BACKSTORY: I recently gave one of my new clients the All 4 Belly Lift to do for homework.
This exercise is one I learned about from the Postural Restoration Institute, whom I highly recommend. But if you’ve been reading here for a while, you already know that (exhibit one, two, three, four, and five).
He was already familiar with the exercise and the above video I sent him, but wanted to know the difference between something like this and just doing a toe touch or sit and reach and breathing?
The All Four Belly Lift is a way to take a few degrees of freedom (a.k.a. compensation options) out of the equation. What I mean by that is being on your knees limits your ability to use your ankle to avoid expanding through your back and tucking your pelvis underneath you.
This exercise is also a way to inhibit your back side and teach your front side to turn on. Specifically, it’s really good for helping someone feel their abdominals working, helping them get all the air out, shutting of spinal extenders, and opening up the back of the hips.
A toe touch and sit and reach breathing can also accomplish these things. I like the belly lift because I think it’s easier to cue someone to keep their neck muscles off.
With the other two, you’re putting the hamstrings on a stretch. That’s fine for some, but for people who have extra flexibility in their hamstrings (most lifters, including you), they will get a lot of this motion from their hamstrings, not pull their pelvis underneath them.
For these people to get the motion of the exercise, they will tend to reverse their spinal curve. That is, their lumbar spine flexes and thoracic spine extends. If this happens, we’re actually accomplishing the opposite of what I want. See drawing below if it helps.
I know, it’s beautiful. One of my science classes last semester was in the art building, so I’m an artist now.
The same kind of thing can happen with the toe touch. One thing that the toe touch offers that the other two do not is the sensation of the feet in the ground. Being able to hold a toe touch and breath is a progression in terms of complexity, but a regression in terms of how much strength one needs to perform the exercise correctly. Most lifter types need a little bit of external load to overcome to help them feel the positions that I want them to achieve. This is why I tend to dole out more all four belly lifts than the other two variations.
They all can be effective, but there are differences to consider.
The other day I got a question from a friend of mine:
“Hey man my hip flexor, mainly my psoas is tight. Need some advice on how to loosen up. Also I think my pubis symphysis is out of line to”
When I asked how he knew his psoas was the problem, he said:
“A. It hurts B. Watching videos of me standing up Oly lifts out of the hole show I don’t hit full hip extension”
I thought I would answer this question publicly because it’s a common misconception in the fitness industry.
This post will show you when stretching is a waste of your time and when stretching is bad for you. And even when you might want to incorporate it. Spoiler alert: it depends.
Logic Through Rationale A
Hurting in the hip region does not mean there’s a psoas problem. Many people would have what most describe as a “tight hip flexor” but don’t hurt in that region.
Also, this pain does not mean the psoas is causing the problem. The psoas could be (and likely is) an adaptation of a broader problem.
To figure out if the psoas is really stiff, many people will perform a Thomas Test. One leg is fixed up into flexion to secure the sacrum to the table, while the other is brought down into extension while maintaining 90 degrees of knee flexion. Straightening the knee allows me to differentiate between the rectus femoris and the psoas by shortening the rectus femoris, but not the psoas. If full hip extension is then achieved, the problem is a stiff rectus femoris, not a stiff psoas.
However, the commonly accepted results from the Thomas Test assume a neutral position of the pelvis. That is, they assume length-tension relationships that are like what you see in anatomy textbooks. This is hardly ever the case. I also need to know the position of your pelvis. For this, I’ll just use an Ober’s Test. If you can’t adduct in the Ober’s Test, then I know that half of the pelvis is tilted forward and externally rotated. I have a video of me performing these tests on Jess later in this post.
Logic Through Rationale B
When I asked him for a picture of what he meant by his second rationale, he sent me this:
What he’s showing me can be interpreted as both a hip extension limitation as well as a shoulder flexion limitation, though he’s specifically focusing on the hips. The issue is that people focus on the obvious symptoms, like limited hip extension or limited shoulder flexion. I did this for years and it was very helpful in forming my framework for movement dysfunction. I now, however, prefer to look at what is linking the hip and the shoulder: the core.
