Written By: Kevin Cann
If you put me in a Delorean, hit 88 MPH, and sent me back in time to a couple of years ago, I would have told you to “Never load dysfunction.” I was a product of where I worked and who I worked for. The people I worked with and the people I worked for are very good at their jobs and if they believed that it worked than so did I.
The Functional Movement Screen (FMS) was a staple in my training.
Every potential client went through it. I even had a whole class on assessments in graduate school, the FMS being a part of it, so it must have been the way to go.
I had great success doing this. People tended to get better over time. However, fast forward to today and I will tell you that they got better for reasons other than what I was telling them. All the education and experience I had told me that I was right in my thinking, that poor movement equates to poor performance and an increase in injury risk.
I held onto Shirley Sahrmann’s “Diagnosis and Treatment of Movement Impairment Syndromes” like it was the Holy Grail of coaching. I would use the analogy that the human body was like your car, it needs a tune up every so often. The problem with this is the human body is not like a car at all. It is not a machine, but instead a very complex ecosystem.
I may have never figured this out if it was not for experiencing a back injury training in July of 2016. Two days before my wedding I was to test my deadlift. I missed a squat and bench two days before and my back was already a little sore. I got into a bad position on the pull, but tried to keep pulling it. My back locked up into spasm.
You may be thinking that my bad position on the deadlift is what led to my injury. However, I had been pulling in this same bad position, even worse ones when I started, and I never got hurt. Was it the bad position, or was it the fact that my back was fatigued from testing my squat and bench press and during the deadlift the tissue exceeded its ability to handle the stress?
The poor position definitely plays a part. In a rounded back position the back muscles can handle far less stress than if I was in a better position. However, this does not mean that I would not have gotten injured if it was in a better position.
You see, people get hurt when they train in good positions as well. There are many people that deadlift for years with a rounded back and do not ever get injured. To only view this injury issue as a mechanical issue is very short sighted.
My personality does not go well with injury. I tore a bicep tendon training in MMA and convinced myself for 9 months it was fine. It wasn’t, it needed surgery and is now forever deformed. I had this same attitude with back injury.
I made sure to walk as much as I could tolerate. I stood up the entire time at my wedding two days later. My ass was tucked underneath and the spasm was so bad that it shifted my spine over to the right an inch or two. It hurt like hell, but I managed to walk around and stand up the whole time. I was going to be damned if I let this ruin my wedding.
I took the following week off for my honeymoon at the Cape. I swam in the pool at the hotel, I walked up and down giant sand dunes, and sat bent over at bars for an entire week. Believe it or not I started to feel much better. Maybe it was the constant moving, or the constant booze? Who knows?
I came back to TPS the Monday after my honeymoon, and even though I was still sore, I decided to put a bar on my back and squat. I worked up to 225lbs for a few sets of triples. When my back started to feel worse I decided to bench.
On this day I loaded dysfunction.
I could not arch on the bench like I typically do. However, I benched with a smaller arch just fine. I kept it light and worked up to 185lbs for sets of 4 repetitions. I followed that up with some light accessory work. This gave me a baseline of where I was at for those two lifts. This is a starting point. In other words, this was my assessment.
That Wednesday I came in and I pulled off of 5” blocks. I was able to pull 80% of my one rep max for sets of 2. This was a much higher percentage than what I used for squats and bench. I slowly progressed the rest of that week and the following week (8 total training sessions). By the end of week 2 I was back to full training with far less discomfort.
This was a far cry from the PT telling me “This is the worst spasm I have ever seen. I do not know how you walked in here like this.” I also had a sprain of my SI joint. I had known multiple people with similar injuries that took months to come back from this. Why did it only take me 10 days away from the gym and I was able to squat again?
This led me to learn everything I can about pain science. One of the biggest lessons I learned from my research is that my perception of my pain might have been a huge reason why I was able to return so quickly. It also explains why I could still fight with a freshly torn bicep tendon.
The way that pain works is a sensory receptor, called a nociceptor, receives a stimulus. The nociceptor takes this message and sends it to the spinal cord. Now it is up to the spinal cord to decide what to do with this message. If the spinal cord feels this message is important it will send it along to the brain. If the spinal cord does not see this as an important message than the message dies there and the person will continue without pain.
There are many people out there with torn labrums and disc herniation that never experience pain. Others will experience pain and get scans completed and told that the torn labrum or herniation is what is causing them pain. This is why I am against people in pain getting scans, in almost all cases.
The difference between the person in pain and the person not in pain is that the spinal cord is sending the message to the brain in the person that is experiencing pain. The other person’s system is not as sensitive to that pain. The thing is, the stimulus to the nociceptor could be the exact same in both of these people.
