Team/Strength Modified Explanation
Much like our clearance process we have created a Modified Program for Team and Strength to help with handling ‘Biomechanical’ issues we incur with during a training program.
The most important thing here is that we want to establish that not all exercises are good for everyone. Having a systematic approach to modifying exercises is paramount to long term success. Forcing exercise that is higher risk based on pre-existing issues is a mistake that we want to avoid.
The biggest reason we place someone in the modified group is that they incurred an injury either during training or outside of the gym. The best predictor of future injury is previous injury. It should go without saying, back injuries are the biggest category of injury we have to consider in the way we structure our program.
There are a couple of back injuries we need to really consider: herniations, spondylolisthesis, and ‘strains’. Most back injuries are undiagnosed, however, still 75-85% of all Americans will still report back pain in their life. We compound that in environments that are competitive that leverage resistance to change body composition, body mass, or increase performance.
The other consideration we have to make is a diagnosed injury or coming off surgery/rehab. Pain by itself alters movement patterns. When someone is in pain, that person will find the path or direction that does not cause direct pain. This leads to compensations and what probably will lead to pain or injury elsewhere. This is why we place so much emphasis on asymmetry assessments on ForceDeck, NordBord, and Functional Movement Screen. It helps us see objectively compensation patterns more readily.
The answer is to not stop training. Losing a routine is net negative for anyone. The momentum we gain by staying on a consistent routine while working through pain or injury is massive towards long term results. This creates a crossroads - if we choose the exercises that potentially may cause pain or injury, we will assuredly not be able to continue with any routine.
This creates a need for a modified version of our program. There are couple of non-negotiable line items for Allegiate’s Programming that we need work within as me modify the program:
Total Body Training 3 Days a Week
Equal Distribution of Pushing (Squat/Horizontal Press) and Pulling (Hinge/Vertical Pull) Exercise Variations
Additional Option of Stretch (Increase ROM), Conditioning (Body Composition), and Hypertrophy (Lean Muscle Mass) to help someone fast track their goals
With this framework, we can achieve essentially any goal. Nowhere in that framework is that someone needs to do a specific exercise. In fact it is quite the opposite. Myopically focusing on one exercise without consideration of underlying biomechanics to execute that exercise increases risk of causing pain or injury. The goal is to get three times a week with equal distribution of pushing and pulling exercises. In order to do this we need to avoid exercises that can increase risk.
We modify exercise based on a framework of Lateralizations/Regressions. With Lateralizations we are choosing a modification if someone does not have pain but cannot execute the movement without compensation. With Regressions we are choosing a modification if someone has pain and cannot execute the movement pattern. The biggest difference is the presence of pain forces us to make a choice that does not increase or cause new pain.
For Team Modified it means that you will not Back Squat or Deadlift from the ground. Back squat is a great exercise if you do not have previous back pain or injury. Risk reward essentially makes back squat an obsolete exercise for us for people with previous injury (specifically back pain). The placement of the bar on the back externally rotates the shoulders and lifts the rib/sternum. This causes a lordotic position of the lumbar spine and an anterior tilt of the pelvis. This could exacerbate the impinged (compression of one side) of the spine and cause reinjury. Front squat on the other hand places the bar in front (flexion and internal rotation of the shoulder) which keeps the ribs down and pelvis up - less lordosis and subsequent impingement spine.
Another big reason back squat is not a great exercise choice with someone that has experienced low back pain, is people can finish a crappy rep more readily. With the placement of the bar on your back we can squeeze out ‘bad reps’ more readily. People that gradually lose their toros position place more shearing forces on their back which can more readily cause reinjury. Instead we focus on the front squat, where it is a natural self limiting exercise.
The final reason why back squat is not a great choice for someone with pain is the absolute load you can lift. It is mechanically advantageous to have the bar on the back because you can center mass is posterior. This is good and bad - we can more readily use load, but we have a propensity to compensate to accommodate that load. If someone that has experienced back pain or injured their back, the goal is to not reinjure an area. Absolute load is not a great focus for someone with an injury - instead the front squat has a lowered ceiling with better biomechanical constraints. We get high value with less risk.
The other modification we make is to not deadlift from the ground. With back injuries we want to be conscious of range of motion (ROM) under load and potential compensations that may cause pain. A big screen we focus on with hinge patterns is the FMS Active Straight Leg Raise (ASLR). If someone has limited ROM or control in the ASLR they will have limited ability to go to the ground in deadlift. The problem with deadlift is a fixed end range (the height of the plate resting on the ground). This is probably more ROM than someone with back pain or low ASLR can move through without compensation. So the answer for us is to use lesser ROM options like going off blocks or trap bar higher handles.
With Strength Modified it is a 100% someone that we cannot execute a lower body movement based on injury or rehab status. In this example we are going down a Regression pathway over a Lateralizations path. For Regressions with Strength we want to take the joint away as much as possible that we cannot load directly: specifically the knee. When someone tells us they have an injured area or coming off rehab, our response will be to put you in Strength Modified and to focus on single joint actions (isolation) programs. Instead of things like squats we utilize Passive Range Lift Offs of Hip Flexion. Instead of hinges we will utilize Passive Range Lift Offs Hip Extension.
The end result is that we can keep you coming in three times a week and working with the group at your preferred time slot. We appreciate the willingness to come in and keep fighting to get stronger - however there is inherent risk involved with everything we do. For people with back pain/injury or coming off rehab or general injury certain exercises are not a great strategy. By sticking to the framework of three days a week balancing pushing and pulling exercises we can achieve any goal, we just need to be strategic with pushing with the right exercises.