One of the best things about working on the Perform Better tour is getting to meet and interact with real experts. Stuart McGill is one of those real experts, a man who is using his lab every day to validate what so many of us just think or blindly do. Stuart was nice enough to read my Sports hernia articles (https://strengthcoach.inspire360.com/node/6015930 https://strengthcoach.inspire360.com/node/6015947 )
and send me some comments. In addition he was also kind enough to allow me to pass on his comments to our readers. Stuart stated the following in an email:
"Just read your piece on sports hernias -- thanks Mike. I have a hypothesis that seems to be unfolding. For some reason the ability to hold the side bridge for longer than 70 seconds is protective for the sports hernia -- a couple of S and C coaches have made me aware of their perceptions in this regard -- Matt Nichol of the Maple Leafs is starting to think this. (I have a few thoughts but for now but the 70 seconds is a start). I think the biological mechanism for the tear is eccentric-forced lengthening of the obliques (where the tear is). I have found these with ultrasound. Placing the probe over the area, the athlete repeatedly contracts and relaxes the abdominal wall. With each contraction one can see the muscle fibres pull together as they should. However, at the site of the hernia the fibres pull apart (either in internal or external oblique -- not transverse abdominis -- surprise, surprise). This is very cool to see and I don't know of anyone else who has made these observations. I guess I should write it up. I think this may turn out to be a definitive diagnosis which has been missing. "
Stuart's comments are excellent and reinforce the anti-rotation and anti-flexion concepts we have espoused on this site. If you haven't read The Real Core Exercises and Anterior Core Training, check out these links. (https://strengthcoach.inspire360.com/node/6015807 https://strengthcoach.inspire360.com/node/6015875 ).
If we think about the function of the obliques ( prevention of anterior pelvic tilt ) we can see why exercises like side bridges and rollouts are so important.
Stuart's comments also bring to light a couple of other points he was kind enough to expand on for me. One point Stuart has made in recent lectures is the use of isometric exercises as a test vs training. When asked Stuart noted that the 70 sec side bridge is a test and not a training technique and reiterated that training should focus on 10 sec holds to avoid creating an ischemic response in the tissues. His explanation is below:
"In the isometric contractions we have measured we have noted less oxygenation in the muscle in sustained contractions even as low as 8-10% of MVC. The capillary bed is squeezed. For people in pain and even in some very athletic people it is better to groove these patterns every day. (This is why we begin spine stabilization progressions with holds not longer than 10 seconds and we build endurance through repetitions of the 10 second holds). This is consistent with the Russian "descending pyramid" approach for training endurance without compromising form from fatigue. Of course the progression will advance to more demanding challenges later that may very well include longer holding times."
So even though Stuart is recommending a 70 sec hold as test, training should consist of repeat bouts of 10 sec holds where the repetitions are increased with progress. Having stated this he notes that this is a separate issue from the several progressions he has documented that evolve into power-endurance and strength-endurance challenges that involve much longer durations, when desired in a program.
An article like this would not be complete without referencing the point raised in the forum question posted by Bruce Kelly on October 3rd (www.strengthcoach.com/members/forum/openthread.cfm?forum=1&ThreadID=7717 . The post generated a little bit of controversy and actually appeared the next day in a different form on the Beginners Forum. The post revolved around an article from EliteFTS that was written by Dr. Michael Yessis and originally posted at dryessis.com. In the article Dr. Yessis calls both the front and side plank " a very poor exercise for strengthening the core for several reasons"
Yessis goes on to state that isometric strength isn't transferable to dynamic strength and that the plank exercise "is specific only to holding the position seen during the exercise". Yessis goes so far as to say "you do not want to do plank exercises".
Yessis then recommends sit-ups, trunk twists and back extensions as well as hip abduction exercises.
This is in direct contrast to McGill's research-based work of the last four years. McGill states in Ultimate back Fitness and Performance "given the quantitative evidence of spine loads and stability, the optimal technique to train the quadratus lumborum, transverse abdominus and abdominal obliques appears to be the side bridge". (Note that "optimal" means the balance between sparing the joints and activating muscle -- anyone can design exercise to destroy the joints). Both McGill and Physical Therapist Shirley Sahrmann have often mentioned that the prevention of motion may be as or more important than the creation of motion.
But McGill weighs in: The trick is to match the best progression with a specific individual. Every athlete that I am referred has an injury history with compromised load tolerance in the joints (usually their back). I must establish joint sparing motion and motor patterns, then establish stabilizing patterns to allow the joints to bear substantial loads, and then progress them to high performance. Control of spine posture is paramount in maintaining the ability of a back to bear load. Bending the spine discs with situps and twists rarely fixes a back. Some world class rotational athletes that I have worked with ruined their backs with this approach. Instead performing the plank and rolling to the side bridge without any motion between the ribcage and the pelvis salvaged their back. This move was then sped up as they progressed to become more robust with less pain but interestingly they performed better. I might also point out that progressions continue for the quadratus lumborum and obliques with 1 hand carries such as the suitcase carry. We have documented this approach in strongmen training that also adds strength throughout the body (upcoming issue of Journal of strength and conditioning). There is usually more behind the "soundbite" that the readers hear!
Obviously a disagreement with the points made by Dr. Yessis. One of the major problems in our field is the issue of dueling experts. Interestingly enough Yessis recommends conventional exercises, most for the posterior core and rotational exercises for the obliques.
The key to core training may lie in not choosing which exercise is best but in choosing the best exercises. Core training will continue to evolve and experts like Stuart McGill who are actually doing the studies will lead the way.
Special thanks to Dr. McGill for taking the time to email and for allowing me to include personal communications is written form for our readers.