Novak Djokovic has made every world class tennis player aware of the importance of mobility(flexibility) by the way he moves. His movement is a balance of strength and mobility. I have had the good fortune to see Djokovic train at the Australian Open Gym, and found it remarkable how the physiotherapist stretched Novak between each strengthening exercise he performed. The world’s number one tennis player takes mobility very very seriously.
The greatest stretch you can learn from Novak is the “Anti Sitting Stretch” which his phyiso is performing in the video above. This Thai Stretch is fantastic at opening your spine into extension and we all need more spine extension. The simple reason we need extension is we sit too much and our spines are suffering from “Sitting Disease”. Whether your know it or not your spine is becoming modeled to the shape of a chair.
The importance of maintaining your spine range of motion cannot be underestimated. Over 20 years ago at University of Florida, spine surgeon Dr. Mike MacMillan shared this clinical pearl: “Loss of spine extension is the first sign of aging.” As the study from The Journal of Physical Therapy shows, we go from 41 degrees of spinal extension to 17 degrees as we age ( see graph below).
Dr Mac hit the nail on the head. You actually lose more then 50% of your spine motion and your spine becomes very very stiff.The simple solution, start stretching the spine in the opposite direction you are sitting in right now. Start with a physio ball and eventually find a physio or even better yourself in beautiful Thailand opening up your spine. Thanks Dr Mac for your great pearls of wisdom and thank you Djokovic for demonstrating this Thai stretch. The Worlds Greatest Stretch.
Low back pain is the most common orthopedic symptom we will suffer from, yet ironically the low back muscles are the least favorite muscle to be worked out by many pro athletes (and maybe even you). Too often even the world’s best athletes become focused on the “bathroom mirror” and bomb and blitz their as abs while neglecting their back. So, to optimize my athletes’ performance we first restore full range motion to their spine and then balance the core by strengthening the back muscles with Manniche Protocol. Eventually, like Dimitry Koklov, we bomb and blitz the erector spinae muscles with back extensions and reverse hypers.
Ok I know that you are probably not ready to go beast mode on the back like Koklov, but intuitively he knows the importance of strengthening the low back (as well as his abs). Dr Manniche, one of the worlds leading expert in low back pain also had the sneaking suspicion that strengthening the back thru a full range of motion was very good for the back. Dr Manniche went one step further and proved it as a cure for low back pain over 2 decades ago.
The Manniche Protocol ( picture from his scientific article below) was used with great success in 44 nurses with low back pain but for some reason this solution never reached you.
If you are worried about the large range of motion of these exercise, remember the spine was designed to move and it is very important to restore extension as we all sit too much (sitting disease). Since the Manniche protocol is totally new to each patient I have treated over the last 20 years I am sure it will probably seem draconian to you. You should always start a new exercise at 50% of what you feel you could do and proceed slowly. You can always do more next time and maybe one day hit beast mode like Koklov.
So in Dr. Manniche we trust and Dimitry Klokov you are a beast.
Welcome to the operating room of the Houston Rocket’s team surgeon, Dr Bruce Moseley. Dr Moseley is a maverick orthopedic surgeon who wanted to investigate whether belief could heal a condition as serious as arthritic knee pain. In a radical experiment Dr Moseley performed ‘placebo’ surgery on five patients. As part of this experiment, he entered the operating theater where a patient was unconscious and ready for knee surgery. He then opened an envelope to find out whether or not he would perform surgery on this particular patient.
On five patients, Dr Moseley did not perform arthroscopic knee surgery, instead he created the illusion of surgery by purposely making small wounds to represent typical surgical incisions. With a clearly visible scar and painful knee, the patients were convinced they had had surgery, when in fact they hadn’t.
All five patients who had the placebo surgery reported their surgery was a success. All reported less pain and all reported they would recommend the surgery to a friend or family member.Here’s how Sylvester, one patient who had the placebo surgery, described his results:
“The surgery was two years ago and the knee has never bothered me since…it’s just like the
other knee now. I give a whole lot of credit to Dr Moseley. Whenever I see him on TV during a
basketball game I call the wife in and say, ‘Hey, there’s the doctor that fixed my knee’.”
In high performance we say, “You are either improving or you are getting worse.” As I traveled the world watching training, I noticed that core training is not improving ( yes it is actually getting worse). Today the buzz in core training are anti-flexion, anti-extension, anti-rotation exercises and you may have even found yourself performing planks in the gym. Every trainer tells their client the platitude of keeping your spine in neutral and not letting it moving to the extremes to protect your back.If your spine does not move of course it will not hurt.
The spine is made up of 76 joints. They are designed to move and in the sporting arena the spine is often in the extremes of motion in performance. I have watched Rodger Federer train on many occasion and as he serves, his back is in extension a long way from neutral spine (0 degrees). Exercise physiology 101: There is only a carry over of 15 degrees from the angle you strengthen. Meaning if Federer performs planks in neutral (0 degrees) there will be no carry over to typical 15-40 degrees of spinal extension he uses on the court. All the planks are going to do nothing for Rodger when he serves or reaches for a very wide ball. His back is likely to get injured.
3 minute planks are great for your posture but do little for end range where all spinal injuries occur. As Gary Gray the famous physical therapist said: “you always regret not strengthening the position you were injured”. During my days at the University of Florida I had the good fortune to work under Dr Mike Mac Millan the professor of orthopedics. He was a big believer in full pain-free range of motion exercise for all joints, including the spine which was a far cry from all transversus abdominal stuff I learned at University of Queensland in Australia (ground zero for Transversus Abdominus).
Dr Mac ( a spine surgeon) presented the evidence, rehab was progressed to the next level and our patients improved. At Univeristy of Florida we developed a comprehensive protocol for rehab that included neutral spine and progressed to full pain-free range of motion. Unfortunately popular core strengthening today is more like our initial rehab stage not our final stage for optimal performance. The answer is to progress rehab thru all stages and eventually to learn full pain free range of motion exercises like the GHD sit up demonstrated in the video.