An Honest and Controversial Question

Categories: Blog, Press RESET, Training, physical therapy Nov 22, 2022

And now, a guest article by OS Clinician and friend Dr. Kurt Brooks. Buckle UP!!!

An Open Question:  What is our fascination with “perfect form” when strength training?

I’ve been a physical therapist for 30 years now and have had a burning question for a couple of decades… At what point do we teach our patients or train our clients to perform a ‘sloppy’ movement?

I’ve seen physical therapists and personal trainers teach “pelvic neutral” lumbar stabilization techniques for decades.  We still teach the squat, deadlift, and kettlebell swing with the back somewhat arched to “lock out” the lower back.  More recently, I’ve seen the push-up change from elbows-out to elbows-in (to protect our shoulders). But why?!?

Again, at what point do we train our patients or clients to perform a sloppy squat or deadlift? Specifically, when do we teach them to slouch or round out their backs when picking up a load?  

I know! I know! We don’t!  …But why not?  Because that’s where most people are weaker and more likely to injure themselves?!?  Isn’t that the point???

We’ll get back to that in a minute, but let’s look at the lessons we have learned from rehabbing ankle sprains and ACL tears.  Ankles are anatomically weaker in full plantar flexion (toes pointed).  The bony alignment allows for more wiggle in that position, and the muscles are at a biomechanical disadvantage.  The vast majority of ankle sprains, obviously then, occur in this position.  ACL tears typically occur when the knee is hyperextended or when hit from the side (causing a valgus stress).  So, when we rehab an injured ankle or work on an injury-prevention program, we don’t shy away from those dangerous positions… we work up them and attack them!  We start with ankle and knee strengthening exercises in safer positions but then work up to jump training.  We add anterior/posterior stresses, then add lateral stresses, then rotational, then more ballistic activities.  But we always end up attacking those dangerous positions… agility drills up on your toes… jump landing drills… cutting, turning, and twisting. We train the body and the brain to stabilize and to protect those joints in those dangerous positions…

…not by avoiding them! But by working in those very positions that put us at a higher risk of injury.

Now back to the back!  We know most people hurt their backs when bending forward.  Picking up a heavy box off the floor… reaching into the trunk of their car to get the groceries out… lifting a child out of their car seat… etc.  We are in a biomechanically disadvantaged position… but one that we NEED to be able to get into! We have joints, discs, ligaments, and muscles that are made to flex!! And humans tend to use those positions a lot!  (Extension is a great place to be, but is limited by the bony congruency of the lumbar facet joints.  That bony congruency gives us great stability! The only muscular requirement is to keep us locked out in full extension… but that’s the easy part!)

If the lumbar spine is fully capable of achieving a flexed posture and it is a natural position to get into to interact with our world, why do we avoid it when working with our patients and clients? Our patients and clients certainly aren’t going to avoid those positions. We know people are more likely to get hurt there, so why aren’t we working on strengthening the lower back in a flexed position?  When do we fully elongate the multifidus, quadratus lumborum, and other erector spinae and work to overcome that stretch-weakness that we know exists?

Shouldn’t we instead incorporate poor-posture deadlifts, squats, kettlebell swings, etc., into our patients’/clients’ programs?

In the same vein, there has recently been a trend to stop our clients from doing push-ups with their elbows out.  This is to “protect” the shoulders.  

But that is B.S.!!  If we arbitrarily choose to avoid certain movements, aren’t we creating a weakness (neuromuscular or even just strength) in that position? If we change the push-up to elbows-in (and avoid elbows-out), do we not lose the strength in that 90-degree position?

What about quick reactions that require us to reach out to the side? A football player trying to make a tackle reaching out sideways to grab the running back.  A parent quickly reacts to their toddler dashing toward the street.  That quick lateral reach to catch that glass or box falling out of an overhead cabinet.  If we have avoided that position during our rehab or our training sessions, we are creating an increased risk of injury in that position.

If we, as physical therapists, chiropractors, doctors, trainers, fitness coaches, etc., are afraid of the human body and its use (in all of its available positions and postures), our patients and clients will be too!

I want to hear your opinions on this one!  I don’t know everything and haven’t read every research or fitness article out there, so let’s hear from you!  

Kurt is a physical therapist with almost 30 years of experience. Working with orthopaedic and sports medicine injuries, he continues to build on his love of learning - from completing a manual therapy fellowship and earning an advanced doctorate in Physical Therapy to teaching at the Duke University School of Medicine/ Department of Physical Therapy. His love of movement has evolved from participating in all major sports during his childhood and playing college-level volleyball to attaining his 2nd-degree black belt in Tae Kwon Do and challenging himself with Spartan races in time for his 50th birthday. Kurt continues his love of anatomy and biomechanics, of life-long learning, of caring for others, and of movement by incorporating Original Strength concepts into his clinical practice and daily life.

Kurt's average client is 10 - 100 years old. Most have a fear of movement for one reason or another. Sprains and strains... aches and pains... to pre and post-op care. Sports conditioning and general fitness.

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