriceps complex is comprised of four main muscles: the rectus femoris, the vastus intermedius, the vastus lateralis, and the vastus medialis (which seems to have become the most buzzworthy muscle of the four). The vastus medialis obliquus (commonly referred to as the VMO) is the middle “tear drop” shaped muscle of the quadriceps complex. Both personal trainers and physical therapists often blame generic knee pain on this guy being weak, but the literature just does not seem to substantiate that concept. If a doctor or physiotherapist has ever told you that you need to strengthen your vastus medialis, then he or she is spouting off outdated and false information.
I have seen many an article claiming that one can “isolate” the vastus medialis, or emphasize its activation, by raising the heels in a squat, by narrowing one’s squat stance, or by doing some wild exercises. These exercises are frequently prescribed to individuals with patellar tendinopathy, patellar tracking, or post-op ACL tear patients. While these concepts sound excellent in theory, the data has shown that those ideas are effectively no more than broscience. The vastus medialis and lateralis muscles contract together, and no amount of heel raise, hip external rotation, or close-stance squats will change that.
Do decline squats increase VMO activation?
The first exercise myth about the VMO is that raising the heels will increase its activation in the squat. While using Olympic lifting shoes or standing on a board will undoubtedly increase total quadriceps recruitment, as your torso will be more upright, the vastus medialis receives no preferential treatment. Rather, the vastus lateralis and medialis simultaneously work harder to squat when the heels are elevated. Similarly, the high bar squat is more quad-dominant than a powerlifting low-bar squat, and a front squat is the most quad-dominant of the three.
Does squat depth influence VMO activation?
When analyzing the angles at which the vastus medialis and lateralis are most active, Lee et. al. found that 90° or less of knee flexion was optimal. Essentially, deeper squats allow for greater vastus medialis and vastus lateralis contraction. Again, both muscles are being targeted in this instance, so the VMO is working harder, but so too is the vastus lateralis.
The other take home here is that if you want quads of the Gods, you can’t skimp on your depth. If you have to ask someone if you’re going low enough, you’re probably not! If mobility is an issue for you, then you should seek the advice of a qualified professional and dedicate time at the end of your sessions to improving your bottom position. What about narrow-stance squats?
None of the research to date indicates that squatting with a narrow stance impacts the vastus medialis to a higher degree. In fact, it doesn’t appear that it changes the activation in any of the quadriceps muscles at all. I’m not quite sure where this myth arose, but it seems to be contradicted by the literature.
Squatting with your feet close together won't increase VMO activation,
but it may result in faulty mechanics and potential for hip impingement.
One study with Paoli et. al. looked at the EMG in 8 different thigh muscles, measuring activity in three different squatting widths and three different intensities (no load, 30% of 1 RM, and 70% of 1 RM). They tested both quadriceps and hamstrings muscles, and there was effectively no statistical difference in any of the muscles except for the gluteus maximus. No matter how close the lifters stances, their quadriceps muscles (vastus medialis included) were no more or less active at any intensity.
Surely foot position matters?
This is one that I have heard for years, and even believed myself for a while: trainers boast that externally rotating the feet will preferentially recruit the VMO, whereas a parallel foot position would lead to more evenly divided muscular recruitment. Unfortunately, no studies to date have confirmed this concept.
Murray et. al. tested twenty physically active adults in 4 different foot positions during a partial squat on the Power Tower machine. They found no real differences in EMG amplitude in differing levels of external/internal rotation. Similarly, Ninos and colleagues tested two varying foot positions (externally rotated and neutral) in the Olympic squat, and there was no noteworthy difference in vastus medialis activation.
The take home? If you have strong quads, you have a strong VMO.
Trainers have managed to come up with many creative circus-trick exercises for targeting the vastus medialis muscle, but while they might look exciting to try in videos, the basic foundational leg movements are all you need; squats, lunges, step-ups, and split squats will help you build strong quadriceps muscles, and, in turn, strong vastus medialis muscles. You can perform your leg extensions with your feet externally rotated all day, and you still won’t be able to isolate your medial quadriceps. Instead, just stick to those previously mentioned core movements and reap the benefits of your tree trunk legs!
