Category Archives: Injury prevention

Should you wear a brace?

What is your opinion about tennis elbow/knee braces and straps? I read an article where they recommend it pretty strongly. Do they really help or it is just “mental support”?

That’s a great question I received in response to a blog post I wrote about training for tennis. In fact it was such a good question, I decided to write a blog post instead of just replying in the comments.

The question actually included a link to an article which I read but chose not to link because the content irritated me. Specifically this comment: “Due to the physical nature of this condition (tennis elbow), it is more likely to affect men than women as far as playing tennis regularly goes” First of all, what? And second of all, no. Tennis elbow, or lateral epicondylitis, does not affect men more than women, according to science.

Now that I got that off my chest, I’ll get my thoughts on braces and straps off my chest. My opinion is quite simple: If you wear a brace or strap for an injury, it should be because a healthcare practitioner told you you need it.

What shocks me, is the number of people who decide they need a brace and then go to a drug store and buy one without any input from a healthcare professional. How is that a thing? I can sort of understand this if you live in a country without accessible healthcare and money is tight. If that’s you then Dr. Google may be your only choice, and she may tell you that a brace is a good idea for a person who has an injury that may or may not resemble yours.

For those of you who blow buckets of money on much less important things than your health, or for those of you who live pretty much anywhere but the US, ask your actual doctor if you need a brace. If your doctor is not a sports medicine or orthopedic specialist, then ask your doctor for a referral to a specialist. Your doctor may also refer you to a quality physical therapist, athletic therapist, or chiropractor. They are all good choices for providing input about whether you need a brace or strap for your golf elbow, or patella tracking, or whatever else is bothering you enough that you are thinking about a brace.

The cool thing about this approach is that you will probably get an actual diagnosis for your injury, along with actual treatment for your injury, likely in the form of manual therapy and exercise prescription. Wait, there’s more! If it turns out you actually do need a brace, the healthcare professional can tell you what kind of brace you need, versus you randomly buying a brace that may literally do nothing to help your injury.

Elsbeth Vaino, B.Sc., SCSC, is not a doctor, nor does she play one on TV, and thus she is as unqualified as you are to tell you whether you should wear a brace.

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Which exercise caused low back pain?

I recently had a client mention he has had some low back tightness on one side after his last couple of workouts. I found this out after he finished a really nice set of deadlifts, to which I asked about adding more weight. His response was that his back has been bugging him so he wants to not push the deadlift. I can certainly agree with that.

Given that response, however, I gave extra attention to form on his next set, in case I had missed something. I didn’t; or at least I still couldn’t see anything wrong. Note that this is not someone with a history of low back pain. I asked if he felt it during the workout or after, and he replied that he felt it later. I also asked if anything had changed in his life – overtime, stress, sleep or nutrition changes. He answered that all was normal.

Hmm. The deadlift is the obvious culprit, but it really looked good. In fact I had recently switched him from a straight bar deadlift to a trap bar deadlift, which had a positive effect on his form (he tended toward a low hip deadlift which to me is a sign that the trap bar may be a better choice). The reason this change struck me as relevant is that the soreness had been for the past few sessions yet he switched from straight bar to trap bar before his last session. Logically it seemed unlikely that both versions would yield the same back tightness. He also mentioned that it was one side only. His deadlift is square: No shifts to the side, no one hip higher than the other, no bulging spinal erectors on one side. So how would this yield (or contribute to) low back soreness on one side?

I took a closer look at his workout sheet to see if something else could be involved. The single leg glute bridges and half kneeling band Pallof press both caught my attention. Both are great exercises that can contribute to a happy back by strengthening the muscles that support it. But both also could yield movements that disrupt the low back if his brain chooses that path.

The single leg glute bridge, when done with a rib flare (not desired), or with too much range of motion, can be driven by lumbar extension instead of hip extension. Even though glute bridges are often used as an exercise to help someone with low back pain, if form is off, it can contribute. The fact that he was doing the single leg glute bridge (versus a two leg one) makes more sense as a contributor to unilateral back discomfort than does the bilateral deadlift. As I thought about it, I remembered that he had previously mentioned having a hard time feeling glute bridges in his glutes.

I watched his form carefully when he got to the single leg glute bridges and noticed that he was exploding up and his ribcage was flaring a bit in the process. Bingo? I cued him to bring the ribcage to the pelvis, and to slow down. I then watched him struggle with my ribcage to pelvis cue, so I asked him to engage his abs. This cue worked perfectly, and the rib flare in his glute bridge decreased. He also slowed the pace down. I can’t recall his exact reaction, but it was something along the lines of ‘huh’.