What we need to do is educate people in pain with the right information. Poor posture and poor movement are poorly correlated with pain and injury in the literature. On top of that, we do not have a defined set of rules for movement. There are many elite athletes that experience valgus collapse of the knees when they run and they never get injured. Same with anterior tilt of the pelvis. Fixing these may actually decrease their performance!
What we need to do is help the person desensitize from pain. Removing the painful movements for a little while may help to do this. This is why I was experiencing success with the FMS. I would remove certain movements, regress movements, or decrease the volume of movements, based upon the test. This helped the person desensitize from the pain.
Other aspects that help to desensitize pain are the person’s perception of pain, nutrition, hydration, sleep, and stress levels. We have a Method member that has severe scoliosis. This diagnosis was given to her by a doctor. This same doctor and a chiropractor told her she would never be able to lift weights.
These doctors gave this member the perception that her back was weak. If you think you cannot lift with scoliosis look up Lamar Grant. 5x body weight deadlift and multiple world records in powerlifting. Women have thicker and stronger lumbar vertebrae than men. This an evolutionary trait that benefits women during pregnancy. However, many women still get low back pain during pregnancy.
This member with scoliosis frequently gets back pain while lifting, especially deadlifts. Is this pain caused because of actual damage, or is it based upon the perception the doctors gave her about her back? The stimulus that she experiences while deadlifting is no more than you or me under the same intensities, volumes, and training age.
What differs is that stimulus gets passed along further down the line. If you had experienced back pain or an injury in the past, this can happen as well. The body learns from past experiences. If you hurt your back previously your body is more sensitive to that stimulus. Our goal is to desensitize the body to those signals.
We do that by first changing our perception. It takes thousands of pounds of pressure to cause damage to the spine and/or the surrounding tissue. A massage therapist, foam roller, and Donnie Thompson’s X-wife are not causing any changes to the tissue. You would need a bulldozer to do that. Instead it tells your nervous system to feel that sensation instead of the typical pain. This gives the person a small window to train in before that sensory pain returns. With good training, over time we can desensitize the body to the initial stimuli by doing this.
We can alter mechanics of the exact same lift itself. It is ok to experience a little pain, but we do not want it to be too intense (I say like an RPE 3-5), and we do not want it to get worse. By altering the mechanics we keep the movement similar to the one causing pain and we can continue to load it in a similar manner.
Being able to squat with weight on person’s back gives them the perception that they are stronger than they think. In most cases when people experience pain in the squat they immediately think they should not squat. This is one way we educate the person to perceive their body to be stronger than what they think. It is not a lie because the human body is really strong and adaptable.
TPS Method is also a community. The social aspect of Method can help desensitize the person to pain. Having them perform the same or similar exercises with the group is important for fast recovery. Removing this community can actually increase pain sensitivity. Sleep and nutrition are also important. The more good things we do here, the better our body will be at handling the pain stimulus.
I no longer perform an FMS, or any assessment for that matter when people come to me with issues. I ask them questions about what they have been doing, I ask them what movements hurt, and we go from there. Giving an assessment and having them fail tests gives them the perception that they are weak and at higher risk of injury for failing that test.
This is not true as I have seen some poor FMS results from elite athletes that never got hurt. Instead, I let them tell me what is wrong and we go right towards the painful movement. From there we will alter the mechanics, load, volume, and ROM accordingly. This gives us a starting point. Over time we will progress this just like any other strength program. Eventually the person can go back to doing what they did before and probably never experience any pain again.
As coaches we need to get away from telling people they feel pain due to mechanical issues in their lifts as this just does not hold true in the literature. I did this for many years and it took me getting hurt to learn more about this topic. We need to be careful babying clients with exercises.
Murph is a good example of this. He toe his patella off and went to PT after surgery. The PT gave him some unloaded exercises to do for his knee, but it did not work. Instead he used a high box to load squats and ended up feeling better.
Christian came in with back pain, could not touch his toes, and had pain on rotation. He felt a little pain (RPE 3) with 125lbs on the bar during a squat. That is where we stayed for weight and we were able to do 5 sets of 3 without increasing pain. He was very surprised that it did not hurt. This gave him the perception that he was still strong, and he is.
Christian Squatting with Back Pain
These loaded exercises will have much higher rates of success than unloaded exercises. In other words choose to load dysfunction. As coaches we need to find the right dose of strength training for the client at that given time. This gives us that baseline to improve upon. PTs should be doing the exact same thing.
We will end it on this note, mechanics still matter. However, they matter more for performance than they do for injury prevention. People still get hurt when they utilize good form. Someone may be feeling pain from over utilizing a specific movement. Taking this out, or altering it for a time period can help the person desensitize to pain. Vary your movements in the gym and experience a wide array of them. Do this with the appropriate volumes and intensities and you will make yourself even more robust than millions of years of evolution.
Do not be afraid to load dysfunction.