Often times, pain in the body is associated with injury or illness of the patient. Pain is not, however, as straight forward as it may seem. There are quite a few misconceptions about what pain means, or what causes pain itself. Here are a couple facts about pain:
I want to start off by saying, just because you’re in pain, does not necessarily mean you’re injured or ill. Pain can be your body’s way of telling you that a dysfunctional pattern needs to stop. When you overuse a muscle, it’s gonna say, "hey, give me a break." As Lorimer Moseley puts it, "100% of the time, pain is a construct of the brain." Basically, this means that it is the brain sending messages of pain, not the muscles. A lot of people seek out temporary cures like cortisone shots, NSAIDs, ice baths, etc., when what they really need is some corrective exercise. This will stop the pain response in the long term by treating muscular imbalances, rather than temporarily treating the symptoms.
Mirror therapy tricks your brain to believe that the
missing limb is still attached to your body.
Similarly, you can feel pain on a limb that's not even yours. Yes, you read that correctly. Take, for example, the case of phantom limb pain. Patients often report feeling shooting pains in an appendage that was removed years ago. A technique called "mirror therapy" has been very effective in treating this phenomenon: "a procedure utilizing the visual recreation of movement of a lost limb by moving the intact limb in front of a mirror, has been shown to be effective in reducing [phantom limb pain]. However, the neural correlates of this effect are not known." While the exact science of phantom limb pain and its treatment is still widely a mystery, this just goes to show that pain is multifactorial and complex.
Conversely, if you’re injured, you might not necessarily experience pain. Not every torn ligament, disc herniation, etc. is symptomatic. There are people with disk herniations who experience 0 pain, and they're able to continue on with their daily activities: "On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions... Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental," noted a study executed by Jensen et. al. Your body remembers previous traumas, and “pain” pathways form in your brain. So, if you suffered from an injury a few years ago, you may experience pain in that same area without having re-injured it. Let's say, for example, you fell while you were ice skating and sprained your wrist two years ago. Now, your brain forms a negative association with ice skating. You may notice your symptoms reappearing every time you go back to the rink, even though you've long since healed.
Emotions can influence your symptoms. We can physically manifest stress in certain areas of the body. If something in your body is bothering you more than usual, consider other environmental stressors that could be contributing to the pain. Did you lose your job? Are you fighting with a friend? Neuroscientist Dr. V.S. Ramachandran puts it succinctly: "Pain is an opinion on the organism’s state of heath rather than a mere reflexive response to injury … Pain is an illusion.” This can mean that if you're upset about something, or you've convinced yourself into thinking there's something wrong, then your brain will respond accordingly by sending a pain response to the area.
Treating the pain symptoms (i.e. taking NSAIDs, icing, etc.) does not necessarily treat the cause of the problem. These will work as short-term solutions. See a doctor, physical therapist, or a chiropractor to figure out the source of the pain before you try to treat it on your own.
There are a million different factors that contribute to pain. Here are a few listed by Dr. Kathy Dooley:
Environment
Memory programming of pain (i.e., cerebral programming)
Systemic inflammation
Pain receptor irritation
Heightened awareness, due to neurotransmitter activity/inactivity (i.e., drug exposure, depression)
Circulatory issues (i.e., blood stasis)
Fatigue and energy deficiency
Improper hydration/dehydration
Psycho-social components (i.e., your back hurts because you hate your job)
The moral of this article is thus: don’t just lump “pain” into one category. Pain does not necessarily mean something is horribly wrong, but you do need to look at why the pain is occurring in the first place, if you want to eliminate it in the long term. Be your own detective.
At some point in nearly every athlete or active person's career, he or she will experience some injury, either major or minor. Whether you've torn a tendon or ligament, sprained a muscle, or you just have a nagging painful area that won't seem to go away, you understand how frustrating it can be when you're making a lot of progress and your body forces you to a screeching halt.
