Jared Powell:
Welcome to the shoulder physio podcast, a podcast dedicated to exploring meaningful topics in musculoskeletal healthcare. I'm your host, Jared Powell, before we begin, the primary purpose of this podcast is to educate and inform the views expressed in this podcast by myself and any guests are information only do not constitute professional advice and, uh, general in nature. If you act on the basis of any podcast episode, you should obtain specific advice from a qualified health professional before proceeding
Jared Powell:
Today's guests are Andrew Lock and Greg Lehman. A feature of the shoulder physio podcast is to host debates or conversations between people with seemingly opposing viewpoints on certain topics within the physiotherapy and sports medicine landscape, a contentious topic that sporadically rears its ugly head is that of lifting technique and its purported influence on low back pain or injury. So to cut through the Twitter arguments and often confusing recommendations in the literature, I've invited Andrew and Greg on to the podcast to discuss lifting technique in a P open and honest way to see if there is a happy middle ground for confused clinicians to stand. This conversation was originally recorded in September, 2021 for my YouTube show on the shoulders of giants. Before we get into the nitty gritty of the conversation and for your information for the first time in two years, I am running my one day shoulder workshop in Sydney and Melbourne in may and June, 2022. Tickets are limited to 30 participants at each event. The course offers a complete distillation of the evidence base for shoulder pain management equipping you with up to date, knowledge, techniques, and clinical reasoning skills that are clinically actionable. If this is something you are interested in, check the show notes for more information without any further delay. I bring to you my conversation with Andrew Locke and Greg Lehman. Here we are. We are live. I am joined today by Andrew Locke and Greg layman. Hi guys. Thanks for coming on the show.
Andrew Lock:
Great man. Good to see you.
Greg Lehman:
Thanks for having me.
Jared Powell:
No problem. So we've, we've managed to make this work. We're we're talking to Greg who is in Canada and Andrew, who is down in Melbourne and I'm up here in the beautiful gold coast. So let's get into the, the nitty gritty of the conversation. And so today, today, today we wanna talk about, um, the significance or lack thereof, perhaps depending on your viewpoint of lifting technique mechanics and the onset of low back pain or injury. And I just wanna give viewers a little bit of a background as to how we got here. So there has been some online chatter. There always is on this topic in, in recent months, especially the relevance of lumbar flexion, the dreaded lumbar flexion and lifting. So what I did was I surveyed my audience and I asked who they wanted to come on and talk about this polarizing subject and overwhelmingly you two gentlemen. We're the most common pick. So congratulations, eh,
Andrew Lock:
Naturally
Jared Powell:
before, before we immerse ourselves in this admittedly very nerdy conversation on a Tuesday morning or, or Monday evening, I want to introduce both guests. So Greg first and foremost is a chiro physio and strength and conditioning specialist out Canada. Greg has a reputation of being a critical thinker. I don't know what Greg thinks about that, but that's how I view Greg persistently challenging sometimes annoyingly, to be honest, cause sometimes you don't want new beliefs, challenged, uh, dogmatic, beliefs and assumptions in the musculoskeletal medicine sphere. Now, despite Greg's obvious positive contribution to the profession of his, you, I'm actually more impressed recently by his journey towards mastering the skateboard and you can follow his progress over on the socials. It's always good fun. So thanks Greg for coming on.
Greg Lehman:
Yeah.
Jared Powell:
Mastering. Exactly. Right. So, so Andrew is a physio out of Melbourne Australia. Andrew has post-grad qualifications investigating spine mechanic and also disc herniation. Andrew is also a credentialed, uh, McKenzie therapist, most impressively though. Andrew is the world master bench, press record holder. Andrew, talk to me about that. What's the number?
Andrew Lock:
Well, actually the number is 200 kilos, but I think the record I said was with 180 6, I said three national records all over that. We haven't had a national, I haven't had an international judge opportunity to take it higher. Let's see if we can make 2 25 this year. Huh?
Jared Powell:
Wow. That's very impressive. That's very, very impressive. How long have you been
Greg Lehman:
Dumbbell?
Andrew Lock:
Yes. Kilos. Yes. 25. Anyway. Very, very good. I told bill Kamar that I wanted to best press 500 pound. He just looked at me and said, why not 600? Why not these other giants? We walk amongst
Jared Powell:
Hundred percent. Hence the name of the show, shoulders of giants. You've you've hit the nail on the head already.
Andrew Lock:
Big shoulders. They are.
Jared Powell:
All right. So, so let's get into the, the talking points guys, and we're gonna get straight into it. But the first and I think is almost the most important here. So I want you both, and I'm gonna start with you Greg, to declare your position on this topic and also want you to tell me and tell the viewers how committed you are to your viewpoint. And are you open who would've thought to having your beliefs change? So, so Greg you go,
Greg Lehman:
So just to clarify, the, the topic is the onset or causation of low back pain.
Andrew Lock:
No.
Jared Powell:
And the relevance of lifting.
Andrew Lock:
No, it's not the onset of low back pain. It's lifting. It's a very different thing between pain and lifting is injury.
Jared Powell:
So there's difference between pain and injury. Okay. That's fine. We'll get, we'll get into that in a minute. Mm-hmm so I, I think we're gonna go lifting techniques slash mechanics and the onset of low back pain or injury. And you can just discuss answers around that
Greg Lehman:
Onset onset. All right. Yeah. I mean, my I'm certainly open to changing my view because done it through, uh, my career. I mean, I had a master's in spine biomechanics 20, uh, three years ago and I was certainly on the neutral spine train. And where was
Andrew Lock:
That? Where was that masters at
Greg Lehman:
Group is that university of Waterloo
Andrew Lock:
Right now? I was told it wasn't under biomechanics, under McGill that you actually did never did biomechanics directly under mcg guilt himself.
Greg Lehman:
I don't know what that means.
Andrew Lock:
Well, it means he never taught you biomechanics personally.
Greg Lehman:
I don't, say he taught, he taught a course called six 20. I went there for my masters.
Andrew Lock:
Your masters was on the, the spinal chiropractic manipulation and EMG placement.
Greg Lehman:
Yeah, it was also, yeah, I know, but you don't get a, you don't, you aren't, you aren't given a master's based on just what your, your thesis is. Hmm.
Andrew Lock:
It's just good to know that we clarify that you didn't do biomechanics directly under mcg guilt itself personally. That's something implied.
Greg Lehman:
I I never, no, I did my masters in biomechanics. I don't, I don't know what to
Andrew Lock:
That's good. It was just to just clarify. That was all
Greg Lehman:
No, if, if you, like, what you ever can do is you type in my name and my initials G and then you'll see what I've published in. I have.
Andrew Lock:
So, and that's what I saying, I know directly from, even though you say you've you were one of his students, but it was clear he's
Greg Lehman:
I didn't, I actually, she didn't say I was one of his students.
Andrew Lock:
That's what I say quite often. It's good to clarify, perhaps, cause it's a misprint termination about you.
Greg Lehman:
No, I, I didn't say it right now. I was there and he was my supervisor
Andrew Lock:
In that, in that masters. Correct?