During his next set, I ask him to finish a bit lower this time. This cue often helps for those who extend the back during a glute bridge as it is often the point at which hip extension ROM runs out that they take over with lumbar extension. Reduce the range and they don’t need to use the lumbar end range. This worked to get rid of the extra back extension that remained with the previous cue. I also asked him to hold for a second at the top. Often when people have a hard time feeling their glutes in an exercise, just giving it an extra hold can make all the difference.

At this point I was fairly sure it was the glute bridge that was the culprit in his back tightness, but I knew the half kneeling band Pallof press had the potential for this as well.

Like the single leg glute bridge, the half-kneel band Pallof press (really all variations of Pallof press) is a great exercise. It is typically considered a lateral core exercise, meaning it works primarily the muslces on the side of your core, or the obliques.

The problem with Pallof presses is that, depending on the individual doing them, it might not be working the lateral core. In the past couple of years I’ve become aware that many people do not work their lateral core when doing lateral core exercises. A lot of people feel Pallof presses in their back. If you have never asked clients where they feel Pallof presses (or chops, lifts, or side planks…), you really should. I suspect you will be surprised how many are not feeling it where you think they do. In some cases putting fingers on their side can help them to fire these muscles, while in others this simply gives you confirmation that these lateral core muscles are not doing much.

After his set of the half-kneeling band Pallof press, I asked my client where he felt it. He said his abs, so I asked side or front, noting ideally he’d feel it in one side. He said both (abs and side). I watched his next set and it looked good. Since it looked good and he did not feel it in his back, I crossed it off the suspect list.

At the end of that session I felt relatively confident that the tightness he had been feeling in his back was from his single leg glute bridges, but I maintained a degree of uncertainty until I heard back from him two days later with confirmation that his back was not tight.

It makes sense if you think about it. Every muscle in the body has multiple functions. Given that, how can we be sure that every brain is going to pick the muscles you think it should to perform an exercise? The brain has a collection of personal experience and unique anatomic features to consider when choosing what muscles to tap for a given task. In the case of the Pallof press, that may or may not include obliques; and in the case of single leg glute bridges that may include a larger contribution from spinal erectors than glutes.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa, Canada, who was an engineer in a previous career and thus loves any opportunity to assess (and ideally solve) a problem.

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Maximalist is the new minimalist: The absurdity of fitness trends

I saw my first pair of maximalist running shoes in a store last summer and I had to do a quick self-check: is it April fool’s Day? Nope, it’s August. This was the shoe I saw on the shelf in a reputable running and triathlon shop:

I was there waiting to pick up my bike but I had to ask about the shoe. And that’s when I learned about the new maximalist running shoe trend. Apparently extra cushioning is what we need to prevent running injuries in 2016. That’s one mighty big pendulum swing when you consider that in 2010 we learned that we need minimalist running shoes to prevent injuries.

Aside from putting an amused look on my face, the Hoka (the clown-like shoe above) brought me back to two conclusions that I have often hold:

  1. Scientists and/or companies claiming that “this is the one true answer” is your first sign that you should be sceptical of everything else that person or organization says. Science is rarely that certain, and it is never that certain before the science has had a chance to be vetted by other scientists. This typically takes years, which means by the time there is evidence that it is “the one true answer”, it’s probably not that exciting any more so nobody is talking about. So pretty much if you’re talking about an amazing new scientific discovery, understand that it may or may not be true at this point. This is not a dismissal of the scientific process. That is sound. It’s an accusation that most of the science that makes it to the mainstream has cut corners out of the scientific process.
  2. There probably isn’t a “one true answer”, but rather there are different best answers for different people and different scenarios. Minimalist running shoes may be the best option for you; so may maximalist. Heck, maybe the running shoes that got run out of town in 2010 are the best option for you. Or maybe running isn’t great for you. How can you tell? Great question. I’m not an expert in running shoes, but I’m going to go out on a limb and suggest that trial and error is probably your best bet.

Unfortunately the “this not that” mangling of the scientific process is also prominent in the nutrition world. I just read an interesting article about how “leptin resistance is the main reason people gain weight and have such a hard time losing it.” Some of you will remember that not long ago “The real reason that you may have struggled to lose weight is insulin resistance.” It would seem that leptin is the maximalist shoe of the nutrition world.

Elsbeth Vaino, B.Sc., CSCS, is an engineer turned personal trainer who is both amused and annoyed at the inadequacy of what often passes as science.

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Corrective exercise is like coriander

People either love coriander and that guacamole without it is an abomination, or they run screaming at first taste when they see the little green bits in their salsa. It’s amazing that an herb can be so divisive. Not that there are other divisive herbs.

