This installment of the Building Bigger Stronger Muscle Series is going to focus on the bigger, major muscles. There are many other muscles in the back and hip that we need to be concerned about, particularly in regard to the care and prevention of low back pain and disorders that plague the American population. I will save those muscles and issues for a future installment of FITBITs.

Muscle:

Erector Spinae. The erector spinae is actually a large group of muscles: the iliocostales cervicis, lumborum and thoracis; the longissimus capitis, cervicis and thoracis; and the spinalis capitis, cervicus and thoracis.

Origins:

The large grouping of erector spinae muscles have origins beginning at the lumbodorsal fascia (this is a tough, fiberous membrane of the lower back and hip). The lumbodorsal fascia has its origin at the lumbar vertebrae, posterior surface of the sacrum and the posterior iliac crest. The lumbar vertebrae are the bottom 5 vertebrae, the sacrum is the beginning of the “tail bone” (the sacrum and coccyx form the “tail bone”, the coccyx at the very bottom), and the posterior iliac crest is the backside of your hipbone. The other muscles have origins that continue upward along the vertebrae and medial ribs and continue upward to the top ribs and cervical vertebrae four.

Insertions:

The large grouping of erector spinae muscles have insertions that run up the entire rib cage, vertebrae and into the skull.

Function:

The erector spinae extends the trunk. Contracting one side of the erector spinae assists in lateral lumbar flexion. The most recent EMG studies indicate that the erector spinae does not operate in the agonist-antagonist relationship the way other muscles perform. In the agonist-antagonist relationship the antagonist always acts as stabilizer during agonist flexion. EMG studies however, show there is no activity of the erector spinae in full lumbar flexion. Keep this is mind when you have reason to have your athlete completely relax the exector spinae, full flexion of the trunk causes the erector spinae to relax.

Muscle:

Quadratus lumborum

Origin:

At the posterior crest of the iluim (back side of your hip bone, runs from the lateral edge of the sacrum, across the top of the iluim to the lateral edge of the iluim (hip bone).

Insertion:

At  the  transverse  processes of the five  lumbar  vertebrae

(L-1 through L-5) and into the inferior edge of the twelfth rib. The transverse process refers to the lateral protrusion of the vertebrae and the inferior edge of the 12^th rib refers to the very bottom of the very most bottom rib located in the back.

Function:

The quadratus lumborum extends and can hyperextend the spine. When one side of the quadratus lumborum contracts it can cause lateral flexion. If the upper torso is fixed on its side it can lift the legs. Conversely, if the pelvis is fixed on one side it can lift the torso. The quadratus lomborum helps supports the pelvis and the lumbar spine.

Muscle:

Piriformis

Origin:

At the concave, lateral edge at the base of the sacrum and the inside surfaces of the pubis and ischium (lower portion of the inominate or hip bone).

Insertion:

At the inside surface of the greater trochanter (the thick process (knob) a the top upper end of the femur (thigh bone).

Function:

This is a small muscle in the hip that holds the femur into the acetabulum (the depression on the lateral surface of the innominate bone - {hip bone} that provides the socket into which the head of the femur fits). The piriformis helps to outwardly rotate the leg. The piriformis is notable, not because of its size or function, but because of how often it is injured during strength training, sports and/or exercise. The piriformis is a small, deep muscle in the hip that can easily be over trained, injured and inflamed. Unfortunately, because of it’s close proximity to the sciatic nerve, inflammation of the piriformis, will cause pain to radiate down the length of nerve into the legs, due to the muscle inflammation causing friction along the nerve. This can be extremely painful and debilitating. Trainers should use extreme caution when an athlete complains of deep hip pain, with radiating pain going down the back of the thigh.

Muscle:

Gluteus Maximus

Origin:

At the posterior gluteal line of the ilium (rear medial part of hip bone), posterior iliac crest (rear part of the hip bone as it curves downward), lateral posterior sacrum and sacrotuberous ligament (along the lateral edge of the tail bone).