Greg Lehman:
It wasn't that
Andrew Lock:
Mechanic, but it was not on the biomechanic your masters, the thesis you published was not on the mechanics of the spine. The masters you did was on chiropractic manipulation and the see of the muscle. That was not a mechanical study
Greg Lehman:
And spine kinematics.
Andrew Lock:
Okay. Within that study and know I've read it, it isn't in there. That's all about
Greg Lehman:
The, what isn't in there.
Andrew Lock:
It's only about the muscle response to the chiropractic manipulation. It doesn't measure
Greg Lehman:
Movement and, and, and we measure the kinematics. So I don't, I, I don't know what you're trying to say. Like
Andrew Lock:
It's interesting. Cause biomechanics is fairly specific and that topic itself was upon manipulation. A chiropractic manipulation.
Greg Lehman:
Yeah.
Andrew Lock:
And the EMG of the spinal muscular ship. That's not a biomechanical study in itself.
Greg Lehman:
Okay. Sure.
Jared Powell:
I mean, I think we're getting good luck. So
Andrew Lock:
Let's, we'll continue. We'll continue. So
Greg Lehman:
Like what the are you kidding me? You just said before that you wanted people to have a discussion and you wouldn't interrupt and then you immediately interrupt. And now I think you have this little gotcha thing. Oh, I dunno what your point is. I have a master's in biomechanics. I didn't say that's all it is. I have a master's in biomechanics. It's not the only thing that I published on at the time. We also did study looking at the EMG during different, uh, exercises and my, my master's thesis, which is not your masters of biomechanics, your thesis, which is one part of acquiring a master's degree. Just one part, right. Was in kinematics of the spine, which the, is the measure, the movement of the spine, as well as the electromyogram. It was thesis. I, I, I don't have, I, I don't even need to defend it cuz I could care less about manipulation, but I don't really know what your point is here.
Andrew Lock:
Continue on.
Greg Lehman:
It's so weird. Like what the are you doing?
Andrew Lock:
Jared Powell:
This is a fun stuff. Do, do,
Greg Lehman:
Do, do we wanna answer the question or not go
Andrew Lock:
For it? Continue on.
Greg Lehman:
I'm like good. Gosh. Did you go straight to an ad? Hominin
Andrew Lock:
Oh, no, not yet.
Greg Lehman:
no, I think you did. Okay.
Andrew Lock:
No,
Greg Lehman:
Actually go on. Tell, tell, tell us more about my masters from 23 years ago. What? I don't know. You're
Andrew Lock:
Entirely
Greg Lehman:
Had. Let's hear your point. You're
Andrew Lock:
Entirely correct. We'll leave it. Cause I shouldn't have interrupt. I shouldn't have interrupted you. So let's continue on just as you suggest and we'll leave other stuff at the end. That's absolutely correct, Greg and I apologize.
Greg Lehman:
Okay. Thank you.
Jared Powell:
Good. All right. So all right,
Greg Lehman:
Greg, what is the original original question? So
Jared Powell:
Your, your position on this, as we can see very touchy topic and also are you open to having your beliefs changed?
Greg Lehman:
Yeah, I, I absolutely am because 23 years ago, I don't know what I was doing at that time, but I did have a strongly, uh, different view. Uh, and I like to read the totality of the literature and it has my view changed, uh, through the years. I just don't really feel like anyone can hold very strong opinions on this topic. And if you actually look through sort of the history of this debate through a broad range of reading different people's views on pains and different biomechanists, you'll see that this debate has never been settled. So I've chosen one side of the fence where it comes to the first onset of low back pain. I don't think that technique is that important or at least the Quis that so many people have about technique, like worrying about keeping the spine in neutral or how much it's flex.
Greg Lehman:
I just don't think it's something that we really need to think about. And I hold that view with pretty much technique across the spectrum. It's the same thing in the running world. We get caught up on the knee caving in or a four foot strike versus a heel strike. And all of these things are just tiny little pebbles, which for the most part, they might be relevant at an individual level. But I don't think that we can and you don't even know until after someone's injured, you can't make any broad views or broad statements on a population level about the I D way for the spine to be in terms of spinal flexion when it comes to the onset of low back pain. So I have no real skin in the game. I have no problem changing my mind. I just would have trouble seeing it changing in tonight or in the next few months, unless we actually have better reassure research that has ever come out. And we, and to be honest, the research that's been done to date doesn't really address the question. Beautiful. It's just hard research to do. And so it, it, it could be done. So my, my position could change. That'd be fine by me.
Jared Powell:
Cool. Okay. So can I just summarize quickly? So you're open to having your belief exchanged. Absolutely. When, when confronted with the, with compelling research and your, your viewpoint right now would be that lifting technique for the lumbar spine and also across the body, maybe just one element in the causation of pain slash injury.
Greg Lehman:
I, I would, sorry. I, I would say just probably an element that doesn't even really matter when it comes to spine flex 90% flex versus 40 50, just you're worrying about the wrong things there.
Jared Powell:
Great. Andrew, what about you, mate?
Andrew Lock:
Oh, well look as the famous variety Piper once said, I've come here to chew bubble kick, and I'm all had a bubble gum today. So let's enjoy it. My key political viewpoint, it's one I challenge every day, every day, I test something with a patient at clinic that I just don't expect to change often say to a patient. I don't expect that to change, but I have to taste test it just in case it did. I test my beliefs every day. Also I've worked for over 25 years in rehabilitation and lifting my area. People I've worked with include dead Cohen, the greatest lift to have ever lived. Several one world records, 10 world championships, Brian Carroll who's lifted the heaviest weight by any human being 1,306 pounds. I work personally with the coach of the world's strongest man and holder. The biggest deal lifted history, 501 kilos.
Andrew Lock:
And I've personally competed in some of the biggest contests as you know, I've set records. Yet Greg seems to indicate that he has more science and authority on the lifting than most of us. And this is weird. Greg bounces in a trampoline in crimes, walls and skateboards. You know, you have a look at his most famous student, got heard deadlift 180 kilos. When you listen to us, look at the numbers that I've got behind me. And this is science facts about my approach. Lifting is clearly bounded by principles of physics and all branches of physiology, all the principles of the top coaches, every single Olympic athlete in any sport says there is a best technique fact. All biological tissue have fatigue and load capacity injury occurs when applied load exceeds failure tolerance injury during occupational and athletic endeavors occurs as a result of accumulated trauma produced by repeated low loads, sustained long duration, and usually a final precipitating event.
Andrew Lock:
Very few back injuries and lifting are a result of a single event. The usually a result of cumulative trauma that leads to accumulating injury can be defined from micro trauma all the way to complete tissue failure. I say injury is totally predictable. You don't adapt to technique. You get hurt in the technique. I mean, have a look at the me and deadlift injury. He did a set up challenge that involved repeated spinal flexion. Now that would've softened the ground substance between the collagen fibers of the Aus, that will set up a delamination of the Aus that produces a disc injury. When the end range flex segmentally and under load with a porn form deadlift, it's got nothing to do with his mental state that has everything to do with load frequency and form failure. I say it's entirely scientifically predictable. There are principles that we know and apply.