Corrective exercises are like coriander in that they too seem to be quite divisive. In particular, they come up as a reason some people have for disliking the FMS (Functional Movement Screen). I have read many a rant about how people who use the FMS are wasting their client’s time because they spend their entire training session corrective movement patterns, and that if they want their clients to succeed, they need to get their clients squatting and deadlifting instead of wasting time with mini bands.

I completely agree. Training clients entirely with corrective exercises and doing no strength training is not great training. In fact every trainer I know who uses corrective exercises would also agree. The assumption that someone who uses corrective exercises ONLY uses corrective exercises is ridiculous. If someone tells you they like coriander, you wouldn’t assume they only eat coriander. Coriander elevates salsas and guacamole to new heights that could never be achieved without it, but without the salsas and guacamole, it’s just a plant.
Corrective exercise is the same way: Its presence elevates the training.

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I view the use of corrective exercises as a very efficient way to prepare for the workout. My clients will do a warm-up that lasts between 5 and 15 minutes based on how well they move, how fit they are, and how old they are. The primary goal of my warm-up is the same as it would be if I didn’t believe in corrective exercise: To prepare the body for the work ahead. The only difference is that I accomplish this with specific exercises intended to improve weak or limited aspects of the person’s body instead of general exercises.

Ask any engineer how much they love accomplishing two outcomes with one task and you’ll understand why I love warm-ups built on customized corrective exercises.

Now that the warm-up is done, we move on to the pillars of the workout: power, agility, strength, and conditioning. My clients pick up heavy things and put them down again just like yours do.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa who likes to do mini-band walks before lifting heavy weights.

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Can the FMS predict sports injury?

I’ve been reading a lot about why the FMS is good and why it’s not recently. I’ve even co-written a point-counterpoint discussion with Bret Contreras about it.

I am a proponent of the FMS, but I have read some studies that have made me question it. I also attended a couple of very compelling presentations at a strength & conditioning conference at the University of Toronto recently that pointed out some shortcomings.

I have not read or heard enough (yet?) to change my mind about continuing to use the FMS for my clients, but I have just started to use a new assessment approach for my clients in addition to the FMS. For the next few months, I will use both approaches and will take notes about how well each one worked, both during the initial client consultation and over the first few training sessions.

I will also continue to read and listen. In fact I just read a study this morning that suggests the FMS is very beneficial in predicting injury. Here is a link to the study, titled ASSOCIATION BETWEEN THE FUNCTIONAL MOVEMENT SCREEN AND INJURY DEVELOPMENT IN COLLEGE ATHLETES. Or more specifically, that an FMS score of less than 14 combined with previous history of injury equated to athletes (in the study group) being 15 times more likely to sustain an injury over the course of a season.

I didn’t love the study abstract and write up because it didn’t address the difference between the FMS, the previous injury, or the combination of the two. Thankfully one of the tables in the study did just that. And as you can see from the screenshot below, it would appear that the combination of previous injury and an FMS score of less than 14 is a strong predictor.

Screenshot 2015-05-14 11.05.15

What I would like to see (and maybe I just missed it in the presentation of the data) is what this number changes to with higher FMS scores. What was the injury rate among athletes in the group with a history of injury and an FMS score of 15? of 16? If there is a significant drop there, then that makes for a very compelling case for a combination of:

  1. using the FMS
  2. finding out about previous injury from your clients or athlets
  3. appropriate training as a means to in increase the FMS (and conveniently training is also a great option for performance improvement)
  4. re-FMS to see if the person has moved into a lesser risk range

I think this study does show that having a low FMS score and a history of previous injury makes one much more likely to sustain an injury. That is good information to have, but only if there is something we can do with it. If there is also a proven link that the risk is lower with a higher FMS score paired with a history of previous injury, and if there is a proven link that appropriate training is a tool to get us to the higher FMS score (which I believe there is, although I need to re-review the literature), then that would be a very compelling reason to use the FMS for athletic clients. While the study is not quite a home run, it definitely sits in the “pro” column for continuing to use the FMS.

Elsbeth Vaino is an engineer turned personal trainer who enjoys the science of training

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Are you doing the right workout?

Depending who you talk to, the best exercise option is one of the following[1]:

Aquatic exercises
Climbing
Cross-country skiing
Crossfit
Cycling
Elliptical
Equestrian
Free weights
Functional training
Intervals
Kettlebells
Olympic lifting
Pilates
Playing my favourite sport
Plyometrics
Power lifting
Running
Skating
Strength training
Stretching
Swimming
Tabatas
TRX
Walking
Yoga

Did I miss any? I was about to add aerobics, but I’m pretty sure that’s one 1980s fad that hasn’t come back. Or has it?