Insertion:

At the gluteal tuberosity of the femur (top part of the thigh bone) and the iliotibial band of the tensor fascia latae (T.F.L. is a short muscle that originates below the lateral crest of the hip bone and inserts into the iliotibial band (IT band is a tendon that runs from the top of the thigh bone, along the entire length of the thigh bone and inserts into the outside of the tibia).

Function:

The gluteus maximus is the strongest and largest muscle in the body (at least on J-LO). The gluteus maximus is a very powerful extensor and outward rotator of the leg. It aids in abduction of the thigh, but the lower fibers also adduct the leg. The muscle maximally contracts during walking with long strides; this makes the walking lunges and the wide stance single leg squat popular exercises.

Muscle:

Gluteus Medius

Origin:

At the lateral, upper surface of the iluim, (upper, side of the hip bone), above the gluteus minimus.

Insertion:

At the lateral and superior surface of the greater trochanter of the femur.

Function:

The gluteus medius works in conjunction with the gluteus minimus to abductor the leg. Since it is considerably bigger and stronger than the minimus, it is the primary abductor of the femur and assists in medial rotation of the thigh.

Muscle:

Psoas Major

Origin:

At the transverse processes of L-1 through L-5 (Lumbar Vertebrae 1 through 5) and the bodies and discs between them.

Insertion:

At the lesser trochanter of the femur and the shaft just below the lesser trochanter (medial (inside) the thighbone, just below the top.

Function:

The psoas major is the larger of the two psoas muscles (the other is the psoas minor) and it flexes the leg (as in the leg raise). It can also flex the torso on the pelvis when the legs are held down as in the traditional (BUT CONTRAINDICATED) SIT-UP.

Muscle:

Tensor Fascia Latae

Origin:

At the anterior, lateral surface of the ilium below the anterior iliac crest and posterior to the anterior iliac spine (below the most lateral part of the hip bone).

Inserts:

At the iliotibial band that travels the lateral thigh and itself inserts into the lateral patellar retinaculum and lateral tibia (below the knee, to the outside of the shin bone).

Function:

The tensor fascia latae assists the gluteus medius and minimus in thigh abduction, thigh flexion and medial rotation.

Indication of Weakness

Test for weakness in the erector spinae group by using the “Biering-Sorense Position”. You have your athlete extend their upper body, face-down, countilevered out from the end of a bench/massage table/etc. The athlete’s waist is at the edge of the bench and you secure their pelvis, knees and hips (this can easily be by you strapping their feet down or holding their legs down. You can substitute a Roman chair, but observe carefully for failure of the erector spinae, not the hips or hamstrings). The athlete holds their arms folded, across their chest, with the hands resting on the opposite shoulders. The test is complete when failure occurs (when the athlete’s upper body drops from the horizontal position).

Normative data for this test was collected from young, healthy individuals with an average age of 21. Men held position for 161 seconds and woman for 185 seconds (men have heavier upper bodies - just in case your wondering).

Obviously, weakness in the erector spinae decreases lumbar extension strength. Lack of strength leads to instability of the lumbar vertebrae. Instability leads to injury and pain. Overuse - chronic contraction of the erector spinae, from continuous standing, walking or lifting can cause spinal curvature of the lumbar spine, potentially creating pain in the facet joints. Therefore, it is critical to determine if the erector spinae is weak and needs strengthening or it is over used and needs flexibility to increase ROM.

Weak hamstrings can cause many back problems. Particularly in women, who often have weak hamstrings. Weak hamstrings can increase hypertonicity in the erector spinae, because the weak hamstring allows the ilia to rotate anteriorly, increasing the lumbardic curve. This can cause lordosis (excessive arch in the lower back, picture a female gymnast walking with an excessive lower back arch and her gluteals poked-out). This lordosis can cause jamming of the lumbar facet joints and excruciating pain.

Weakness in the quadratus lumborum can cause muscle spasms during lumbar flexion (any crunch type movement). Shortening of the quadratus lumborum can also create a jamming of the facet joints. Extensor test is also an indicator of the quadratus lumborum.

Caution:

The ‘weight lifters arch” is the proper biomechanical position for both squats and dealifts, but if your athlete presents “lordosis” be extremely careful. Lordosis and/or inflammation in the facet joints can make any squat or deadlift type movement extremely painful.