The middle of the body requires stability before the hips and shoulders can demonstrate mobility, strength, and power.
My friend does not have core stability because he always uses an extension pattern for stabilization. This is necessary under big weights, but too much steals range of motion elsewhere (in this case, at the hips and shoulders). You cannot get away with this extension stabilization in Olympic lifting to the same degree that you can in, say, powerlifting because more mobility is required. Those who stabilize in excessive extension lock up their mobile joints (hips, shoulders) and start asking for the immobile joints to provide the extra range of motion (back, SI joint).
This ties back into the Thomas Test scenario we were just talking about: I don’t get an accurate representation of your mobility if I don’t know what position you’re in. So the first thing we need to do determine your position.
Can you adduct and internally rotate your hips? These are my first two questions.
For shoulders, I want to know if you can internally rotate, flex, or horizontally abduct. I can also press on your rib cage to see how well it goes down (internal rib rotation). If I fix those ribs down with my hands, I can have you take a breath and see if you can breathe into the opposite side.
The body is naturally asymmetrical. To understand this, you first need to accept that the most important goal of our subconscious mind is to breathe. Without oxygen, the brain quickly dies.
So the position of the diaphragm is important because that muscle is our primary breathing muscle. With opposition from the abdominals, the diaphragm maintains a dome shape. It’s attachment sites become fixed and the muscle is able to pull on the bottom of the lungs, increasing their volume. This increase in lung volume creates a pressure gradient that pulls air into the lungs.
With a malpositioned diaphragm, breathing becomes harder. In an extension pattern, the diaphragm shortens, flattens out, and extends the spine. The extension of the spine drives the rib cage up, and this becomes the means for increasing lung volume.
One of the main components of the body’s asymmetry is in the diaphragm. The right half is larger than the left half. These asymmetries, coupled with the fact that breathing is the most important goal we have, make us prone to being on our right side.
So we like to position our larger right diaphragm because it can handle our breathing. We’ll use the left half for holding ourselves up. Subsequently, the right ribs go down easier, while the left ribs don’t go down very well at all.
If I have this side-to-side asymmetry present, I’ll expect limitations in:
L hip adduction, IR, and possibly extension
R shoulder IR
L shoulder flexion and horizontal abduction
All of these limitations assume there is normal bodily tissue length because the block is secondary to position of the fossa (shoulder or hip socket). These limitations can be on both sides, especially if I have someone who lifts heavy weights consistently.
For more on this, I highly recommend the Postural Restoration Institute (PRI), as they offer the most specific interpretation of test results that I’ve mentioned.
Once I find out if my client likes their right side or their back (or is neutral, but that’s unlikely upon a first evaluation), then I have a rationale for cleaning it up.
Interpreting the Thomas Test
If I have a client who likes using their back muscles, I hope to see limitations in hip extension on both sides. This is secondary to the position of the pelvis and its acetabulum.
If I have a client who really likes staying on their right side, I hope to see limitation in hip extension on the left side. Again, this is secondary to the position of the pelvis and its acetabulum.
I say “hope” because there is a bony block that works together with the anterior hip ligaments. If I have full hip extension, but poor position (i.e. I can’t adduct my hip), then these anterior hip ligaments have become compromised in order to achieve “fake” hip extension. We call this a “pathology”. Pathology is common, but makes it harder to reposition and make the repositioning stick. Sometimes the back of the hip capsule will tighten up as well to accommodate for the loose front side. My treatment strategy will be different for people with pathology because I need to prioritize getting them into the back of their left hip. Initially, I will focus more on facilitating left hip internal rotators than the right side external rotators.
This problem could be present on both sides, though it is less common.
What position was Jess in? Take a look at the following video:
Jess cannot adduct on either side, but he can extend on both sides. This means his anterior hip ligaments can’t do their job quite as well as they once could.
It is important to note that he may still have stiff hip flexors even though he has full hip extension. For this scenario, I need to facilitate the abdominals to provide a flexion torque that fixes the spine. This will lengthen the hip flexors, because they extend the spine. Only once I do that can I worry about making the hip flexors longer by extending the hip. This progression may not happen in one day.