The point being – it’s a pretty long list. And each one has staunch supporters who are eager to tell you that their favourite is the best option. Who is right? Are you doing the right or workout? How can you tell?

In truth – it’s really quite simple. Answer the following 3 questions to find out if you’re doing the right workout for you:
1. Do you do it?
2. Are you staying healthy (or not losing health)?
3. Are you reaching your goals, or on track to do so?

If you answered yes to all three questions, then you’re doing it right. Period. And yes, for some of you that means crossfit is the right option for you. Daily yoga might be it for others. Or running. Or going for walks with your best friend, spouse, or kids.

What about those of you who can’t answer yes to one or more of those three important questions? For you, there’s clearly something missing. “I do it”, “it isn’t hurting me”, and “it’s helping me reach my goals” shouldn’t be too much to ask of your exercise regime.

This leads to the question: if you answer no to at least one of those questions, what do you need to change?

1. “I don’t do it”. If you’re not doing it, then you don’t enjoy it enough. Try something else until you find something you enjoy. This is the single most important determinant in what you should do, because if you’re not doing it, the details are irrelevant. Not sure how to find out? Find a friend who’s willing to experiment with you. You might be surprised to hear this, but you may find that you will actually enjoy lifting weights. Seriously – some of my clients actually look forward to their sessions. Others look forward to their yoga classes, or their running group. Personally, I feel this way about skiing and ultimate. Try to find that thing that you will look forward to, and do that. It may be about the activity, or it may be about the people involved. Either or both is fine. Whatever it takes to get you to enjoy moving!

2. If you love what you’re doing but your body doesn’t, that’s a problem. Sorry for bursting your bubble, but exercise should enhance your ability to move, not reduce it. If it makes your knee, or back, or shoulder hurt, it’s doing the opposite of that. A little secret: this applies to the more “gentle” exercise types like yoga and pilates. Some yoga poses will cause problems for some people. I’m not saying yoga is bad; it’s not. But I am saying that if your body responds poorly to yoga, then some part of it is bad for you.

Similarly, I think we all know runners who run for hours blocking out the pain from their knees, hips, or shins. Or weight lifters who have a constantly sore back. And soccer players who wear as many braces as they have joints. They’re doing it wrong.

I believe there is one exception to the rule that your exercise choice should make your body should feel good: if you are someone with a chronic, degenerative joint problem who has pain 24/7; it’s highly unlikely that your joints will magically stop hurting during exercise. But the initial question still holds true for you: “Are you staying healthy (or not losing health)?” What this means for you, is that the exercise you do shouldn’t make this problem worse. If it does, that’s a problem. If it is the same or a bit better, then awesome. You’re doing it right.

If your exercise approach is hurting your body, what can you do about it? Try something different. I don’t necessarily mean you should completely stop doing your thing; but it may be time to cut back and add in something that complements it. For most people who only do one type of exercise, this typically means adding in something else that works your body differently. For instance, I believe most people do either too much or too little yoga. I think those who do yoga as their sole source of exercise should add in strength training; and conversely, those who do strength training as their sole source of exercise should add in yoga. Most runners will also benefit from strength training and/or yoga (depending on how they move), and/or swimming. Take a look at what you’re doing and think about whether you’re missing anything. If you are, add or substitute it in. Personally I workout at the gym with strength and mobility exercises as a means to keep my arthritic hip happy enough that I can keep enjoying skiing and ultimate.

Last word on this: if you are finding yourself injured or sore all the time from your exercise, you may be due for some massage, or a visit to an athletic therapist, chiropractor, or physical therapist. The health benefits of exercise are so vast it’s almost ridiculous, but if you use your body, some maintenance of the muscular system is advised. You wouldn’t drive your car for years at a time without changing the oil, filters, and spark plugs, would you? Then why are you doing that to your body? You’re probably not going to have the same car 30 years from now, but hopefully you will have the same body. If car maintenance takes a higher priority for you than body maintenance, you’re definitely doing it wrong.

3. Let’s talk goals, shall we? Do you have fitness or performance goals? If you do and you aren’t meeting them with your current exercise approach, then your current approach isn’t working for you. Simple. You can really fix this in one of two ways: change what you’re doing, or change your goals. That latter part was not meant to be cheeky, but rather is a reality for many of us.