Andrew Lock:
There's not one club length in golf, not a single spike seat height. There's not one stride length in running. There's not one shoe size, but we'll fit the shoes to the foot. We'll fit the body to the ans. Now lift the principles of bios that we do apply. And there's more to it than that. There's also biological and physiological principles. We adjust everything to a cool tool. Kitter principles is neurological skill acquisition rehabilitation is teaching the skill to move efficiently and effectively. I can't say I wouldn't say Greg agrees with those that principles exist. There is not a best. He can't say, you know, there's not a best way to fit a correct golf club to a person or a racing bike to a person and lifting positions the same to imply that there's only one best lifting technique that you only mean one position and that's preposterous.
Andrew Lock:
That's a smoke stream that I actually heard from many pain science advocates. They seem to hide behind it. It's not a mature argument. It's not what anybody says or means. We say that there are a set of noble principles with variables that an educated professional can learn to use and produce a safe lifting technique or high performance, a nonspecific lifting technique. You could only come from a person who's incompetent, ignorant unskilled, or all of the above. There is only one best position is said by no one Sebastian. I coached the world's strongest man stated we can't ignore the laws of physics. When we lift, we are using our body levers to move load and to optimize strength. We wanna make those levers as efficient as possible. You know, put that on a t-shirt that's a fact naturally that means we have bodies that vary. We apply the principles to the individual.
Andrew Lock:
Strength is specific lifting a specific to task. We have so much evidence that there is best technique, and we want the proof it's called the Olympic games. It's called the world power championships. It's called the world's strongest man contest. Every athlete there is coached and all their coaches say that they work on best technique for each lifter. According to applied science based principles. If you find a study by non lifting professional upon a group of occupational lifters and think that that's proof otherwise, then you have to be delusional and maybe probably don't lift that often yourself, or you don't have an idea of real research quality as applied to the actual life situations. Remember the rule, if your research outcome conflicts, with the reality of solid science, then it's gonna be a research that has the era, not the science, basically the earth orbits the sun. And if your research says otherwise, it's probably just someone saying pain science, okay. Only a person who doesn't live or lives in a world of denial. And delusion would say that technique does not matter. There's my position. I'm open. As I say, I tested every day.
Jared Powell:
That's a comprehensive position. Uh, yeah,
Andrew Lock:
I live
Jared Powell:
Any comments to add there, mate. There's quite a lot. I imagine.
Greg Lehman:
I think we're confusing, uh, technique for performance with, uh,
Greg Lehman:
I think that we're confusing. Cause I didn't say technique is irrelevant when it comes to performance. And I think that there was a case made in there about technique for performance, which I wouldn't disagree with. What we don't have a lot of research on is the technique to minimize the risk of long term injury or pain. That's just where we are. And we can, we could discuss where the research comes, uh, to build the case for eye injuries occur. And that might be worthwhile. I just, there's just so many ad hominin in here just to say that if someone doesn't disagree with you, they're, they don't how to think, or they're not good scientists. That's, that's kind of a, a non-starter for me. I think that we can all recognize that we're different and we have different backgrounds and we can look at this same research and maybe come to different conclusions. That's what reasonable people are allowed to do here.
Jared Powell:
OK. So can we, can we get into the question? All right. So let's have a look at, is lifting technique important for preventing low back pain or injury. And you can talk about the difference between the two of you like Andrew. Um, and I, and I want you to sort of explain why, and perhaps give reference to some, to the empirical evidence base. So let's start with Andrew.
Andrew Lock:
Sure. Here's lifting technique important for preventing lower back injury, essentially. Cause I don't wanna, I don't wanna cross too topics. I wanna be very specific cause it's a specific situation. Look, is it important to cross the busy freeway or you put on a, you just put on a blindfold manifest, tore screen and say, Hey, I'm safe now because I was told the evidence says, I am, if you were, I'd say check your evidence techniques, a tale of two very specific cities. One is hip. The other is Lu spine control. I'll give you an example. I was contacted by JP price who held an all time world record, right? 2,364 pound in power lifting. He's one of only two people over squatted, a thousand pound of bench press 600 pounds. JP had a problem. He was debilitated by back pain. He hadn't been able to compete for two years.
Andrew Lock:
He's done a lot of professionals that he, he ended up having hip surgery. He couldn't lie down on the friction, be press without even having pain. Now I had JP send me a video and I saw his problem. I reckon within two seconds and I'm 15,000 kilometers away. Consider it. JP weighs a bit over 300 pound. And that means to walk out a thousand pound that's the single leg stands with 1300 pounds. Now, you know the idea, these are the people I've gotta work with. I've gotta be pretty good at this. I've gotta be very specific. JP lacked a a similar amount, a small amount of hip extension. As a result, he was loading himself into lumber, extension facet, joint loading unilaterally 1300 pounds after my product goals and work with addressing the situation JP after those time has now been fixed. 600 pound again is squatting heavy PainFREE is due to technique restoration.
Andrew Lock:
Part of that problem related to aro neuromuscular inhibition at the hip. That's an a Rine feedback mechanism issue. It all comes back to principle. Number one, all biological tissue has fatigue and load capacity. When capacity is outstripped by load, you are gonna get tissue injury. Let's look at some established facts and not conjecture on lower back loading people generally don't have back problems. They have back solutions. Their back is usually their strength, not their weakness. Lower back injury occurs when your best worker, your lower back finally fatigues due to making up for usually poor hip extensive talk. And that's commonly the straw that breaks the camels or perhaps the Meen back. You must clinically subcategorize lifting problems. You've gotta subcategorize you examine and subcategorize lifting the same way you examine and subcategorize low back disorders. You can find people who are extension intolerant, lifting flexion, intolerant, lifting, load intolerant, lifting.
Andrew Lock:
Non-specific lifting as the same as nonspecific lower back plane. It's clinically useless for us. You can only be successful subcategorize and then you can produce scientifically based clinical reasoning of Sullivan. McKenzie McGill, myself, numerous educated professionals have shown this less, make it clear. Spinal flexion is unavoidable. I love it will all love it. We use it all the time. Remember though, we're hard to gather as an industrial and technological society. We weren't born to live in this society with the body that we are currently using. Lifting is about the hip access. We often get obsessed with the back. As I said, vending forward is flex on the hip rotation. Access more than is, is the spinal flex movement. So if you are just thinking in terms of lumbar spine, there's no one you would get lost. There is central prevention to low back injury. Realistically is the evaluation in interrelationship of three important components.
Andrew Lock:
That is the minimization of external moments. That is the closer, the low to the access to rotation. The lower, the external moment down. That's gonna reduce spinal compression forces. That's physics. That's a fact not opinion. You wanna maximize the internal talk. That means you wanna maximize hip extension talk around hipster site access clans of paper, 1999. We'll start a lot of things. Glu heels has the greatest potential for creating high extensive talk has yet been disputed. We basically work with that. Now. Number three, you've gotta be able to balance sheer forces on the spine and spinal axial loading tolerance and McGill and others have shown that the spine that is not fully flexed ensures that the past unborn fibers provide a poster shear force on the superior vertebra. If you had to end range flexion, this is where your problem's gonna occur. You're gonna lose that.