Use abs to fix the spine (see “clean up the core” below)
Then learn how to extend the hip
Step one may take anywhere from five seconds to several weeks. Only after successfully accomplishing step one do I care about moving on to step two. I’ll give you some more exercises to fix this later in the post.
How to Clean Up the Core
First, we need to define the core. For me, this means anything directly attached to the spine. There are three main “rudders” that steer the body’s metaphorical ship: the sacrum, the sternum, and the sphenoid. This post will not discuss the sphenoid, but that doesn’t mean you shouldn’t learn about it.
What do I need to do to reposition the core?
Posteriorly rotate each half of the pelvis (maybe only the left side)
Internally rotate the ribs (maybe only the left side)
Even if I have to do this on both sides at first, like I do with Jess, the natural asymmetry of the body still underlies. So eventually, I will have to place more emphasis on that left side.
How do I reposition a front-to-back asymmetrical core?
Shut off paraspinal back muscles
Get abs on abs on abs on abs
Reeeaaaaaaach to get both serratus anterior muscles
The first exercise I tried with Jess is a mouthful: the Supine Hemi Extension with Alternating Respiratory Rectus Femoris and Sartorius. I usually just call this “The Hemi.” This exercise alone was enough to restore position of Jess’s pelvis.
Another great one exercise (also stolen from PRI) is the all four belly lift. Here’s a video I made that shows this exercise and its various progressions. Pick the level you can perform successfully to see maximum progress.
Push ups are a great supplement to add into your training program, but you have to make sure you reach your arms long through the ground at the top of the movement.
How do I reposition a side-to-side asymmetrical core?
Inhibit the muscles of right stance by facilitating the left biceps femoris, left ischiocondylar portion of adductor magnus, and right gluteus maximus. This brings my hips over to the left side.
Inhibit the right side muscles that pull my thorax into right stance by facilitating the right lower trapezius, right serratus anterior, right side external rib rotators, and left abdominals.
The purpose of repositioning is to inhibit the muscles that hold me on the right side. Facilitating muscles is secondary to inhibition.
My go-to exercise here is the 90-90 hip lift with balloon.
There are endless repositioning exercises, and I won’t always choose the one above. This post will not go into all possible derivations of repositioning.
Exercises to Inhibit the Hip Flexors
Remember the steps we talked about earlier:
Use abs to fix the spine
Then learn how to extend the hip
The Hemi (video above) uses reciprocal inhibition and the crossed extensor/withdrawal reflexes to shut off the hip flexors. If I give someone a different exercise for repositioning, I may add The Hemi in afterwards to further inhibit their hip flexors while reinforcing the correct position of the pelvis and rib cage.
The kettlebell pullover is another great exercise to learn how to fix the rib cage down and tilt the pelvis back. It is a core exercise, not a lat exercise.
Lastly, you can perform a standard hip flexor stretching in a half kneeling position using a stick or table to help facilitate the abs while actively roll your pelvis back (posterior pelvic tilt). Hip flexors stretches are constantly done incorrectly all around the world. We need to talk about why.
The Wrong Way to Lengthen the Hip Flexors
Many, MANY people all over the place will set up for a hip flexor stretch on one knee, then drive their hips way forward. They claim they are stretching their hip flexors.
I have bad news: they are not stretching their hip flexors. 10 degrees of hip extension is normal. Many of these people shove far beyond this range.
Where is this motion coming from?
Recall our talk on position. If you don’t have opposition from the abdominals, there is nothing to fix the spine. The hip flexor pulls the spine into extension. These people are getting “fake” hip extension that is actually back extension.
The pelvis is also out of position. Pop quiz, now’s your time to shine: What happens when the pelvis is out of position?
That’s right, hip extension is blocked by the acetabulum. So you’re forcing yourself into more “fake” hip extension. You’re stretching your anterior hip capsule, not your hip flexors. You are creating pathology. You are making yourself harder to fix.
Instead, use a stick or table like we just talked about to get into the right position and facilitate your abs.
I may want to stretch someone, but I can’t make that decision until I’ve fixed the position of the pelvis.
