Last week we talked about the extension compression stabilizing strategy (ECSS). I had described the reason for its prevalence, the utility in it, and the long-term effects it can have by creating low back pathology. We now have a better understanding of the issues with this stabilizing strategy and how we can create stability with better strategies. This week, I want to focus more on what we can do for those already suffering from the effects of ECSS or other trauma in the low back.

We need to understand the common method of creating stability in the spine, the extension compression stabilization strategy (ECSS). This is a common contributor to next day low back soreness and overall long term risk of disc injury.

Dialing in our macronutrients could be the lowest hanging fruit for maximizing performance, recovery, and injury prevention and rehab. Depending on our goals, we can calculate what should be our percentage calories from carbohydrate, protein, and fat from our total calorie target. Before diving into calculating targets for each macronutrient, we need to establish our total calorie goal that addresses our resting metabolic rate and physical activity level (we can factor thermal effect of food into this as well or ignore it, considering the margin for error already in place for these calculations). See the previous blog article for more on calculating this!

Learn to take the first step in mastering your nutrition with calculating total energy expenditure! This is vital in how we determine macronutrients and total calorie goals for atheltes and exercisers.

How foot pronation relates to performance and injury prevention. Learn how to test and improve foot pronation in the rehab process and performance training.

If the thoracic spine and rib cage has lost mobility, than we cannot expect our shoulder joint to make up that range and allow us to access ovehead positions with compensations!

Foot mobility is crucial to performance and injuryprevention. Further, we need to learn how to use that foot mobility to create certain motions like pronation, supination, dorsiflexion, and plantar flexion.

Dr. Nick discusses external rotation and its signifigance in sport and exercise. It is vital to have adequate external rotation measures to create the space in the joints necessary for high intensity movements. Further, we need to know how to train these motions and integrate them with sport to maximize our ability absorb and then produce force.

First, internal rotation is described as the rotation of a joint towards the midline in the transverse plane. For example, if we are standing with are arms at 90 degrees to our sides and elbows flexed at 90 degrees with the palms facing the wall in front of us (like we are making a field goal), if we rotate our palms down in this position without letting the elbow drop, this is internal rotation of the humerus bone at the shoulder joint.

Now, more important that the anatomical definition of internal rotation is what we use internal rotation for (it’s more than just mobility to achieve different positions). Internal rotation is necessary for force creation! When approach the bottom of a squat for example, we are lengthening muscles and moving through joint positions as we control the descent. This is more of a globally externally rotated state as the body and joints create space for the bones to move in. Eventually, we need to overcome these positions and an internal rotation state is needed to close the joints and take space away.

The squat is broadly a movement of hip flexion, knee flexion, and ankle dorsiflexion. These motions also require femur external and internal rotation (more external) and tibial rotation. Don’t forget about the pelvis, which needs to be able to flex and extend as the sacrum nutates and counter-nutates. That being said, we also need strength in the core to create stability for the lower extremity to move. So, there is a lot going on!

To summarize, we often think of hip hinging as a deadlift or some deadlift variation, but there is much more we can do that utilizes the hinge. For instance, in sport we are hinging and creating force from a hinged position constantly. Think of a lineman in 3 quarter stance or tennis players reaching low and exploding back out of the position. CrossFit of course uses the hinge in all deadlifting variations but we can also see it in motions like toes to bar and kettlebell swings.