Sometimes our goals don’t fit any more. It may be a factor of the time we have available to commit to exercise, or it may be that our goals are more appropriate for a younger version of ourselves. That’s not meant to be defeatist! Appropriate training can work wonders in terms of preparing the body to take on great feats, regardless of age (just ask these 80, 90 and 100 year olds). But there are two realities to consider in regards to how our bodies perform at 50 versus at 25:
1. A 50 year old body has 25 more years of wear and tear on it. If you’ve spent those 25 years playing a sport at a high level, odds are you have a joint or two that has suffered as a result.
2. while a 50 year old body has the physical potential to accomplish a lot, it has some physiological limitations like stiffer connective tissue, and slower recovery.

If the reason your exercise approach isn’t helping you meet your goals is that your goals don’t match you or your life, then work out some new goals, and start working toward them.

If your goals are appropriate, then the problem is your exercise choice. This is where you will need to get into more details, and you may find you need some help figuring it out. If your goals are weight loss related and you’re not meeting them, it may be a factor of your choice of exercise, or the amount you’re doing; but more likely it is a factor of nutrition choices. If you’re not sure how to address that, consider getting help from a nutritionist. You may also find my Get Lean program will be a good start to helping you address some habits that are slowing your progress.

If your goals are performance related, then what is the deficit? Most athletes know their shortcomings if they really reflect: is it speed? Endurance? Strength? Flexibility? Power? Are your opponents getting away from you on the ice because they sneak around you, because their first step is better, or they eventually overtake you? Or is the limitation related to question 2 – is there an injury problem limiting you? Often some self-evaluation can help you to recognize what you need.

Maybe your goals are about life-performance? Want to be able to play with your grandkids in the park? Or be the coach of your kid’s soccer team? But maybe you’re worried you’ll be huffing and puffing after demonstrating one drill? Or that you’ll throw your back out with one kick? For most people, reaching these goals will be best achieved with some combination of strength, flexibility, and endurance training. Unfortunately there isn’t a book or website I can point you to that will find the answer for you. What I can suggest is that you find a health care professional that you trust and ask them for guidance. Odds are they know who the good fitness professionals are who can help you figure this out. And of course if you’re in the Ottawa area and you think this all makes soooo much sense, then you may be interested in getting some help from me or one of the personal trainers who works with me at Custom Strength. We’re all about helping people find the right exercise for them.

How do you fare against the three questions? Are you doing it right? If so, what are you doing? And well done! If you answered no to one or more questions, has this been helpful to steer you to a better path?

Elsbeth Vaino is a personal trainer in Ottawa Canada who loves that she gets paid to help people reach their goals.

[1] I recognize some of the “exercise types I listed are really tools (TRX, kettlebell) or protocols (Tabata), but I often hear people speak about them as though they were types, and following the perception is reality philosophy, it made sense to me to include them. In a similar vein, some are overlapping or flat out redundant, for the same reason as above.

What motivates you to workout?

I don’t love working out. There, I said it. Weird right? I mean, I love being a trainer. But I don’t think “yay, leg day” when I get to the start of my workout. What I do think is “this is going to give me a shot at being like this guy“:

96 and still skiing. So awesome! I want to do that. And for those who think you’re too old to start something, did you notice that George Jedenoff said he didn’t start skiing until he was 43?

Then there’s the centenarian skier:

It’s a fact: I would like to still be skiing at 100. And I’m pretty sure that getting there will require some body maintenance. That’s why I work out. The fringe benefit is that working out also let’s me have the stamina to perform the sports I love without having to stop early and without that pesky next day soreness. As awesome as playing is, sport can take a toll on your body. Or at least they can if left unchecked. Each sport has its repetitive movements, and depending on how your body adapts to those movements, can start wearing down your joints. Yes working out helps with performance, but in my mind, this is the true gift of working out. Playing a sport often results in specific muscles getting stronger and in some cases also getting tighter. Over time, this can lead to joints getting out of their natural alignment. I can’t think of any sport that is truly balanced in terms of the movements you do during the sport. Working out can help with this. A good sport-specific training plan will not only address the movements and energy systems needed for your sport, but also the movements your body needs so that it can balance out the impact of your sport. If being able to play for another 50 years is one of your goals, then this has to be a consideration.

For those not into skiing, the next inspirational interlude features Ruth Frith, who continued to set world record at 103 years old.