Weakness of the gluteus maximus make any squat or deadlift type movement very difficult. In case of a very deconditioned gluteus maximus the patient may have difficulty rising out of a chair and will need their hands to push off the armrests to get up. It may also cause lateral knee instability when the knee is loaded during squats or dead lifts. Failure to keep the knees tracking over the toes requires you to decrease the load. If necessary use less than body weight by using a Vortex Machine or similar (CLICK TO VIEW). If the gluteus maximus become shortened or hypertonic, this can also cause lordosis. If it is hypertonic on one side, it may present as scoliosis on the affected side. Test for both strength and flexibility (with ROM tests) to determine if strength training and/or flexibility training will be the best remedy for your athlete.

Weakness in the gluteus medius will present as decreased leg abduction strength and pain in the gluteus medius when doing any squatting type activities on the affected side. Performing a standing a posture exam will reveal that the ilium is higher on the affected side. You can use an Alignabod to help you perform an accurate posture assessment.

Weakness in the psoas will cause instability in the lumbar spine and may cause pain in and around the inguinal ligament (groin area). If the psoas is weak on one side only, walking stride will be shortened on the affected side.

Hypertonicity in the psoas can also result in lordosis. The psoas major and minor are grouped with the iliacus and called the iliopsoas group. Hypertonicity can be caused by athletes doing the old, traditional (contra-indicated) “sit-up with feet anchored”; the old fashioned sit-up with the feet anchored causes a pattern called the “flexor synergy”. The flexor synergy contracts the tibialis in the shin, the rectus femoris in the thigh and the iliopsoas in the pelvis. This can overdevelop and tighten the iliopsoas causing lordosis and the resulting hyperextension on the spine, leading to lower back pain and resulting injury. Flexibility training can remedy this problem. This is what causes lordosis in gymnasts.

Weakness in the tensor fasciac latae can cause pain in the lateral hip (the origin point and/or the lateral knee area (the insertion point). Weakness can decrease lateral knee support during flexion (as in any squatting type movement or running). This combination of hip and knee dysfunctions is commonly referred to as “snapping hip syndrome”, “IT back syndrome” or “Iliotibial back syndrome”. Flexibility training and strength training can remedy this problem.

Optimum Training Principles

The power clean is argueably one of the best exercises for the lower back and hips. Unfortunately, it is a fast, explosive, high-intensity exercise that requires the athlete to be both an experienced strength trainer and well conditioned.

Another, less explosive exercise that should be a main stay for conditioning the low back and hips is the deadlift. The biomechanically correct technique for the deadlift should be used by everyone, every time they lift an object off the floor. Improper lifting mechanics can lead to serious injury for anyone with even relatively minor back and hip dysfunction.

The deadlift uses most of the muscles in the back, hips and thighs, with the erector spinae being very highly active. Use extreme caution and great attention to detail for anyone with any level of back dysfunction.

For details on correct technique, refer to the IFPA Personal Fitness Trainer Certification Manual; The Book on Personal Training, 2006 by Doctors Jim Bell, PhD and Karl Dauphinais, M.D. and Robert Simons, PhD and Mark Kovacs, M.Ed., Chapter 10.

How to Perform the Deadlift Correctly:

Preparation:

1. Stand with the balls of the feet directly under the bar.

2. The feet should be flat on the floor with the toes pointing directly forward or slightly toe-out (5-10 degrees).

3. Stance is relatively narrow with feet positioned between shoulder width and hip-width apart. {See the IFPA PT Manual, chapter 10 for Sumo Deadlift or Narrow Stance Deadlift variations}.

4. Keeping the hips below the shoulders, squat down until the trainee can grip the bar with an alternated (mixed) grip.

5. The hands should be slightly wider than shoulder width apart; arms completely straight and outside the knees.

6. While in the squat position, the bar will be approximately one inch in front of the tibia (shin).

7. The body position will be similar to the squat and all good lifting positions:

7.1. Head neutral

7.2. Shoulders back

7.3. Upper back straight

7.4. Trapezius relaxed and slightly stretched

7.5. Chest up and out

7.6. Scapula retracted

7.7. Maintain “Weight Lifters Arch”

7.8. Shoulders over or slightly in front of the bar

7.9. Eyes focused on a point slightly upward or straight

ahead.

