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| Number Nine, October 2002 - SPORTS MEDICINE & USAPL
SUSPENSION LIST
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Dr. Michael Hartle
Medical Committee Chair
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Trunk Stabilization Concepts and Exercises
by Michael A. Hartle, D.C., D.A.C.B.N., C.C.N., C.C.S.P., C.S.C.S., E.M.T.
Part Five of Six (skipped on the last issue)
FIX IT!!
Now that we know what is going on when we wear a belt and why it 's use should be stopped for long term health benefits, we should just throw away our belts, right? Wrong!! Three things need to be done first. First, we need to assess our level of lower abdominal coordination and strength. Second, once we know what our strength is, we need to increase it to normal levels and beyond. Last, we need to wean ourselves off of the belt so as to prevent injury.
One of the best ways to assess the lower abdominal function is to utilize biofeedback via a blood pressure cuff. By laying prone on top of the BP cuff (at the level of your umbilicus/belly button), normal function of the TVA (contracting it by pulling in your umbilicus) will allow you to reduce the pressure in the cuff by 10 mmHg without flexing your hips, pressing your shoulders into the floor or moving your spine. For each 1 mmHg less than 10 mmHg that you are able to reduce the pressure, you can assume a 10% loss of function. Reduction of 6 mmHg of pressure yields approximately a 40% loss of TVA function. If your level of function is below 100%, this test just performed becomes the actual exercise and you will need to utilize the example format shown under the heading "Sample TVA Training." Getting the TVA to fire is hard for some people at first, particularly females. My clinical experience has been female patients with multiple births and C-section births most commonly have a weak TVA. In order get the TVA to start firing as soon as possible, I recommend a 4-Point TVA exercise. After you have performed the 4-Point TVA Exercise every day for a week, retest yourself with the BP cuff. During the time that you are increasing the firing of your deep abdominal wall, you can also work on your lower abdominal strength and coordination.
Belt use has been shown to alter the natural recruitment patterns of the abdominal wall, favoring the rectus abdominis (7), erector spinae (8) and potentially disrupting recruitment sequences in the legs (9). It is therefore no surprise that belt users frequently present with abnormal coordination in the abdominal wall when assessed clinically. It is very common for belt users to have reduced ability to control sacral base inclination, or pelvic tilt. Clinically, it has been found that the inability to control pelvic tilt is also commonly related to such spinal pathology as spondylolistheses, spondylolysis, spinal instability and disc herniation.
To test yourself, lay on your back and place your hands under your spine (palms down). When your fingertips are just behind your umbilicus (L3), flex your hips to 90° and keep your knees fully relaxed. From this position, roll your pelvis posteriorly until you can feel the spinous process of your spine pressing on your fingers. Now, while holding the pressure on your fingers with your spine, begin lowering both of your feet to the floor, always keeping the knees fully bent. If you have normal lower abdominal coordination, you should be able to slowly lower your feet to the floor and bring your legs back to the point of 90° hip flexion without the pressure of your spinous processes at the L3 level ever coming off your fingers (10). If you are unable to hold consistent pressure while lowering and raising the legs as described, it is very likely that you have facilitated hip flexors (11,12). A simple approach to correcting the problem is to stretch your hip flexors (psoas and rectus femoris) and repeat the test.
After you are able to finish week 4 of the BP Cuff Exercise (if it takes you 1-2 weeks longer than 4 weeks, that is okay), have passed the lower abdominal coordination test and have removed and corrected the deficits found when you first tested yourself, it is time to start weaning yourself off of the belt. At this point, you should have achieved the ability to recruit your deep abdominal wall and restored normal lower abdominal coordination.
WEANING OF THE BELT
1. Throughout the belt weaning process, continue to use the abdominal retraining techniques mentioned above.
2. Remove the belt for your warm-up sets, then place it back on for your working sets, especially if you don't normally lift higher than 75% maximum intensity (12 repetitions).
3. If you lift higher than 75-80% intensity, then start by only wearing your belt for lifts greater than 80% intensity (8 repetitions).
4. Take your belt off for your first working set, then place it back on for subsequent sets for that particular workout for that exercise.