If you’re watching the videos, you’ll notice a theme: These people all work at it. And they don’t mind working at it, because the joy they get from their sport is more than worth it. Everyone reading this who has a sport they love knows that feeling. Or at least those of you who do are probably smiling right now. How cool would it be to extend that feeling into your 90s and 100s? So what are you doing about it? Working out is what I’m doing about it. Here’s another example, this time the world’s fastest centenarian:

Further to the note above about training the movements that you don’t use in your sport to ensure your body stays healthy, it is also important to listen to your body. It gives clues when there is a problem. I used to be that person who kept playing my sport even though it hurt so much that I followed each game with “vitamin I” and then hobbled around for a few days until the next opportunity to play. Then one day I thought “how will this impact my dream of skiing at 100?” I think it’s fair to say that “Negatively” is the answer. For this reason, I no longer play ultimate in the winter. It turns out that my hips don’t like the pounding that results from playing ultimate on turf. I could still do it, and as an athlete, having a sore joint after playing is not that hard to just suck up. But when I think about that sucking it up now could mean not skiing when I’m a senior, I quickly change my mind. In fact I would argue that playing your sport year round, especially if you have a nagging injury, will not only lessen your chances at awesomeness in your senior years, but it will likely reduce your performance in the short term. If your joint hurts with every step or every pivot, or every throw, are you really able to put your all into that play? If so, for how long? How many games did you miss last season because your body finally couldn’t hack it? Maybe it’s time to look at the off-season the way professional athletes do: As a time for recovery and a time for preparation.

Speaking of performance, here’s gymnast Johanna Quaas with a brief gymnastics display shortly before her 89th birthday:

So that’s why I workout: So that I can have the best shot at doing the things I love for the rest of my life. And I love my job as a trainer because it allows me to help my clients workout so that they too can enjoy the sports they love for the rest of their lives.

Why do you workout? And before you answer, here’s one more inspirational video, this time it’s 82 year old Madonna Buder crossing the finish line at the Ironman in Penticton in 2012, making her the oldest person to ever finish an ironman:

Elsbeth Vaino is a personal trainer, skier and ultimate player in Ottawa.

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Why do you have FAI?

FAI, or femoro acetabular impingement, is a hip “abnormality” in the shape of either or both of the femoral head and acetabulum. If you have it, or suspect you have it, you’re probably relatively young (seemingly too young for hip problems), and you’ve probably been dealing with hip and/or groin pain for a while without knowing what was going on, until someone finally came up with FAI.

I was diagnosed with it in 2007 after almost two decades of on-again, off-again hip pain and dysfunction. Since then, I’ve read a lot, chatted with many people who have it, and have trained many clients with it. I recently wrote briefly about my own experience with FAI, and have also written an at-home exercise ebook for FAI.

As more is known about FAI, more research is being published. I’ve pulled out five particularly interesting facts (or so I think) from the research, and have included my interpretation of them and their potential relevance. Enjoy, and please ask questions in the comments and I’ll get to them as soon as I can. One note: use of the term “young” in this post refers to people under the age of fifty. Funny how our concept of “young” changes as we age! With respect to hips and FAI, studies tend to focus on people under fifty.

Fact #1: FAI is much more prevalent among men than women, with studies suggesting anywhere from 14% to 24% occurrence in young men with asymptomatic hips , but only 6% in young women with asymptomatic hips.[1]
Interpretation: FAI is a real thing, even among people with no symptoms. The question is, what does it mean? If someone has FAI but has no symptoms, should we do anything about it? Take my hips for instance. I had twenty years of hip pain in my left hip, and zero years of pain in my right hip, but I have FAI in both. My sense as a trainer is that it’s important to recognize that not all hips are built “to spec” and that the two biggest areas where we should keep FAI in mind are in relation to stretching and squats. With hip stretches, I keep tabs on whether it causes pain or discomfort. If it does, I’m going to tend to assume we’re pushing into a bony end range (maybe FAI; maybe another hip structural anomaly), and I’m going to back off that stretch. I’ll talk about squats down a few facts.

Fact #2: FAI is twice as common among men with limited hip internal rotation as those with normal hip rotation range of motion.[2]
Interpretation: I think an important question to ask about this finding is whether FAI is more common in the presence of reduced internal hip rotation, or whether reduced internal hip rotation is an early sign of FAI. Either way, I think the take home is similar to the take home for fact#1: If someone has limited hip internal rotation, there might be a structural contribution, so be careful with your efforts to increase internal rotation range of motion. In fact this might be a situation where seeking input from a good physical therapist, athletic therapist, or chiropractor would be in order.

