Tuesday, May 26, 2009

Cause or Symptom?

Frequently (at least once a week), I get an email or private message asking a question like "I have pain in my XYZ when I squat. What should I do to correct that?"
If I was irresponsible, I'd just prescribe some extra form work and an arbitrary exercise or two and send them on their way. Although I'm pretty good at guessing what a cause(such as a mobility or strength deficiency) may be for a given symptom (like form breakdown), it requires time and observation, and sometimes an MD's expertise and resources, to be sure. In order to effectively deal with a symptom (in this case, pain in XYZ), we have to find the root cause and deal with it... quickly.

This doesn't mean that dealing with symptoms is not important however. Never listen to advice that starts out saying "WELL, THAT'S JUST A BAND-AID! DON'T WORRY ABOUT SYMPTOMS - YOU HAVE TO DEAL WITH THE ROOT CAUSE!". This is, of course, rubbish. That's like saying "Well, you have pneumonia, but we aren't going to treat your fever or poor lung function because those are just symptoms. We really need to get rid of the viral/bacterial infection FIRST."

Symptoms can kill you.

Over time, ignoring symptoms often creates a variety of referred pain and further symptoms that can both obscure and feed the original problem. Given enough time to ferment, it can be pretty hard to separate causes and symptoms, because untended symptoms can have very concrete consequences. What starts out as a breakdown in the chain, becomes a deeply rooted system feeding the problem.

So, what's the answer? Well, it's not easy, but aggressively tackling the symptoms with an eye toward correcting the underlying issues as we uncover them is a good place to start.

Take a look at this pic:

I don't know the gentleman in the green t-shirt, but his kettlebell swing form is pretty atrocious and it's a bad back waiting to happen. In fact, I'd be willing to bet his squat form is similar and the bad back has already happened. The lower back flexion is a SYMPTOM. The cause is, very likely, inattention to proper form, weak and inactive glutes and hamstrings, and tight and inflexible hip flexors and hamstrings. If I am right about the underlying causes, which would be pretty easy to check, you would start by working on his swing form while improving his posterior chain strength and flexibility. Simple... but not easy.


Steve Ruiz said...

This is why your posts are always at the top of my reading list. Thanks for being there! Your site continues to be a valuable resource for the strong and fit -- even for us strong and fit wannabes (but I'm gettin' there!).

BTW, where did you find that pic? It is the perfect illustration for your article!

Randy Hauer said...

We used to have a saying in RKC before CK-FMS and Z and all the trimmings..."the kettlebell will reveal where you are strong and where you are weak."

Your diagnosis of the green T swing is right on...that swing shows exactly where that body defaults to get onto "the path of least resistance". His body "is" stronger doing it that way...and that pattern is revealing of a whole host of other potential issues (like the squat as you point out).

Fix the weak links and the whole chain is stronger.

Randy Hauer said...

Actually, the saying was, "The kettlebell will reveal what needs to be fixed."
I hit "publish your comment" too quickly!

Boris said...

Thank you Steve. I can't remember where I found that pic, but I think I googled image search for "kettlebell swing" and it turned up.

I'm a Gray Cook fan and I think the movement screening trend we are seeing is a good thing, but when you've been in coaching and around athletics for a long time as we have (and I know that sounds conceited but it isn't meant to be), then you see compensations, deficiencies, contraindications, etc. pretty quickly using the movements you train for.

I like that saying and I'll use it!