She does not look like she's having a good time.
Unless it is a traumatic injury (broken bone or a complete muscle tear), many people will just bite their tongues through the pain and continue to train normally. Perhaps they'll rest for a few days, or they'll avoid painful movements.
If you're currently suffering from some sort of issue, you're probably trying to figure out what the safest approach is that will allow you to continue to make progress towards your goals.
Injury (or pain) can be a slippery slope. Often times, people will approach me saying "my XYZ hurts. What should I do about it?" First, let me start by saying that I'm not an Orthopedist, a physical therapist or a chiropractor. I simply work in an environment in which people have a pretty high injury risk if they're not being careful, and I've had the opportunity to rack the brains of some very intelligent people who are much more qualified in this area than I am.
Here are some safe approaches to dealing with a painful or injured area without losing your precious gains that you've worked so hard to achieve:
Get assessed! This is the number one, without a doubt, biggest priority. So many people put off going to a physical therapist or chiropractor for one reasons or another. Perhaps they're afraid of what a doctor will say, or they're just too stubborn. Alternatively, they'd prefer to deal with the pain on their own, and they exacerbate their symptoms. Often times, problem areas are a pretty quick fix, assuming you see the right therapist. Finding out what muscles are weak or under-active will be helpful in preventing other similar injuries down the line.
Prioritize corrective exercise. I hear so many people complaining about pain, but yet no one wants to do anything to fix it. Instead, they will pop a couple Aspirin and hope it'll disappear on its own. Sorry to rain on your parade, but that won't work in the long term. Where there is pain, there is dysfunction. Injuries are very rarely caused by one isolated incident, but, rather, the culmination of months (or years) of bad movement patterns. Pain happens when your body says "Whoa, something needs to change. I can't keep working like this." Breathing drills are absolutely important to bring your body back to the parasympathetic nervous system. Correcting your posture will improve your mechanics. Strengthening weak muscles will lead to more optimal movement patterns. Do your shoulder stability work, core strengthening, and hip stability exercises. Without consistency, your symptoms will persist.
Only lift with perfect technique. This goes hand-in-hand with number two. Don't put more weight on the bar than your body is ready to handle. Injuries happen when you compensate.
Don't train painful movements. Figure out a way to work around the pain. If squats are painful when you pass parallel (full knee flexion), try doing box squats or lunges for a while. Are front squats bothering your wrists? Stick with back squats. When a movement causes you pain, you will, subconsciously and consciously, move differently. Your body is going to reflexively shift weight away from a painful area, so you might place more weight on one side of your body than the other, or recruit muscles you shouldn't be recruiting.
Focus on other areas of your body. While your ankle is bothering you, you may use this time to work on your pull-ups and your bench press. Try adding some gymnastics movements into your routine. If your shoulder is injured, now's the time to improve your sprints and increase your back squat. Spend time strengthening the uninjured areas, so that you can still stay on top of your game.
Injuries are frustrating, but they're not the end of the world. If you take all of the proper measures to treat them, you can be back to training normally in just a few weeks.
With an injury, the worst thing you could possibly do would be to ignore it and just hope it gets better on its own. Be proactive and help yourself! Remember, we all experience injury at one point or another, and you can still make progress while you're injured. Always listen to your body and train safely.
The knees are the largest joints in the human body. Unfortunately, these large joints also seem to be an even bigger area for pain and injury. In the U.S. alone, surgeons perform around 700,000 knee replacements annually--that's a lot of bionic knees! Other knee-related injuries include ACL tears, MCL tears, patellar tendon tears, patellar tendonitis, dislocated patellas and osteoarthritis. In my opinion, many of these surgeries or injuries are easily preventable. With the proper training protocol, you can avoid knee pain and inevitable surgery down the line.