Fact #3: “We performed a database review of pelvic and hip radiographs obtained from 157 young (mean age 32 years; range, 18-50 years) patients presenting with hip-related complaints to primary care and orthopaedic clinics…At least one finding of FAI was found in 135 of the 155 patients (87%)”[3]
Interpretation: Yikes! 87% of young, symptomatic hips had FAI? I think the take home here is obvious: Don’t ignore comments of hip pain. Perhaps this is a good reminder that the body is pretty good at telling us when something is wrong, if we’re willing to listen. I always hate to suggest this, but feel I would be remiss if I didn’t: If your hip hurts after you play your chosen sport, maybe you should question whether playing that sport is appropriate for you? That’s not to say that if something hurts a bit, you should stop playing. Definitely not! But if your hip constantly hurts during or after a specific activity, despite having spent months (or years in my case) with a manual therapist and a good training program, maybe your body isn’t built to do that activity. For me, this brings a flashback to the 2007 Canadian Ultimate Championships, and me sitting in the stands between games with a big bag of ice on my left hip while snacking on vitamin I (Advil). Note I did this “in between games”; not after stopping playing because my body was clearly telling me that I was damaging my hip. So yes, this is me suggesting you aim to be smarter than I was.

Fact #4: People with FAI have less range of motion in body weight squats than do people without FAI.[4]
Interpretation: People who have FAI probably shouldn’t squat. How can you tell? Is it painful? Does your pelvis shift to one side during the squat? Do you start to round your back at the bottom? These are signs that you lack the range of motion or stability required to squat so your body is finding alternative ways. If you see this, try to fix it, and if you can, great. But if you can’t fix it, then you are probably someone who shouldn’t squat. Thankfully it is possible to be awesome without squats in your workout.

Fact #5: Hockey players have a higher prevalence of FAI than do skiers and soccer players, and the rate increases as they move up, with particularly high levels noted at the midget level.[5]
Interpretation: FAI might be something people develop in response to biomechanical forces? And it would appear that there is something in the way hockey players skate that produces higher rates of adaptation. It would be interesting to see if similar numbers are seen in figure skaters, to see if it is a skating thing, or if it is a skating with the torso in a flexed position thing? In terms of what I suggest, I need to disclose that I have a conflict of interest: I am Canadian. And that means I can’t suggest that someone consider not playing hockey, because I don’t want to have my passport revoked. But you may want to re-read fact #3.

If you have FAI, are you a hockey player? How’s your hip internal rotation? How does your squat look? Do squats cause hip pain? Do you keep doing them anyway? It’s interesting to think that our bones change in response to our activities. That may seem revolutionary, but in fact it’s a long-known truth. In fact it’s even got a name: Wolff’s Law.

I’m very excited to be launching my new ebook: Training Around Injuries: At Home Exercises for FAI in November.

Did I mention that I wrote an FAI ebook? Head over here to learn more (and to buy it). It’s a home exercise program (4 of them actually), complete with photos and instructions, a link to a video playlist that has all 42 exercises demonstrated and described, and a background section to help you understand what might be going on.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa Canada who also has FAI (technically I had it on both sides but after surgery on the left, I now only have it on the right).

References:
[1] KA Jung, et al, “The prevalence of cam-type femoroacetabular deformity in asymptomatic adults”, The Journal of Bone and Joint Surgery, 2011.
[2] Michael Leunig, “Basic and Clinical Science Advances in Understanding FAI
[3] Leah M. Ochoa et al. “Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High”, Clin Orthop Relat Res. Oct 2010,
[4] Mario Lamontagne, et al, “The Effect of Cam FAI on Hip and Pelvic Motion during Maximum Squat”. Clin Orthop Relat Res. 2009 March.
[5] Marc J Philipon Et al. “Prevalence of Increased Alpha Angles as a Measure of Cam-Type Femoroacetabular Impingement in Youth Ice Hockey Players”. Am J Sports Med 2013 Apr.

Bend at the hips, not the knees, and definitely not the back

Do you ever get low back pain? And can you do this?

My guess is that if you do get low back pain, you probably can’t hip hinge. As I note in the video – be strict with your form. If you can’t feel whether the dowel (or broom handle, just something very light and straight) is coming off your butt or if your head is moving from it, or if your upper back is arching away from it, then get someone to watch you, video yourself, or use a mirror. This is one of the few times I want you to be critical of yourself. If you can’t bend over to the point where your back is almost parallel with the floor while keeping the dowel touching those 3 points, then that’s a problem. Because really what it means is that when you bend over doing normal daily activities, you’re probably bending in your low back. And for many people, doing that hundreds or thousands of time (365 days per year – how many times a day and how many years – it multiplies up!) is a big problem for their back.

If I’m wrong – if you can hip hinge well and you have low back pain – please comment below as I’ll be very interested to talk with you.

I’m in no way trying to suggest that this is the magic pill for low back pain. What I AM saying is that bending at the hips instead of the back tends to reduce the amount of extra strain on your back, which usually makes your back happier.