Andrew Lock:
She of protection 80%, that will impose a load on the inter ligament, which is confirmed in the injury cascade by the recent limb study. And this in turn creates an anterior shear force that will be amplified by the TIFs. You've lost that sheer balance doesn't mean you any into that first time, as I said, it's accumulated micro trauma. We've looked at micro damage in terms of collagen lamination of the functional spinal unit before the actual detection of functional changes as go's 2015, poor loading form produces micro damage that becomes cumulative and leads to injury. The hip spine relationship is the imperative in listing contrary shows that the unin Stu subjects have a greater range of motion. The hip extension than those with low back problems year is 2002 show reduced. Hip extension range leads to reduced hip extension talk. Then Dylan, 2000 low back problems are correlated with significantly reduced hip extension range.
Andrew Lock:
Investigating the kinematics in kinetic. The deadlift said more skilled lifters produce greater hip extension force. Now this is why I believe in nonspecific lifting is an error poor hip extension talk does lead commonly to low back injury lifting and rehabilitation is specific as contextual to task it. Contextual frequency on loading lifting technique for the prevention of lower back injury requires hip extension extension access investigation. So is technique in lifting in rehab important? I'd say about a thousand papers would demonstrate that it is don't confuse pain with injury. In that discussion though, don't confuse studies on lifting with studies on tissue effects of lifting and posture. Outcome studies on lifting are usually terribly internally flawed, conducted by non lifting researchers with ineffective loads and usually quoted by non lifting individuals pushing an agenda. They're not studies that are consistent with the science of exercise performance or evidence of lifting success. As we've said at the higher, which I think is probably the best way to demonstrate the lifting technique truly is imperative. There's my approach.
Jared Powell:
Thanks Andrew. Greg, do you have anything dad? No,
Greg Lehman:
It's good. I think there's, uh, actually a lot of common ground in there. Mm. But again, uh, I, I didn't memorize all of it, but there's a few things again, what I did think that we were just talking about the spine, but what what's nice here that you mentioned about technique is you got away from thinking that spine is the most important thing. And you said it's the hips. And so what we often see is you'll often see people lift like, and they get into a position that allows them to get their hips into the best position so that they can produce the most force and they feel most comfortable there. And yet what I don't understand is when people focus on the spine here. So what, what Andrew's saying is I agree with get into the position where your hips are, where the primary mover can do most of the work and have the load closest to you.
Greg Lehman:
And often with some people, that's why you will see people lifting heavy loads over 700 pounds with a very flex spine, right? The fact like that's what I mean about quibbling over like 80 degrees of flexion or 50 degrees of flexion is silly. Like that's not really the variable that we should be focusing on. Right. And then, and then when we look at the spine kinematic research, we do see that people who lift heavy loads, right. Uh, do flex their spinal on. And we do have to be careful with using anecdote data here, which Andrew did, but it's fine because that's kind of all that we have because I can name people who lift very heavy loads and they don't really care about their spine posture. And they flex set a time. Right? You can see this with the barbell medicine guys. Right. You know, they, they, they flex a lot and they're not worried about that at the same time, there was an argument here.
Greg Lehman:
There's a bit of like a literature dump and the goer's paper. I know that one, that was again, a cadaver paper, which I don't think we throw out. But remember that one, he also compared neutral zone flex with three times neutral zone flex. And there was 124 motor units they studied and there was 24 injuries in those. And there wasn't that much of a difference between going to neutral zone and to three times the neutral zone. So we kind of see that. And then you mentioned this idea of year, which is, which is interesting. And, and this might be what you were angling at with, with the McGill reference to my masters. I did not use Stu McGill's, um, spine model. It's an incredibly impressive, it's an incredible biomechanical feat. And that was not part of any of the training that I've had. That's why I talked to people who have used it and who are familiar with other ones.
Greg Lehman:
And so what we see when people compare different spine models, although the McGill model shows that L four L five, if you are flexed about a hundred percent of your max versus being flexed, 80% of your max, cuz that you're referring to the pot vent paper here, they, you will see more anterior, anterior. She that's at L four L five other research groups. If we're gonna stay in the bio mechanical world here, when they measure sheer at L five S one, the STO posture has less shear. And now the most recent paper that I know of, and you might love this. It's a, it's the co Cho one, you know, this, this paper, it just came out. But Shazi has been doing this research for 30 years. They suggest that there is less, she again at both L four L five and L five S one.
Greg Lehman:
And if we're just talking about loads that there's less disk shear when the spine is more tic versus more lordotic. So this is the difficulty here. When we make like strong conclusions based on these biomechanical models is that these BioGene biomechanists are disagreeing. So if we think I like the concept of, oh, if you load it too much, that tissue will fail. That's a principle. Okay. That's interesting. But then the debate right now is, well, where is there more load? And so you're having these biomechanists disagree. So then we have to go to, to research where they actually follow people, you know, for years in their lifting to see the onset of pain and we don't have that stuff. And so what Andrew said, which I liked was he was doing to modification. Someone came in their back, was in pain. He realized that they couldn't extend well at their hips or they didn't move their hips a certain way.
Greg Lehman:
Aha. You need to move differently. I'll keep you lifting with this other option of lifting. I love that stuff. That's that's reasonable symptom modification and I, I, I do the same, so that that's great. I mean, that's not fancy rehab. Maybe the motor control training is fancy, but the concept of, oh, Hey, it hurts the flex. Maybe don't flex flex as much. Oh, Hey. It hurts to extend. We don't extend so much. I know you lay when I simplify, but so the, the principles are kind of simple and easier here, but I will respect that there's difficulty and skill in teaching. Someone's been lifting their whole life to lift, uh, uh, differently. So that's my rebuttal. I dunno where we're with
Andrew Lock:
That. We're, we're both on the same page, I think in many parts.
Jared Powell:
So something I wanna just clarify, uh, Andrew, what, what, so what's your opinion on lumbar flex, you talked a fair bit about hip extension and hip firing. What, so what do you think about lumbar flex as a risk? The, for lifting injury?
Andrew Lock:
I don't have a problem with lift with spinal flexion. We've gotta use it. We live with it. We walk with it. We tie our shoes that, um, it's about, it's about the basically creating the perfect set of principles that I've yet to see somebody who hits and range spinal flexion. And I'll say, I, I actually say the lift is a perfect example of it. That was end range spinal flexion. OK. That that's fine. Was humping like a dog humping a cricket ball. It was seriously just a freaking new shape that was end range, spinal flexion under load. As I said, it wasn't just that, that did it. But you've got all the proceeding situation. The setup worked that, as I said, it's going to work on your flexion tolerance. I have yet to see a world champion who would hit end range flexion. Flexion's fine.
