A couple weeks ago, a video was discussed on some forums about allowing lumbar flexion during deadlifts. While I believe people have always had some lumbar flexion during deadlifts and squats, traditionally, many believe a "neutral spine" is required to safely load the spine during the movement. Recently, there has been an increase in education and awareness of the flexion motion of the lumbar spine during deadlifts and squats in order to help prove the normalcy of the movement pattern. It is in conjunction with the development and understanding of pain science research that we are learning how little abnormal movement patterns may matter. Does this mean we should change our complete philosophy of movements with strength training?
A couple years ago, I wrote a blog about changing scapular positioning during pressing motions. Many recommend performing a bench press with scapulae adducted in order to improve stability and open subacromial space. I proposed that we should consider altering the positions by adding protraction at the end of the bench press and shrug at the end of the military press in order to fully apply the strengthening exercise to the motions of the muscle fibers. The serratus anterior and pectoralis muscles have the function of protraction (SA also upwardly rotates the scapula). Why should we ignore that component of the muscle's function? There was some significant rebuttal from some clinicians out there on the basis of potentially damaging the rotator cuff by decreasing subacromial space. However, with the development of research showing the lack of correlation between pain and pathoanatomical findings, any "damage" that might be done with this movement pattern (if it actually occurs) can be deemed insignificant.
Now, I am not suggesting that you immediately start training these alternative movement patterns with the load you typically use for your usual exercises. A new motion requires a new start. You will likely have to use significantly less weight when doing your first Jefferson curl compared to a typical deadlift. The same applies to the military press when you add a shrug at the top of the motion. Initially you will be weaker with these motions, but by training them, you will improve your strength and stability for positions that some might label as "unsafe" or "faulty."
The real question that should come from these finding is should we decreasing our focus on research that emphasizes the biomechanical approach? If a RTC tear is not correlated with pain or possibly strength, why should we worry about how RTC tears develop? If a herniated disc doesn't correlate with pain or weakness, should we bother looking at studies focused on disc pressure? Personally, I believe we should still consider these concepts to some degree. Some disc herniations are significant enough to cause urinary retention. Arthritis may be significant enough to severely limit motion in a joint, decreasing the function of that joint. I am not saying that we should worry about every pathoanatomical finding either. I believe that there is possibly a middle ground to be met where pathology should still be considered, but shouldn't be the guiding force. I do not have the answer, but hopefully the research WILL continue in the mechanical area.
Dr. Chris Fox, PT, DPT, OCS
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