What about those doctors who say to bend at the knees instead of the back? If you could see me now, you’d see that I’m shaking my head. Bending at the knees instead of the back is a great way to develop knee pain. It’s also impractical. Think about it – if you are bending to reach something that’s low and in front of you, how will bending at the knees get you there? When bending at the knees, you go straight down. So it’s practical for something you’re picking up at your feet, but if it’s something in front of you, not so much. And even with the item directly below you, if you don’t have phenomenal ankle and hip mobility and a very stable core, it’s not going to work well, because your heels will come off the floor which will shift your knees foreward, and your back will round. Not a great position for most people. Bending at the hips on the other hand – that’s gold! Look how big your hip muscles are! Yes I am saying you have a big butt. At least in comparison to your knees. Those hip muscles were built for bending, so use them.

Work on the two-legged hip hinge above if you can’t do it, and think about incorporating that into your daily life. Pay attention to even the little things, like brushing your teeth: I bet when you lean forward to spit, you bend at the low back. Try bending at the hips instead: it gets you to the same place but your back will prefer it.

Once you get to the bottom of the two-legged hip hinge, start to bend your knees, and you’ll open up a whole world of heavy lifting potential that is much safer for your back. Some of you recognize that what I just described is actually a deadlift. Sure is! And what a great exercise. Head over to this post if you want some guidance on what a good and a bad deadlift looks like. Please do keep in mind that using great form is not a free ticket to lift stuff that’s too heavy for you – common sense is still your good friend. Don’t alienate her.

There are some scenarios where a one-legged hip hinge is a better option for picking stuff up. In the gym we refer to this as a single leg Romanian deadlift, and those of you who have great trainers are saying “hey, I do that in my workout”. Yes, if your trainer has you doing single leg Romanian deadlifts (or SL RDLs) and is vigilant about working on your form, it’s probably a fair assumption that he or she is a good trainer. Unless you look like a weeping willow while doing your SL RDL – that’s a pretty sure sign you don’t have a good trainer.

Here’s a video of the single leg RDL.

What’s that it looks like the bird drinking the water?

Bird drinking water RDL

That’s the one we use at Custom Strength to reinforce what I mean when I say a hip hinge. One of my clients was asking if I had a top hat for them to wear. Think I may go buy one to see if it improves their ability to hip hinge. Anyone know where to find a top hat in Ottawa?

If you’re looking for some more exercise and movement ideas for someone who has low back problems, you may be interested in this article, “6 Exercises for Low Back Health“. Just please note this point near the top of that post:

“If daily living causes you low back pain, I strongly suggest that you look to a health care practitioner as your primary source of guidance for your back health. I won’t suggest what type of professional you see, just that someone who is a doctor, osteopath, physical therapist, chiropractor, athletic therapist, or massage therapist sees and hopefully provides some treatment for your back.”

 

Elsbeth Vaino, B.Sc., CSCS, is the owner and one of the personal trainers at Custom Strength in Ottawa. If you’re in Ottawa and you are thinking ‘I could really use a trainer who thinks like this’, you’re in luck – we’ve got a summer special promotion at the moment.

You sit all day, then you play a sport…

You spend all day like this?

Photo credit: JeremyFoo on Flickr
Photo credit: JeremyFoo on Flickr

Then you go play like this?

Photo credit: bianditz on Flickr
Photo credit: bianditz on Flickr

Or this?

Skiing is awesome
Skiing is awesome

This?

Photo credit: tulannesally on Flickr
Photo credit: tulannesally on Flickr

Or…
hockey posture

Maybe it’s…

Photo credit: cypresschargers on Flickr
Photo credit: cypresschargers on Flickr

And you say you’re having problems with your hips or shoulders? Weird.

Don’t get me wrong: I am a big supporter of staying active, and I think playing sports is the best way to do that. I really do. It’s exercise; it’s camaraderie; it’s often outside in nature; it’s a fantastic stress-reliever; and it’s fun which means we want to continue doing it. But seriously people – if you’re a desk jockey and an athlete, you’re punishing your poor body with those postures! Get yourself to the gym and give your body a fighting chance to survive!

When you’re there, remember that sport-specific training is as much about training movements that counteract what you do in your sport as it is about training the movements and muscles you need to perform. Or at least it should be if you want your body to let you continue enjoying your sport.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa Canada, who works primarily with athletes whose athletic careers include player fees instead of salaries, and the accompanying desk-job-atrophy.

You may also enjoy these posts:
My experience with hip injuries and FAI
The 4 Things I know about sports injuries
Best ever scapular stability exercise