Andrew Lock:
In fact, I like to use it because I think there's a lot of science behind how to use Lu spine inflection go there. This just takes a lot of skill to identify where a person can be safe. And we're not gonna probably start our beginners there because we might just get them working with understanding, lifting. We might transition as they become more elite. If we can find something better, but we've gotta earn the right to move the position. And as I say, with the best coaches, we try and start with the most obvious positions that work with that client. It's very rarely. In fact, I've never seen it, that anyone's gonna start their lifting career under a coach in end range, spinal flexion and lifting. But we don't say, you gotta stay stuck in law doses. We don't say you can only be in neutral. I think there's a lot of value when you look at a person setting. Totally no issue spinal. Selection's a beautiful thing. How else do you think the lifting up an Atlas stone is gonna be achieved? You gotta get your spine around that thing. Essentially. It's probably spinal movement under low. That we'll talk about. Cool
Greg Lehman:
Greg again. So I've, I've heard that argument that, so I, I don't know about Adam's, uh, case in particular. Uh, I do think it would be nice to look at a lot of li like I talked to Tyson beach about, uh, doing this. I dunno if you know Tyson, he worked, he did his PhD with Jack Han. You mentioned Jack. And he is a great biomechanist in there. This area. He's the one that's looked at the ability to change spinal flexion under load in a, in a few studies. And I know he would love to look at some heavy lifters. I'm just not sure that people actually, when they're lifting their max weight are really flexing in the deadlift, not the ATLA stone. Like it it'd be great to have a document of how much people really are lifting in the deadlift. Cause it's definitely more than people think it is. That's that's finally being recognized these past few years. They're definitely not staying in neutral, although it's very hard to say what the hell neutral is. you can do it with like a, you know, if you take the bones out of the body, uh, but it's hard to say it does seem like people are lifting and deadlifting even when they look, it looks like they're in neutral and there at like 70 to 80% of max,
Andrew Lock:
No doubt
Greg Lehman:
At all. What's that? No
Andrew Lock:
Doubt at
Greg Lehman:
All. Yeah. And so I do know that McGill's model, the model would be most concerned with that anterior shear that you mentioned around 80% Tyson. And I was TA talking about this and he went back and read the model. he's like it's 80%. That's where the ligaments sort of kick in. That's where they get out of their, um, you know, the tow region and going the elastic region there. So, so that's interesting that maybe the, the message through the years has kind of changed. It's not about staying in neutral. It's about not going to 80%. And then the irony of that, if you know Patricia Dolan at all, she wrote a paper 98 saying you can't stay in neutral. And I, I emailed her a few years ago. She's like, I'm only worried about 85% max collection, as soon as you get more than that.
Greg Lehman:
And so that's the thing with, I mentioned that Cade Corani and I'm open to this is they had people going to max kyphosis. I don't know if that's max flexion well, so he said, there's not, and he wasn't lifting a lot of weight. I'll give you that. So maybe they do more, but this is what I mean, like we shouldn't have strong opinions here on this topic. This is not well researched enough. Especially with something like a, like deadlifting you just don't have the data to say how much people are flexing and then where the loads are really going.
Andrew Lock:
We better have strong opinions on it, or else you gonna end up with an absolute highway, fully crashed lifters, then
Greg Lehman:
These well here's the thing like, well, your, your athlete that you mentioned JB, the other argument is like, why are we sparing the spine? Are we sparing the spine at the cost of the hip? If that guy had hip surgery, maybe he's should have been lifting with more flexion his whole life. And he wouldn't have got a hip injury or a hip replacement or whatever he had. Like, that's, that's the irony of this stuff. Like the movement has to come somewhere. Well. So like, we, we, I, I just, it see, I just think it almost boils down anecdote here. Cause you're a lifter who thinks, oh, I shouldn't lift, bend my spine completely all the way. And then some other people are like, I don't worry about my spine. It bends a lot. Who cares? I'm safe. As long as I progressively do it.
Andrew Lock:
Well, it's pretty much as I clearly started is low, specific, frequently specific. You can run, you can go to lift 16 kilos in end range, flex probably quite safely. But how many people do you know who end up saying a, I just been able to pick up my sock. There's a whole bunch of lifestyle factors there that are important as well. And the frost 2015 paper, which we can discuss also demonstrates that movement performance,
Greg Lehman:
The FMS one,
Andrew Lock:
The, the one at the Pensacola fighters.
Greg Lehman:
Yeah. It was had a change movement, quality
Andrew Lock:
Exercise based enhancement and injury prevention for firefighters.
Greg Lehman:
Yeah, but they didn't measure injury,
Andrew Lock:
No injury parameters or injury markets. Yes.
Greg Lehman:
Well, the there's potential surrogates, but they haven't been quantitatively linked with.
Andrew Lock:
And what it show is show the coaching and understanding of movement transfers to outside the gym. Yeah. And that's the point of saying, yeah, if you don't address the lifestyle factors and a person comes in with end range flexion, perhaps there's a big chance and there is a big, physical is straightforward. It's gonna be under the laws of physics, biology, and physiology. We know discs creep. We know that exists. So a person sitting at the desk in posterior pelvic tilt all day the size to come in to the gym and go pick up you 16 kilo kettle bell. Well, it's a hit end range flex. And they've had already posterior disc discrete. The mechanism could already be there for that final straw to break. That's why we are probably wise in how we address it.
Greg Lehman:
Yeah. I know. There's just a lot of assumptions there. They, it, it's still based on, even if we stay in the bio biomechanical world, the assumption there is that there's more, uh, load on the disc with that peak flexion and not every biomechanical paper, not every biomechanical biomechanical paper is agreeing with that.
Andrew Lock:
Look at, look at Nason then saying of course we decrease the highs, static pressure by loading the FESA joints. Don't we, we know that decreases the pressure. Yeah. So what's the other end of it.
Greg Lehman:
No, no. Look at I'm telling, look at the co Corani paper, they measured interal pressure. The, the influence of lordosis and OSIS was, was negligible Worked also supported that more than 20 years ago. So this is the thing, like if you take a broader view, like, and read a lot of different people like this debate has not been resolved. People have been saying different things through the years, right? If we take this really broad view here, like it's not unreasonable to have a different opinion,
Andrew Lock:
Unreasonable have a different opinion, but an opinion can be wrong. Just head question three anyways, into the next part. Cause we're heading there. We don't get too lost.
Jared Powell:
Okay. So let's go to all right. So this one's for this one's for Greg let's, let's give Greg a, a moment in the sun here. So just technique or biomechanics have any role in the onset of low back pain and maybe quantify as best you can, perhaps the percentage, I don't know, it's not a linear thing like that, but how much time would you spend on a lifter looking at their technique, perhaps, um, your instead of low back pain or injury,
Greg Lehman:
Honestly, like I, if I think what's important is I think that we're focusing on the wrong areas when we just focus, focus on spine flexion. Right? So, so I'm, I'm comfort. What I would advocate is that people get into a position where they feel strongest, where they feel, I most under control where they're not, if they start to squat or deadlift, they're not gonna like, uh, like lung to the side or lose their balance. Cause I'll totally agree that technique matters if you're squatting and someone jumps on your back, yeah. There's gonna be a biomechanical overload. But I, I, I think once you get into a good position where you feel comfortable and you train smart, you can adapt to that. I mean, if you're training the deadlift with the squat through a week, how many max, like greater than 80% deadlifts, are you doing, you know, 20, like in terms of total reps with all the, you know, three to five minutes recovery between sets and each set is just what, like two to four reps.