I need to make sure I’m making Jess better. To do this, I will use my tests and have him test out the movement in question. I did both of these before providing any intervention like The Hemi. Once I give him an exercise (the intervention), I will retest to see if it worked.
With Jess, The Hemi cleared up his Ober’s Test.
Then I will have him try his overhead lockout again and see if it feels better. I did just that, and here’s how it went.
That’s how I know I’m helping him and not just living in delusions.
From here, he’ll need to be consistent with his exercises (do The Hemi 1x/day if possible). If he does these exercises before he does his lifting, now he has access to motion that he previously could not access. Now he’ll need to learn to feel the new pattern during his lifts. As is always important with the Olympic lifts, he will need to refine his technique to get used to his new body.
Take Home Summary
I hope this helps tell you understand when to stretch your hip flexors and how to do it. Remember:
Test your movement in question and determine what position you’re in
Reposition your core
Left hamstrings, left ischiocondylar portion of adductor magnus, and right glute max
Shut off back, turn on abs, and reaaaaach
You’re already repositioned!
Only then do you worry about trying hip flexor stretches or other hip flexor inhibition techniques
Redo your tests
If repositioning worked, keep the exercise and move on
If it did not work, try something else
If you have questions about anything, leave them in the comments below.
FREE Bonus Complete with Outtakes
Want more? Here’s a video of the whole process. Sometimes it’s easier to understand when you’re there watching everything happen.
One of my goals for my non-athlete athletes (the teachers, moms, doctors) is neutrality.
But what does that even mean? What’s not neutral about me?
It’s reminds me of the intro in Van Halen’s “Hot For Teacher”. I don’t feel asymmetrical.
Asymmetry is Natural
Forgive the morbid visual, but if you cut yourself right down the middle and looked at your right and left insides, no part of your rational brain would think, “I’m a perfectly symmetrical human being.”
And what does that make you? That makes you and I part of the same Homo sapiens family. That’s it. Asymmetry isn’t weird, it’s normal. It’s necessary.
The biggest internal asymmetries that I like to point out to clients are the size of the thoracic diaphragm, the side of the liver, and side of the heart. These make us really good at standing on our right legs and breathing into our left chest wall.
And going back to Van Halen, most people I’m cuing won’t feel asymmetrical until I get them neutral. If you live a life on your right leg (hint: you do), you’d feel weird on your left leg, too! Remember the story I wrote about from that course a few weeks back?
The Origins Project
It’s impossible to say where or why or how this asymmetry has come about to be so prevalent, but I can make a guess (because that’s what the interwebz is so good for: speculation).
It makes sense to me that this asymmetry has come about from natural selection, just like, you know, everything else. The infamous Pat Davidson recently shared a quote with me that sheds some light on the topic from the point of view of a physicist.
“…right-handed DNA for all is the rule. Evolution plays an essential role in this. As only like spirals can link to make a double helix, there is no advantage if some of us had right and others left, or if we had a mix of both. It appears essential for effective procreation, that the half provided by the male matches that from the female, and the most efficient way is if they have only one and the same handedness. While this does not explain how and when the asymmetry in the amino acids of our DNA originated, evolutionary advantage aided by the vastness of time could be the cause.” -Frank Close, “Lucifer’s Legacy”, p. 76
If you think about the beginning of life on Earth, making two sets of DNA would, at best, halve the chances of life forming. So these all-right-sided DNAs had a huge advantage in making copies of themselves.
If I go any further on origins, I’ll be stepping out of my bounds of education, so let’s shift gears. What am I examining to see whether or not you’re neutral?
Well, as someone who works with bodies and weights, the best way I know how to attack the situation is through movement. Even though not every change is orthopedic, these changes are the most tangible to you and I.
So I do some tests. I look at the position of your lower body with an Adduction Drop Test. This will tell me a lot, but most specifically, it tells me the position of your pelvis. Can you adduct?
There are some other accessory lower body tests that I’ll do to confirm my findings because I mess up sometimes. Hip motion tells me a lot of things.
Then I do some tests to look at the position of your upper body. An Apical Expansion test is the first time I ask you to breathe for me. Can you exhale on the left side? Can you inhale on the right side?