5. Take your belt off for your first 2 working sets, then place it back on for subsequent sets for that particular workout for that exercise. Continue this pattern for each workout as you get used to not wearing the belt.
Example:
1RM Squat = 400 lbs.
80%1RM = 320 lbs
Normal Workout progression: 3 sets x 5 repetitions at 320 lbs
1st Week of weaning at 320 lbs: 1st set of 5 - no belt; next 2 sets of 5 for that same workout - wear belt
2nd Week of weaning at 320 lbs: 1st 2 sets of 5 - no belt; last set of 5 for that same workout - wear belt
3rd Week of weaning at 320 lbs: All 3 sets of 5 - no belt
6. Remove the belt for all exercises at an additional 5% intensity, or 2 reps closer to you maximum.
7. This progression continues for 4-8 weeks.
8. Once your beltless lifts have either matched or exceeded your previous lifts with a belt, you may safely remove the belt forever. Place it in a closet, sell it at a garage sale, use it as a tow rope, etc. Congratulations!!
NOTE: If you have any pain in any spinal segment between the lower thoracic, lumbar or sacral vertebrae, or anywhere in the lumbopelvic region, this can inhibit the transverse abdominus and pelvic floor musculature, leaving you open to injury. If this is the case, do not try and wean yourself off of the belt without seeking out a qualified health professional, namely a chiropractic physician or physical therapist that understands strength training or a CHEK practitioner.
It is well documented that coordinative patterns of the abdominal wall are task specific (10, 13, 14, 15); one may have normal abdominal wall function during a squat pattern, but not a push pattern for example. Additionally, loss of abdominal wall coordination is easier to prevent than to restore (16). This should be enough of a reason for anyone thinking about using a belt to not use it.
One method I use to assist the further development of abdominal wall coordination and function involves creating feedback for the patient via the use of the most powerful, performance-enhancing device ever made: a piece of string. This string is tied around the your waist at you belly button level. When performing an exercise, inhale and draw your belly button off the string prior to exerting any force. This teaches your brain to activate the TVA first. One thing to remember is this: when you are lifting any type of significant load, you may eventually cross the stabilization threshold. When this happens you will go from segmental to gross stabilization. You will notice that you cannot keep the string loose around your torso. The next step is to reduce the weight until you can get back under the stabilization threshold which will be identified by you being able to perform the lift and keep the string loose. The goal is to keep the TVA in (the string loose) throughout the exercise.
One final note. It is extremely important to perform enough low intensity lifting (repetition, repetition, repetition,….) to educate the brain to always recruit the deep abdominal wall before recruiting the outer unit, or outer muscles which function as gross stabilizers. This will help remove the faulty motor pattern that is present and teach the brain and the neuromuscloskeletal system what the normal recruitment pattern is.
Next Issue...Exercises...
Michael A. Hartle,