Greg Lehman:
And it's just such a low, like low number of things here. So I, that question there is the same one that we started with. I'm not sure how it's any, any different, I, I will answer another question. cause when you already talk about this one, but when it comes to pain, right? I am, I do think that learning how to change technique and having lots of different options, which sometimes is less flexion, but sometimes it's more flexion sometimes it's, you know, probably more hip and training the hips. That's the seems really reasonable to me. So like, I still think there's utility in biomechanics. It's just really hard to say, like that technique is gonna be trouble as long as you're not like jerking the weight, but in your slowly doing it over time and building up a tolerance through the years, I've really have trouble looking at someone saying, oh no, your lumbar spine is X 90 degrees.
Greg Lehman:
We need to get it down to 78 degrees or sorry, 90% of max. We need to get it down to 78% of max. It just doesn't make sense. And then the whole idea of, I know people will say, oh, it's not, it's not deflection. That's bad or sorry, it's not deflection moment. That's bad. You just can't reextend once you're flexed, right. People say you lock it into flex. Well, that's an hypothesis that isn't really that well supported. When you look at the kinematic data, you know, in general, uh, you, when you start the lift on the floor, yes. The first 15 to 20% hits the hips. But after that, under high loads, your spine is moving. It's not staying flexed until the end. So I've never really understood that idea. Like it's moving, there's nothing wrong with the spine moving as well. Cuz it is. That would be a nice study though. How well you could change that maybe that'll help for symptom modification, but I don't get that one. Andrew just touched on that. So I thought I'd throw that out there.
Jared Powell:
Cool. Uh, I'll just quickly ask another question, Greg. So, so what about if somebody comes in with a, and I think I know your answer here, but I want to hear you say it. If somebody comes in with low back pain, it was sustained during a deadly maneuver or movement and they're a little bit sensitive into flex. How would you sort of go about, uh, rehabilitating that particular person or helping them on their rehabilitate, uh, rehabilitation pathway? Would you look at flex and their technique once they're less sensitive, would you avoid it for a period of time? Would you expose them to it? I know. Depends on the person, etc. Yeah.
Greg Lehman:
Yeah, no, it's, it's honestly, that's actually the, uh, crux of like every rehab encounter. That's the exposed versus, uh, protect debate. And it's always the challenge that you have. I think when you, and I do wonder, wonder, sometimes we have these big debates between big names in the field, if they're seeing different type of people, you know? So I often see, I think avoidance copers, they're not moving their spine at all. They're afraid to move. So of course we're going to do some exposure, but sometimes, or more often when I work with athletes, their endurance copers and they keep doing the same thing over and over again that aggravates them. So, you know, calm down, build it back up is the mantra there. That's where changing kinematics, but more looking at total stressors on the person is helpful as well. You've gotta calm things down and probably do less and build back up.
Greg Lehman:
And here, this is, this might be ironic for you guys. Uh but when I do teach someone to deadlift, I actually kind of recommends sometimes someone being more neutral and answering you guys are like, what are you talking about? So listen, because of what it goes back to Andrew said, because , but it has nothing to do with my worry about the Lumber's fine. It's because that person's like a runner or they're a short stop or a soccer player. And that's the position that they get in when they're playing their sport. Right. Or because I would think if they're a runner, we just want them to work their butt muscles more on their hamstrings more. Right. It's a better stimulus for the other area of the body.
Jared Powell:
yeah. So you use that as a way to, to help you in your own. Yeah.
Greg Lehman:
So same thing with someone with pain to be like here, you, you feel a lot better when you lift with less flexion. You wanna keep training. Yeah. Okay. Let's do that for a bit. But when I deadlift, uh, massive loads, Andrew would free. I feel a little bit better with a more relaxed and less flex spine. It's only flexed about 75%. I can force my spine to be flex about 62% of its max, but I feel comfortable at 75 and it feels better for my beautiful butt
Jared Powell:
It's cause you got weak gluts here. All right, Andrew, what do you think, mate?
Andrew Lock:
I love what Greg said there, because Greg indicated quite clearly he subcategorize and he makes things specific to the person. Yeah, that's what I always say. We do. That's why I don't like nonspecific low backbone. Cuz Greg just said the same sort of thing. If it's a problem with that position, I make a specific change. And absolutely I think that in the regard, by case injury and that's where I like the frost paper 2015, it shows that coach and understanding movement. It transfers outside to the functional life in the gym and that's important. The outside part is it's probably more important than the inside part technique transfer and daily life. It's the imperative to minimize the accumulated poor movement patterns. I like the Oka Guild 2012 on the implications of movement, posture, stiffness stability in regard to daily biomechanical loading, good implications there. Now Nason in 83 study.
Andrew Lock:
Clearly we certainly all agree that motion ment instability exists as a clinical problem. Biome biology is a mistress who keeps score and you've gotta pay a once again. Biological facts, not statistical analysis of poor studies emerging doing that, sit up, challenge, spinal flexion, loading under the deadlift and thinking you're exempt from biology. Of course you're gonna get injured. If you injure a passive structure for a rehab situation, as such as a disc, the effect can actually be permanent. If it's not addressed through specific rehab technique, biome, biome mechanical means and understand that loud and clear unless you know how to rehab the effects of lie back injury. It can have a permanent dysfunction on your client and that's not in their heads or how they think strength is a skill and skill comes from practice. Perfect practice produces perfect skill. It can transfer outside the gym to daily living to say, there's no principles.
Andrew Lock:
Just do it. How you like, let's see how it goes. Let's apply out the hang gliding. Let's see how long you live. So trying say there's no best way to lift. Well, let's find how long it takes you to get hurt. Physics governs us all. It governs biological tissue loading. And by that extent, lifting as well. It governs everything. No matter how you speak to your patient physics doesn't care. Now let's look at the spine who did the hip basically let's look at three postures. A tic posture position will load the facets and unload the I convertible joint. JP a neutral position will unload the facets and entirely lows. The I divertable joint. The injury you may observe here would be an inflate fracture and we'll discuss that end range. Flexion physician does load the disc anteriorly. It's consistent with a common disc injury mechanism.
Andrew Lock:
Biomechanical injury is not random. It's observable, accessible and predictable. I think that's really important thing is knowing that you can predict injury by knowing these things. If the posture is near end range, segmental, flex and segmental con control flex occurs, then the passive disc is exposed to load. There's a wonderful should here and McGill injury under fluoroscopy. That's always worth looking at understand. Disc mechanics are clear. They well studied and there's mountains of published evidence. That's why it's absurd. Tell a and with a chronic low back problem that they are safe and pretend perhaps to their problem might be behavioral. If you don't restore normal function in rehab, they're probably still likely to have a movement disorder. Now, scandal Andre. Other one showed a reversal of disc prolapse with repeated flu extension, which is consistent with multiple. If not countless studies on dis behavior, Oldman, Sant, Donaldson, all very consistent and IBR disc will bulge and it will be driven in the opposite direction to bending its movement with load.