Then I’ll confirm my findings, which I find is especially important for the Apical Expansion test because it’s hard to judge the results without tester bias. Shoulder motion tells me a lot of things.
I always look at the way your neck moves, too. This Cervical Axial Rotation test is important because your neck motion tells me a lot of things.
If I can get all of these tests cleared, you’re neutral. If you’re neutral, you can effectively move side to side. You can walk with two legs instead of a right leg and a left kickstand. You can aspire. You can create.
Based on the natural asymmetry I was talking about earlier, I’m able to make some test predictions. If all of these predictions prove correct, I would call you “classic”. A classic left AIC, right BC, right TMCC. A classic human.
Then I can give you an exercise or push on your ribs to help you get neutral.
After you get neutral (note the wording; I’m not doing it, you are), I give you some homework to make it stick. Neutrality isn’t a forever-defined state.
This reminds me of a tenured client I’ve worked with many times at IFAST. She got neutral months ago and was so proud of the progress she’s made. I imagine me watching this is what it feels like when parents see their child walk for the first time.
Then she got busy at work, started sleeping less, eating worse, not coming into the gym consistently, and getting neck problems. I was able to look at her one-on-one and found out that she’s not neutral anymore. What gives?
The state of your system is dependent on so many factors: what you see, what you hear, the exercises you’ve been doing, what has happened to you in the past, who’s around you… Any perception of threat steals your neutrality and puts you into survival mode. What happens for someone like our client in this case is she forgets what it feels like to be neutral. My job is now to remind her. But how?
For some people who aren’t too far locked into the normal, asymmetrical pattern, the task I give you might be to find your left heel a few times a day while you’re at work. This could be enough to remind your body that you have a left side that likes attention, too.
For most people, I’m going to give you some exercises to do at home and in the gym. You may have years of adaptations and compensations that we need to combat, and those tests I listed above tell me which of these we should focus on. And if you’re trying to get stronger and healthier, these exercises can help mitigate the negative effects of weight training.
Most commonly, I see a locked up pelvis on both sides because I see people who like to lift heavy things. If this is you, part of your program is going to be opening up the outlet of your pelvis. As I tell my anatomy students, this makes it so you can poop. Though this is hilarious to tell people in public, it’s not the only side-effect. Remember Bob Ross?
Then we’ll follow up with a lot of reaching activity. If the butt is closed off, so is the back. Active reaching helps make things stick better.
Then I might give you an exercise that reminds your body how to work as one whole system; an integration exercise. Moreover, I’d like this exercise to be done while standing, because you’ll be standing when you’re going about your daily life without me. I want to teach my baby birds to fly.
This pathway isn’t set in stone, it’s just a blueprint. Some people get different homework. Some people get the same homework for different reasons. Some people get the same homework for the same reasons.
That’s just a quick primer on neutrality. If you know someone at the White House, can you suggest to them that we make the first 24 hours of winter Neutrality Day? Neutral people welcome the winter because they have bodies that can deal with change.
Do you welcome winter?
Before you leave, do me a favor:
Send this article to the last person with whom you talked about neutrality.
If you haven’t yet, subscribe to my newsletter to get the information I don’t put on the blog.
And as always, comments and emails are always welcome.
Phoenix is seriously 40 degrees warmer than Indianapolis and seven thousand less percentage humidity, so I was immediately caught off guard. Though I didn’t have my physical therapist friends test me right away, I’m pretty sure the unpredictable environment would have stolen my neutrality, had any remained after four and a half hours on a plane.
I don’t get to put things in practice as much as most of the other attendees, so this overview is both for you to become aware of what the Postural Restoration Institute is doing, and for myself to cement the information.
I’ll give you some of the highlights of my notes in bullet form. Quotations will not be attributed to any one person to protect anonymity. You can assume I said the inappropriate things and that James said the intelligent things.
“PRI is neurology, but the mechanicoventilatory system is used to regulate neurology.”