We use our knees for a lot of different activities from walking and running to jumping, squatting and lunging, and therefore they withstand a lot of impact. It is incredibly important to prioritize solid movement patterns to avoid any further stress.
I should warn you, that this post will be fairly heavy in anatomical jargon. Brace yourself.
The "knee" covers an area of four bones: the femur, the fibula, the tibia, and the patella. As a hinge joint, the knee can only flex and extend. Though its actions are simple, the muscles around it are vast and complex. Some of the important muscles that directly help the movement of this joint are the hamstrings complex (semimembranosus, semitendinosus, and biceps femoris), the quadriceps complex (vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris), the calf muscles (gastrocnemius, popliteus, tibialis anterior, and the peroneals). If you feel overwhelmed with the laundry list of muscles I just mentioned, fear not! I will elaborate.
Now, we need to remember that the body acts as a chain. One part of the body reacts to the feedback of another part. What are the two major joints near the knee? If you guessed the hip and the ankle, high five! We cannot just consider the knee in the case of knee pain, but rather, we must think about how the surrounding joints are compromising the integrity of the knee. If you have poor hip or ankle stability, the knee is going to work a lot harder to compensate for the lack of stability elsewhere.
Let's start from the ground up, at the ankle. The ankle can plantarflex (point), dorsiflex (flex upwards), invert/supinate, or evert/pronate. Check your feet. Are your arches exceedingly high or collapsed? What happens to them as you squat or jump? Ideally, we want to strive for a perfect balance between pronation and supination when standing. Both of these two movements are completely natural ankle movements when walking or running, but we do not want either in excess.
If, for example, you squat and your ankle collapses (pronates) completely, you will likely experience some collapse of the knee with it. The muscles on the inside of your leg (adductors) are over-active or tight, while the antagonists (abductors) will be lengthened. Do you often feel pain in your IT bands? Well, you may fit into this category of people. Your IT bands may be tense because they're working really hard for some other guys. Think about how this position is going to effect the ligaments and tendons in your knee!
Look at the relationship between his knees and ankles in the squat.
Conversely, if you drive your knees out too much and shift your weight laterally (supinate) your feet, the opposite will happen. Your adductors are going to be lengthened while your abductors will work over time. I was one of these people. The lateral areas of my knee always caused me pain, because I was nearly rolling my ankles as I squatted.
Obviously, the ankle position will effect the knee and hip mechanics, and vice versa.
If one lacks sufficient strength in the gluteus medius and the peroneals, the lifter will, again, revert to a valgus (collapse) of the knees. Weak gluteus maximus will result in an abuse of the quadriceps complex, which is going to pull onto the patellar tendon for dear life. Put more simply, if your glutes aren't strong enough, your knees are going to pay the price.
As I said, we want to maintain a balance in how we shift our weight as we move. Too much outward shifting of the hip or ankle is just as counter-productive as shifting too much weight inward. True strength comes from a balance.
Some of these inefficiencies may be a matter of learning. You might not understand what a proper squat should look like, and there for cueing and repetition will go a long way. If cueing has not helped, then you need to follow a strengthening and mobility routine. The exercises I've listed below will be tremendously helpful.
Now that we've made it through the meat of this article, it's time to learn how to correct these faults. Figure out where you lie on this spectrum of movement dysfunction, and correct your mechanics as necessary.
Here are some great ways to mobilize the hips and the ankles:
Where there is pain, there is weakness and dysfunction. You don't have to "accept" being in pain. Strengthening the hip and ankle muscles are vital in perfecting your mechanics and preventing unnecessary stresses on the soft tissues of the knee. Pay attention to those stabilizers and you will save your knees for many years of heavy lifting to come.
Having a big butt is certainly preferable for models twerking in rap videos, but it's also extremely important in athletic performance. Weather you're a soccer player, a running back or just simply working out to maintain a healthy lifestyle, you need to make sure you're giving your butt the attention it deserves.