Caution:

The body position described above is to be maintained for both the concentric and eccentric phases. Never allow the hips to rise in relationship to the shoulders. This would create a poor mechanical position for the lift and hazardous levels of shearing torque on the lumbar vertebrae. Failure to maintain a retracted scapula, shoulders back, chest up and out position can create hazardous levels of shearing force on the cervical and upper thoracic vertebrae.

Concentric Phase

1. Begin the lift by exhaling and having your athlete drive the energy of the low back, hips, and thighs through the knees and shins into the heels. You can have your athlete visualize this by having them sit back on their heels and visualize driving their heels through the floor. This visualization makes your athlete start with the hips and thighs and prevents them from shifting from the heels onto the balls of the feet and big toe. This prevents an abnormal proprioception of the foot, which could inhibit the hip, erector spinae and other back extensor muscles from fully contracting. This is another of the body’s protective flexor mechanisms. If your athlete allows their weight to shift to the ball of the foot and big toe, the feet will invariably pronate causing high stress to the interpholangeal joints and small, relatively thin muscles of the feet to stretch. This proprioception of the foot protects the muscles and joints from excessive force and damage.

Caution:

Wearing quality athletic shoes with good arch support is very important for both the safety and effectiveness to help your athletes both functionally and neurologically in all their lifts.

2. Keep the bar as close to the tibia as possible without touching. This makes your athletes lifting mechanics much more effective and far safer. When the bar “drifts” away from the shins the strength needed to complete the lift increases dramatically due to the increase length of the lever arm. It also makes the lift more unsafe due to the shearing force on the lower lumbar vertebrae.

3. Once the bar clears the knee, drive the hips forward and the knees will pass under the bar. The bar will contact the thighs near the completion of the lift.

4. Continue lifting the bar and driving the hips forward until your athlete achieves a slightly arched position (hyperextension can stress the low back and hip joints). The end position should be achieved smoothly and simultaneously at the point when both knee and hip are fully extended. Focus should be on the smooth coordination between the extensions of both joints.

5. Exhale with a two-second timing on the concentric phase.

Eccentric Phase

1. Reverse, precisely, the technique described above

2. Lower the bar by slowly and simultaneously flexing the knees and hips.

3. Inhale with a four second timing on the eccentric phase.

How to Perform the Back Extension (On machine or Roman chair):

1. Have your athlete visualize all the numerous origins and insertions of the erector spinae and other back extensors that range from the low back and hips, all the way up along the spinal column and medial (inner) section of the posterior ribs, up into the skull.

2. You can help your athlete’s visualization with proper, judicious and professional use of “touch training”.

3. The focus is on the individual muscles and not on the back as a single-whole.

4. By rounding (flexing) the torso in a sequential segment from top to bottom (eccentric phase) and then extending, sequentially from top (skull) to the bottom (hip); your athlete can maximally contract all the erector spinae and back extensors (concentric phase).

5. Weight can be added (weight plate or dumbbell) as your athletes strength increases

6. Exhale 2-seconds: concentric phase

7. Inhale: 4-seconds: eccentric phase

The reverse back extension machine is also an excellent low back and hip exercise. The machine allows the upper torso to be fixed on the table while the legs hang down and off the table. The concentric contraction is to flex the low back, hips and gluteals to lift the legs and extend them backward. This exercise places no axial load on the spine.

Another important advantage of the deadlift is, that like the squat, the greater load capacity of these two lifts causes the endocrine system to produce increased levels of anabolic hormones, such as Human Growth Hormone (HGH), Insulin Like Growth Factors-1 (IGF-1) and Testosterone (at least in males). Our friends at the American Academy of Anti-Aging Medicine tell us that this increase in anabolic hormones has a multitude of benefits, including increasing lean body tissue, decreasing fat mass and numerous longevity and anti-aging health benefits.