USA Powerlifting Executive Committee Board Member
Chairman, USA Powerlifting Sports Medicine Committee
Chairman, USA Powerlifting Drug Testing Committee
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USAPL Suspension
List, Effective Sept 2002
Name State Offense Date/Offense Length End Date
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Tim King North Carolina Indebtedness to the Association May 20, 1998 Indefinite Indefinite
Chris Kostas California Indebtedness To The Association Jul 20, 1998 Indefinite Indefinite
Refusal To Do Drug Testing At Meets
Steve Gavin Minnesota Indebtedness To The Association May 21, 2001 Indefinite Indefinite
Bringing organization into disrepute
Antonio Garcia Colorado Nandrolone (second offense) Sep 23, 2001 Indefinite Indefinite
Scott Purto New Mexico Nandrolone Oct 03, 1999 3 years Oct 03, 2002
Greg Faulkenberry South Carolina Nandrolone Oct 16, 1999 3 years Oct 16, 2002
Stella Krupinski Virginia Nandrolone Oct 23, 1999 3 years Oct 23, 2002
Michael D. Jones Ohio T/E Ratio 66.6 Nov 13, 1999 3 years Nov 13, 2002
Steven J. Ayre Colorado Nandrolone Nov 13, 1999 3 years Nov 13, 2002
Brett Neuman Wyoming Nandrolone Nov 20, 1999 3 years Nov 20, 2002
Christine Rovnak Idaho Methandienone, T/E Ratio 50.0 Nov 20, 1999 3 years Nov 20, 2002
Andrew Bates Colorado Nandrolone Dec 05, 1999 3 years Dec 05, 2002
Jason Bennett Colorado Nandrolone Dec 05, 1999 3 years Dec 05, 2002
Shane McShane Hawaii T/E Ratio 22.5 Dec 18, 1999 3 years Dec 18, 2002
Zindy Coss Alaska Nandrolone Dec 27, 1999 3 years Dec 27, 2002
Debbie Christensen Utah Methyltestosterone Jan 17, 2000 3 years Jan 17, 2003
Michael A. Bradley Maryland T/E Ratio 9.2 Jan 15, 2000 3 years Jan 15, 2003
Tom Conklin Wisconsin Nandrolone Jan 22, 2000 3 years Jan 22, 2003
Lonnie Coxsey Colorado T/E Ratio 4.4 Feb 13, 2000 3 years Feb 13, 2003
Terry Nelson North Dakota Nandrolone Mar 04, 2000 3 years Mar 04, 2003
Jeff A. Peshek Ohio Nandrolone Mar 11, 2000 3 years Mar 11, 2003
Chris Scott Ohio Nandrolone, Stanozolol, T/E Ratio 87.9 Mar 11, 2000 3 years Mar 11, 2003
Jeff Cook Ohio Nandrolone, T/E Ratio 20.4 Mar 11, 2000 3 years Mar 11, 2003
Jason Buccek Minnesota Nandrolone Mar 18, 2000 3 years Mar 18, 2003
Mary Jacobson California Failure to report for testing Apr 08, 2000 3 years Apr 08, 2003
John Wagner Pennsylvania Methandienone Apr 15, 2000 3 years Apr 15, 2003
Al Dawson Washington Nandrolone, Methandienone, Oxymetholone Apr 15, 2000 3 years Apr 15, 2003
T/E Ratio 181.1
Jeffrey Boutot Maine Nandrolone Apr 22, 2000 3 years Apr 22, 2003
Leonard Brightwell Virginia Nandrolone Apr 29, 2000 3 years Apr 29, 2003
Alex Galant Colorado Nandrolone May 06, 2000 3 years May 06, 2003
Adam Stiverson Michigan Nandrolone May 06, 2000 3 years May 06, 2003
Kenneth Tuohey Virginia Nandrolone May 13, 2000 3 years May 13, 2003
Jerry Willis Michigan Nandrolone May 13, 2000 3 years May 13, 2003
Joe Thompson Wyoming Methandienone, Nandrolone May 20, 2000 3 years May 20, 2003
Chris Berry Idaho Nandrolone May 20, 2000 3 years May 20, 2003
Joe Bider Texas Boldenone, Ephedrine, Pseudoephedrine Jun 11, 2000 3 years Jun 11, 2003
Chris Brigham California Methyltesterone Jun 17, 2000 3 years Jun 17, 2003
James McGlynn Florida Nandrolone, Methenolone, Stanozolol Jul 08, 2000 3 years Jul 08, 2003