I know what you're thinking: "But Arianna! I can squat 250 pounds. My glutes are really strong!" In a perfect world, you would achieve glute activation in the back squat, but many of the back squats I see people execute in the gym make use of the anterior quadriceps muscle and recruit minimal activation from their posterior chain. The truth is, if you are a predominantly sedentary person (meaning you sit for 4+ hours a day at home or at work), you probably don't know how to correctly activate your glutes because you're not using them for the majority of the day. Fear not--you are part of the American majority who sits at a desk job all day. It's no wonder that we don't know how to activate the right muscle groups considering we don't use them as often as we should.
Underactive or weak glutes can cause a ton of problems, including lower back pain, knee pain, IT band syndrome, and a whole slew of other maladies. Your quadriceps may be strong enough to squat 250 lbs, but guess what? If you learned how to activate your glutes properly, you would easily squat over 300 lbs.
The gluteus maximus (one of three muscles that make up what we collectively call the "glutes") is the biggest muscle in your body. Now, if we learn how to properly employ the strength of this tremendous group of muscles, we are going to see some real magic happen. Whether we're doing a deadlift, a squat, a box jump or a clean and jerk, we need to learn to properly harness the power from our glutes in order to move the most amount of weight and avoid injury.
In order to utilize the strength of the ever-powerful gluteal muscles, we must focus on activating them. Some great exercises can be found in my previous article about warm-ups, but I'll list a few more that I really like here:
Once you learn to properly engage your posterior chain, you will see tremendous gains in strength while simultaneously protecting your body from injury. If you have humongous quadriceps and a small butt, that should be a red flag to you that your glutes needs some more attention. Channel your inner Nicki Minaj and start building a bigger booty!
In athletes and deconditioned clients alike, range of motion restrictions are an ever-prevalent issue. Either the individual is not using a full range of motion in a given exercise because he/she wast taught to perform the movement as such, or he/she has severe mobility restrictions.
If you have the ability to train through a full range of motion and neglect to do so, you are doing yourself a disservice. Movements like the pull-up, squat or push-up are the most frequent examples I see in the gym. Men and women alike bust out a quick and sloppy set of push-ups without their chest touching the ground or their elbows fully extending. By using the full range of motion for these exercises, you are not only stimulating more muscle fibers (and therefore getting stronger), but you are also ingraining proper movement patterns into your brain that will be applied across the board.
Training through a full range of motion is extremely important in both injury prevention and treatment and developing strength to your maximum potential. As the famous Kelly Starett, doctor of Physical Therapy and owner of CrossFit San Francisco, warns us:
"If you have ankle pain, chances are good that your calves are tight and are pulling on your ankle, limiting your range of motion. If you have knee pain, chances are good that your quads, hips, hamstrings and calves (all of the musculature that connects to your knee) are brutally tight. It's no mystery why you have pain: You can't get into the correct positions or move with good form because you're missing key ranges of motion. Mitigating overtensioned systems using mobilization techniques feeds 'slack' to the 'injured' site, reducing localized joint pain by improving the efficiency of the system"
In a nutshell, if you're experiencing pain in any given joint, it's probably because you have some tight muscles and are therefore missing full range of motion in that area.
A good percentage of the people I've met have difficulty getting into a full squat because they lack the proper hip and ankle mobility. Before you can even think about putting a barbell on your back, you have to address your poor squat mechanics.
Fortunately for you all, there are many ways of correcting movement dysfunctions and restrictions in mobility. Tools like a foam roller, lacrosse ball, or bands are all useful tools in getting rid of tightness and other movement restrictions.
For more information on specific exercises to mobilize any given area, check out www.mobilityWOD.com.
As I've mentioned 1,000 times (and you're probably sick of me saying it already), we always have to look distally (farther away) from the area in question. Think of your entire arms as a train. If the shoulder isn't working properly, you bet that you're gonna have elbow and wrist problems too. Take a look at the photo on the right from Thomas Myers' Anatomy Trains. You can see here that the pecs of the chest will influence the structures all of the way down to the fingers.
