Last month we talked a bit about how important having a healthy functioning core is to both performance enhancement and injury prevention. In this installment I would like to give some examples of safe and effective ways to train the core musculature.

First, let's talk about some of the things you should steer clear of doing. Many individuals with bad backs are prescribed back and abdominal exercises that involve spine flexion and then have to deal with the inherent spinal compression that comes with it. Exercises such as the "crunch" and sit-up are without a doubt exceeding the tolerance of their already compromised tissue. Furthermore, repeated lumbar spine flexion - even in the absence of moderate load - will lead to discogenic problems.

Another exercise example with high compressive loads is the popular "superman" exercise (prone-lying while extending the legs and outstretched arms) which places 6000N (1400 lbs.) of compressive force on the lumbar spine (McGill)! Even in a healthy population, I would never prescribe this exercise. Or perhaps you are doing back extensions over the end of a bench or Roman chair. Please reconsider doing them. This commonly performed exercise of torso extension with the legs braced imposes over 4000N (1000 lbs.) of compression on the lumbar spine (McGill).

These are just a few examples of exercises which on the surface may seem good, but which in reality are not so good. For the most part, I think too much emphasis in recent years has been placed on flexion, loading at end range positions, and unstable surface training.

Instead, one should stick with exercises which are going to promote whole body and joint stability and improve the endurance capabilities of the core musculature. This will build a solid foundation for eventual strength and power of the core musculature. The bottom line is each person needs to begin at the appropriate level for them. Too often people see someone else doing an exercise and mistakenly think it is the right thing for them to do.

Some exercises to consider that are both effective and safe include planks (front and side variations), iso-holds in standing with tubing, a modified curl up in which the sternum is the fulcrum (McGill), the uni-lateral birddog exercise, and for those that have the capacity, medicine ball and cable chop variations. When these exercises are performed correctly with attention to control they are good for most people.

One last thing to chew on is whether or not the exercise will carry over to athletic performance situations and/or  the activities that you are required to perform each and every day, especially when fatigue sets in. Fatigue changes many things, one being trunk (core) muscle function and balance. That is where the test lies and is an area in which more attention in training is needed.

A patient recently asked me how low he should go on his squat in his workout. I told him as low as he can get before his low back rounds and his pelvis tucks under. We then preceded out to the workout area where I asked him to demonstrate his squat to me. Sure enough...he was going too low for his own good.

Let me first clarify that I am all for full range of motion and squatting with depth. What I am even more in favor of, however, is squatting within your functional limitations and keeping this terrific exercise safe.  Work with the mobility and stability abilities you currently have. Only by identifying the weak links and doing the right things to improve upon your weaknesses, you can safely and effectively increase the depth of your squat.

What exactly am I getting at here? Well, if you squat to the point where your lower back rounds and your pelvis tucks under you are stretching the you-know-what out of your spinal ligaments and putting an enormous amount of load on the discs of your lumbar spine. If you are in the majority of people who will begin to round and tuck as their thighs near parallel to the floor, then you have no business squatting below parallel. 

The next time you are in the gym, ask a partner to watch you squat, or look in the mirror or video yourself squatting, and see where the point is that you begin to tuck under. This is the point you have no business going any deeper than or you will put your lower back in jeopardy. For a short while, set up a box that is slightly above this level to guide you on how low you should go. Work on perfecting your squat within this range.

Now you may be asking, "What are some of the things I can do to help myself squat better and deeper?" For starters, work on soft tissue quality to eliminate any soft tissue mobility limitations you may be encountering. Active Release, Muscle Activation, foam rolling, and trigger point work are all effective strategies which will make a huge impact on movement and range of motion. Areas to give particular attention to include the hip flexors, gluteal muscles, hip rotators, tensor fasciae latae, quadriceps, IT band, thoracic spine, and calves. You also want to do some quality core work to enhance stability of the trunk and spine. To squat safely, you need to be able to load your hips, move through your hips and limit motion in your low back. A good place to start would be with the exercises in the article you just read (wink).  

When you have worked on the above and are feeling more confident, lower the box slightly and see if you can attain that depth without breaking your form. This may only be an inch lower than the original box and that is okay. It may take weeks or even months to be able to break parallel and that is okay. This is much better than putting your low back in danger by going into flexion. 

Last month I wrote about systemic enzymes and how effective they can be to fight inflammation. It is important to know that most disease and pathology begins with inflammation that runs unchecked and turns chronic. Cardiovascular disease, the number one cause of death in the United States, begins with uncontrolled inflammation. With the rising incidence of obesity in our country the numbers of people dying of cardiovascular disease and other inflammatory-induced conditions is only going to increase.

Understand that the development of cardiovascular disease is a decades-long process. For instance, there is evidence of atherosclerosis in 17% of people aged < 20 years and in 28% of people < 30 years of age. In those 50 years and older, 85% of Americans have coronary atherosclerosis (diseased vessels in the heart)! Moreover, in 62% of men and 42% of women, heart attack or sudden cardiac death is the initial presentation of cardiovascular disease. In other words, half of the people who have a heart attack or sudden cardiac death were not even aware that there was a problem!

Fortunately, for us, there is heavy clinical evidence to suggest that chronic inflammation can be controlled or dramatically reduced through diet, proper supplementation, and physical activity. We all suffer from inflammation to varying degrees - either from mechanical or chemical irritants. Our focus should be on reducing our individual inflammation issues, and what you choose to eat and drink is a big key in accomplishing this goal.

A proactive way to fight systemic inflammation is to eliminate some - if not all - of the following pro-inflammatory foods:
 - partially hydrogenated oils (trans fats)
 - most packaged foods as most contain trans fats and highly refined sugars
 - soda, sugar, soy, and dairy
 - meat and eggs from GRAIN-FED animals; instead opt for lean, grass-fed options
 - grains and grain products containing gluten

At first you may find it somewhat distressing that so many foods are pro-inflammatory, and wonder what there is left to eat. Another way to look at it, though, is how distressed and depressed one would be if suffering from any of the numerous diseases and conditions caused by inflammation.