T/E Ratio 150.1
Jeff Himmelrick Nebraska Boldenone Jul 16, 2000 3 years Jul 16, 2003
Scott Brone California Nandrolone Oct 28, 2000 3 years Oct 28, 2003
Jeffery Hunter New Mexico Nandrolone, T/E Ratio 9.5 Oct 28, 2000 3 years Oct 28, 2003
Ralph Kiebach Ohio Nandrolone, T/E Ratio 51.7 Nov 12, 2000 3 years Nov 12, 2003
Thomas Lamoureux Massachusetts Nandrolone, T/E Ratio 8.5 Nov 19, 2000 3 years Nov 19, 2003
Jeff Diederich Kentucky Nandrolone, Oxymetholone Dec 02, 2000 3 years Dec 02, 2003
Jeff Holzbauer Illinois Nandrolone Dec 02, 2000 3 years Dec 02, 2003
Greg Zoeller Indiana Methandienone, Oxymetholone, T/E Ratio 408.0Dec 02, 2000 3 years Dec 02, 2003
George L Ferrell Virginia Fluoxymesterone, Methandienone, Nandrolone Dec 09, 2000 3 years Dec 09, 2003
T/E Ratio 29.1
Jeremy Biewer Minnesota Failure to report for testing Jan 20, 2001 3 years Jan 20, 2004
Paul F Unis Colorado Nandrolone, T/E Ratio 22.7 Jan 28, 2001 3 years Jan 28, 2004
Steve T Fergen South Dakota Nandrolone Feb 10, 2001 3 years Feb 10, 2004
CJ Salas Nebraska Nandrolone Feb 10, 2001 3 years Feb 10, 2004
David Pierce Michigan Nandrolone Feb 10, 2001 3 years Feb 10, 2004
Eric Sampson Wisconsin Nandrolone Feb 17, 2001 3 years Feb 17, 2004
Warren Fahrenfeld New Jersey Nandrolone, Epitestosterone Mar 24, 2001 3 years Mar 24, 2004
James Rictor Oregon Nandrolone, Stanozolol Mar 24, 2001 3 years Mar 24, 2004
Patrick Gratton Missouri T/E Ratio 74.7 Mar 31, 2001 3 years Mar 31, 2004
Matthew Hebert Louisiana Nandrolone Apr 01, 2001 3 years Apr 01, 2004
Boomer Fleming Hawaii Nandrolone, Methandienone Jun 30, 2001 3 years Jun 30, 2004
Jason Berkowitz Pennsylvania Nandrolone Apr 29, 2001 3 years Apr 29, 2004
Robert Abfalter Michigan Nandrolone Jul 28, 2001 3 years Jul 28, 2004
Jacob W Heglar Virginia Nandrolone Oct 21, 2001 3 years Oct 21, 2004
Tim E Geyer Michigan Nandrolone Oct 27, 2001 3 years Oct 27, 2004
Brett J Polofsky Rhode Island Nandrolone, Oxymetholone Nov 17, 2001 3 years Nov 17, 2004
Douglas D Mounkes Kansas Nandrolone, Epitestosterone Nov 17, 2001 3 years Nov 17, 2004
Elizibeth Volk Texas Nandrolone Nov 17, 2001 3 years Nov 17, 2004
Theresa J Fish Wisconsin Nandrolone, Stanozolol Nov 26, 2001 3 years Nov 26, 2004
Toe Preston Hawaii Nandrolone Dec 08, 2001 3 years Dec 08, 2004
Karen C Phillips Virginia Nandrolone, Methandienone,T/E ratio 126.4 Dec 08, 2001 3 years Dec 08, 2004
Garnet C Boudreau Maine Methenolone; T/E ratio 57.5 Dec 08, 2001 3 years Dec 08, 2004
Joshua McMillan Michigan Boldenone Feb 02, 2002 3 years Feb 02, 2005
John Onorato Colorado Nandrolone Feb 10, 2002 3 years Feb 10, 2005
Jim Thompson Montana Boldenone; T/E ratio 44.9 Feb 23, 2002 3 years Feb 23, 2005
Ralph Buckles Minnesota Nandrolone, Epitestosterone, T/E ratio +6.0 Mar 16, 2002 3 years Mar 16, 2005
Dwayne Poucher Florida Nandrolone Mar 24, 2002 3 years Mar 24, 2005
Ben White New York Nandrolone Mar 30, 2002 3 years Mar 30, 2005
Richard Davis Pennsylvania T/E ratio 15 Apr 07, 2002 3 years Apr 07, 2005
Antonio Lanzellotta New Jersey Failure to report for testing Apr 27, 2002 3 years Apr 27, 2005
Avery Adams Tennessee Boldenone May 04, 2002 3 years May 04, 2005
Chad Crigger Iowa Nandrolone; T/E ratio 28.3 May 19, 2002 3 years May 19, 2005
Vincent Niedoliwka Michigan Methylphenidate Jun 15, 2002 6 months Dec 15, 2002