This is a big deal. A lot of people think PRI’s system is just to strengthen some well-illustrated muscles. This couldn’t be further from the truth. The concept of neutrality is the centerpiece. This neutrality isn’t just a pelvis that is in the right position, but a brain that doesn’t perceive harmless stimuli as threatening. We can use these muscles, your shoes, your eyesight, and a million other things to get you neutral. My good friend and hotel-mate, Zac Cupples, gave me neutrality (albeit only for a short while) by softly saying, “Lance, just go neutral, bro.”
“Ron Hruska puts his hands on a joint – and he’s not thinking about that joint.”
That joint is the farthest thing from his mind. This ties into the previous quote. Neutrality is neurology, not biomechanics.
“Girl, that ganglia’s so hot.”
The new pickup line for women who are stuck in extension. James quickly illustrated this point to us by having my table neighbor, Maegan, stick her arms into some bands running vertically down a stretching cage. The bands represent the sympathetic trunk. Maegan’s arms represent closing of the posterior mediastinum from extension. An extended spine forces the vertebrae anteriorly, which compresses the contents of the posterior mediastinum.
A side note that I want to mention: this is why PRI is my crack addiction. James prioritized. He opened with the neurology talk and vividly has Maegan demonstrate to us the detriment of an extended posture. As someone who helps others learn anatomy, I admire the teaching ability of the presenters.
“Don’t fight the brain.”
This was something Mike Cantrell opened my eyes to last month at Postural Respiration. A big breath is worth nothing if it’s perceived as a threat, even if you’re doing a manual technique at the time. The purpose isn’t to get as much air in as possible. So if you see someone fighting through inhalation with their neck muscles, you need to stop that. Slow inhales. Let it come in – don’t make it come in. The same can be applied to putting weight on your right leg. You don’t need to only have your left leg down for PRI techniques to work.
“When I squat the way the strength coaches tell me to, I can’t get off my right quad?”
We discussed the bro mentality that more weight is always better. James suggested looking at the objective outcomes like 40-yard-dash time and vertical jump and seeing what actually improves those measures.
“How come I’m squatting heavy, but my vertical is going down?”
“Make a neurological wedding between the left heel and the floor.”
This alludes to the six reference centers they discuss. If your client can feel those, you’re doing things well. These reference centers are going to be useful when coaching exercises.
“I got Apollo Ohno right butt syndrome.”
Apollo Ohno has to turn left to be good. His right glute max is working well in the transverse plane instead of the general PEC patterned individual’s “sagittal plane only” right glute max.
“‘Trunk’ means above T8.”
This was something I had struggled with for a long time. Now the semantics make sense.
“The key to triplanar performance rests in a triplanar ZOA.”
The Zone of Apposition (ZOA) is not found unless it is found in all three planes. Thoracic abduction (a frontal plane translation), lateral flexion, rotary orientation, and extension all need to be taken care of. Abs are not a good thing if you have them without a triplanar ZOA. Use exhalation to get good abs.
“That’s my favorite weight belt called bilateral low trap.”
Picture the spine as a flagpole. Each low trap can prevent the flagpole from tipping over (in the frontal plane). A right arm reach can orient the spine back to the left. It can also get you a triplanar zone if you couple it with exhalation. Hold the reach. Inhale. Then you get right trunk rotation with filling of the right mediastinum. Right low trap is important to consider because it’s being lengthened from both ends (scapula protracts, IRs, anteriorly tilts while spinous process moves away).
“Serratus without low trap day at the gym? Stay home.”
The upper body musculature works together to intricately. Right upper trap opposes subclavius. Low trap is useless without serratus and vice versa.
Right serratus anterior acts as a sling on the side of the chest. When this contracts, it pushes the thorax to the left side. A movement called left thoracic abduction. The left low trap pulls the spine into left thoracic abduction at the same time to reinforce this movement. And this is only the frontal plane.
“Breathing is gait and gait is breathing.”
If you don’t use the mechanicoventilatory system as a tool, you’re making things hard on yourself.
“Left pec is a stupid muscle.”
Why is he trying so hard to get air in? Just get a left ZOA instead.
I love PRI. It is my addiction. See you at the next course! They’re coming to Indianapolis next year…
This may have further confused my search. What should I do with the rest of my life? Well, I don’t know, but I want to be able to get people neutral. What’s the best avenue for that?