Andrew Lock:
At the end of the story, that's physics. It's a fact and it's been published multiple times. We INE mental stability of that passive system. That disc, for example, gets injured. Then a neuromuscular system has to be able to take over the dynamic control of the Lubar spine. You need to know how to do that. You have be educated to do it. It's specific. It's not random muscle contractions produce stabilizing load comfort and modern 2001 stability dysfunction is diagnosed is by site and direction that relates to symptomatic pathology. Global muscle retraining is required to correct directional dysfunction. I love our Sullivan back in these times too, he was supporting Punjabis neutral zone hypothesis. I love his thoughts there. It was specific trainings, also consistent with the assertions that motor learning and control are not simply a process of strength training, but it does depend on patterning and inhibition of motion neurons.
Andrew Lock:
It is the acquisition of skills of carrying through a selective inhibition of unnecessary muscular activity, as well as the activation of additional motor units. This is consistent with all the world's best coaches. I like me girls's work. I love Cho wikis, which work but major eant there's heaps. It's essential to re force motor programming and rehab. You've gotta reinforce motor programming, such that the desired patterns will occur. Naturally. You need to learn to move in the best pet pattern for that body. It's not automatic on return after injury. You got a lot on that. Dysfunction poster. Disc injury is absolutely predictable. And did you know you can actually predict dysfunction from knee. Remember, I didn't say pain dysfunction a couple of times.
Jared Powell:
Tell me what dysfunction is before you. You get into that before we avoid get into the nuances
Andrew Lock:
Altered normal movements, best way to say so it's not moving as it would've pre-injury.
Jared Powell:
How do you
Andrew Lock:
Measure that? How do we measure it? Well, perhaps it has been best said coming out fairly sooner regard to some of the work I'll go with. But once again, if we looked at a person who had becoming injured and often see, would see that in a clinic where they would tend to be moving from their back, when that's the thing that's getting hurt and you you've lost their hip extension control. So maybe AST neuromuscular inhibits happened around that shift. So as a result, they're actually, and this is we would take hours now, cause I would actually have to take you out clinically how I would work with the patient in this regard. So measuring it's actually very, very much what I would do in a clinic. I would look, and this is very experience comes in is clinically I'm in their everyday. I see people move it.
Andrew Lock:
And this is where I'll going to. That's why clinicians are like great hunters, good hunters. Don't need to see the animal. They can smell the air. They can see fur on the ground. They can see tracks in the snow and they can tell you what the animal is. Now. A poor hunter becomes a vegetarian. A good clinician is like a good, we know what the problem is because we know how all those behaviors exist, looking at nuts. And there's so many situations here, which you would clinically look at it yourself, Jared. I know. And you would see a person and you would be able to with experience, know what perhaps is behind it. It guy called Gladwell wrote a book called blink, which is about how expertise can pick up things before you're consciously aware of them. And that's clinically of course, where I am now.
Andrew Lock:
I just look at the studies there, like a good hunter. I can look at all the evidence. So, you know, I think we'll go into Richardson, highs, things like that, where we know that inhibitions because of malt atrophy. Well, that means it's not the same way you get atrophy of blue tails. For example, you won't get the same talk hip talk. So it's really what you're looking at. You're a clinician and you're a good hunter. If you look at nuts in, in 44, for example, way back proposed an instability diagnosis from flex extension radiography, Soderberg and bar, back in 83, they showed that control in the Lu region was significantly lower in patients with chronic low back disorders when compared to normal. So we know it's there. We don't actually have to see the creature to have to measure it. We can know the evidence Soho in 97, patients with chronic low back disorders had disturbed joint motion and abnormal EMG, regardless of how you speak to them. Now, Richardson in 90 proposed neutral zone decreases with muscular activity. So we're talking about neutral zone control here. You've got an injury, you'll have increased neutral zone perhaps at the disc. So it's clear that you have to know how to address these things in the clinic. Now often I would use anti to improve SA plane transfers, plane applications, technique really matters in rehab. And that's super important. So when Greg says, Hey, you know, just if you fail a load, just load it more and they're gonna adapt to it. That's pretty preposterous. It Cohen.
Greg Lehman:
So what, I'm sorry, when did I say that?
Andrew Lock:
Oh, actually it's on quite a few of your, um, YouTube videos. Um, load it more and they will adapt. You have said that. Do you deny actually saying load it more and they will
Greg Lehman:
Adapt? No it and it's context specific. Yeah. So sometimes when you're not loading something and you need to stimulus to adapt, you need to stimulate yourself.
Andrew Lock:
Well, perhaps you need to put the context into those things. Cause it wasn't very
Greg Lehman:
Clear. I certainly do. I would listen to all of them
Andrew Lock:
Because yeah, load adapt. That's pretty dangerous. So you would agree. So you agree that if with an injury you are going change that because that
Greg Lehman:
If someone comes with a hamstring tear, I'm gonna load it. It's gonna adapt
Andrew Lock:
Follow back problem in lifting.
Greg Lehman:
It depends
Andrew Lock:
Good to hear. You're making things specific. We have to pull things apart. Nothing's not
Greg Lehman:
Specific. It's not a specific diagnosis to say it hurts when they flex. It's not a diagnosis.
Andrew Lock:
Uh, who said it was a diagnosis is a clinical reasoning pattern.
Greg Lehman:
The point of nonspecific low back pain is saying that you have no idea where the source of ception is
Andrew Lock:
How
Greg Lehman:
It hurts when you flex doesn't mean that you can make an, uh, a decision about where the tissue is damaged
Andrew Lock:
Well said. And how useful is adding clinical reasoning.
Greg Lehman:
It's not the research. What I'm saying is like to, to denigrate people for using the term nonspecific low back pain. That is, there's an issue with that.
Andrew Lock:
Well, what's the issue that doesn't help us clinic. If it doesn't help us clinically, what's the use of it.
Greg Lehman:
That's what I'm saying. You don't need to have this a tissue specific diagnosis.
Andrew Lock:
Good. Why do people use it then?
Greg Lehman:
Why do people use, why
Andrew Lock:
Nonspecific lower back pain?
Greg Lehman:
Because they're being academically honest. That's what they mean by it. When you say something is nonspecific, it doesn't mean that you can't have an opinion of what the contributors to that pain is.
Andrew Lock:
Oh, so you, you
Greg Lehman:
Could say you're training too hard. You're not recovering. You need to work on your sleep, a ton of stress in your life. And you're coping with your life stress by over training. And then the thing that aggravates you, you keep doing in the weight room, but can I tell you what tissue is? No.
Andrew Lock:
So, as we said, it's clinically useless. And do you ever use it in your lectures to indicate any situation where you would say exercise has demonstrated a poor outcome? Would you ever use a study, which has said not a specific, lower back pain study of such and such exercise in the case that there's no application?
Greg Lehman:
Uh, when I talk about exercise and low back pain, I'm incredibly cautious to say how great or how poor it is. Uh, and, and because again, like we're on a different topic here, and this is the idea. If you tailor your exercise to pro your program to someone that your results will be superior.
Andrew Lock:
Great. That's how you,
Greg Lehman:
No, no, I don't agree with that. This is what's surprising. It's surprising how often that doesn't work. And you could look at the research of Paul Marshall and Mitchell Gibbs, who looked at tailoring a spine stability program to someone versus a general progressive overload program. And there wasn't any difference. You mentioned the Linda van, Dylan paper. She has one, she did the same thing a few years ago where there's no difference, but she has one out. Now that's more recent where the one was a difference. So that's kind of interesting. I mean, there there's, there's so many assumptions in here. You, you mentioned Joan Scandal's paper, where with repeated extension, the disc will migrate anteriorly. What about the bulk of it? Paper outta the same lab, where with inflection was followed by extension. It led to more damage in the disc. So we gotta be careful with just cherry picking our papers here, you know, like there's again.
Greg Lehman:
And I I'm, I'm gonna guess when you make an assumption, you like you keep saying you have these principles as if you know where there's more load on the spine, right? It there's no principles here. That's where the debate is in the biomechanical world. They can't agree where there's more load, like read the Shirai ad labs papers. They're disagreeing, read Peter Conan's work, read King's work. Not everyone's agreeing that there's more stress on the disc when there's more flexion. I mean, that, that's what Patricia Dolan said. But again, like I said, the Shirai ad lab is not saying that there's more, interal actually inter pressure. So I, I, I don't get how people can be. So certain you say that you understand principles here, but you are ignoring such a massive body of research that disagrees with how you apply those principles.
Andrew Lock:
Well, Greg, it's funny, you ran away from something very interesting that just,
Greg Lehman:
Oh, I ran away. Please tell me what I ran away from. Well,
Andrew Lock:
You just said that you don't tailor things to the client
Greg Lehman:
That I did not say that. All right. So I told you a research paper that didn't tailor it.
Andrew Lock:
No, what a sec. It was very interesting because you were, you actually ran away from a very interesting thing where you were heading to saying that you don't change people. And yet previously you said, if a person had pain, that position, I would change them. And that was going to the clinical application. And that's where we were. And you kept going away in clinical applications. So you said you do specifically change individual characteristics
Greg Lehman:
Of an, I might specifically change in some people. Hmm. So like, I'll give you a running example. Uh, sometimes we might, in the short term, have people take shorter strides when they're running, if their knee feels better. But I would not say that that has to be done forever in the future. And the same thing with when someone has low back pain, they might benefit from not flexing their back and being in a more neutral posture for a few weeks. But I wouldn't say that they have to avoid that forever. And I mean, Mackenzie did that. Like, you have a wonderful background there because everyone misrepresent Mackenzie and says he just does directional preference to extension and then never goes back deflection. Like, I think that's horrible that people do that. You must like, you must know that more than me, but it's the same idea. It's a temporary modification. I don't think people have to do it forever.
Andrew Lock:
Well, that's
Greg Lehman:
Beautiful. Thanks for letting me clarify.
Andrew Lock:
We're coming to a really good point. There is what we do is we are actually taping the patient as an individual, and we're listening to specifics about each individual patient. And that's where I was coming with the concept of nonspecific low back, even being quoted, realistically, doesn't give us any clinical use. Everything is specific about a client.
Jared Powell:
Yeah. I think let's move away from nonspecific about that. That's a whole conversation.
Andrew Lock:
Now. We got, we got the midnight that,
Jared Powell:
Yeah. So, so, so Andrew, can I ask you a question? So you you've said a few times it physics governs us all.
Andrew Lock:
It does. Yes.
Jared Powell:
Can't run away from physics, I assume. You mean, would you say only in physics?
Andrew Lock:
Well, what would you say, Garrett? Jared does physics rule us all?
Jared Powell:
Uh, yeah, but all branches of physics. So do you think, do you think pain is a Newtonian phenomena?
Andrew Lock:
No, I wouldn't say it's a Newtonian phenomena.
Jared Powell:
So, so then how does the, pain's not principles guide?
Andrew Lock:
Pain's not where I'm living, I'm into lifting injury today,
Jared Powell:
But do you think pain is a manifestation of injury?
Andrew Lock:
I think pain's a very complex topic. And that's why that's where we find that wonderful misinterpretation of Nason Nason was very good as saying things were specific, then people go, but Kinson said, nobody know, knows a source of pain. Yeah. He moved into pain, construction and understanding. And that's where it was that context, pain, construction understanding. I've worked probably with pain science. Since about 96. I was actually in the, in the United States, I did functional capacity evaluation. And we worked with psychologists. I met patients who were quite considerably. I think would've been almost certifiable by the psychologist at the time of the psych psychiatrist. I've seen many manifestations of pain and there isn't many manifestations of pain. As there are human beings, pains of personal experience and personal construction. I seem to be very fortunate that I can address situations with clients. And I think that's one of the clinical skills that comes with seeing over a hundred, perhaps 10,000 patients now is you can identify, who's got a fear.
Andrew Lock:
You can delay that fear, but you also able to do it as a, perhaps an experienced clinician in such a way that you can take them to the movement. Pattern changes comfortably. There's a lot to it. You would know every human interaction, whether it's you with your client, Greg, with here's me with mine, it's gonna be different. And our ability and experience comes, comes to that wealth that we have from every single patient we build upon. So the pain experience is very much that therapist, client in relationship for us and every single patient is different and client. And that's the tools that we have developed. I'm very good, good at clients who have behavioral influenced problems in regard to perhaps the problem they come and see me with in regard to playing. And I'm good at being able to understand that person, perhaps for a refer, if that needs behavioral modification, I am not a behavioral specialist.
Andrew Lock:
I will refer to the appropriate professional. That's where I would come with behavioral problems. And the cognitive assessment of pain is gonna come from so many influences, but that's not where I'm going to have to go with the clients. I great success perhaps because of my and nature with, and relationship with them that I can move well with a client who has different patients who have different assessments of pain and clinically that's okay. We are friends in that clinic and they trust me. So the construction of pain, I don't go to the physics of pain,
Jared Powell:
But you have to, if you go to the physics, why of lifting an injury, then you have to look at the physi because, because do you treat people in pain?
Andrew Lock:
Yeah.
Jared Powell:
But then why don't you try and understand pain?
Andrew Lock:
Who said, I didn't understand it. Who
Jared Powell:
Don't,
Andrew Lock:
Who said, I don't understand human beings who are sitting in front of me.
Jared Powell:
Yeah, I know. So you understand it's
Andrew Lock:
But I, to understand the physics to understand,
Jared Powell:
But then why do you go off? People don't understand the physics of lifting
Andrew Lock:
Cause lifting is far more about moments and leaves. Isn't it? What do you see? The physics of pain being than Jared?
Jared Powell:
The physi, the pH the processes of pain will say which, which physics, underpin is extraordinarily complicated and, and built upon by multidimensional factors.
Andrew Lock:
And explain that, please.
Jared Powell:
We can't, we can, we can't. I reduce it to one factor is, is kind of where we're at here.
Andrew Lock:
Now, what physical principles are you using? Physics?
Jared Powell:
Pardon me?
Andrew Lock:
What physics are you using? What principles are you using there
Jared Powell:
Of pain?
Andrew Lock:
You just said physics of principles are related to pain. I want to know the principles you're dealing with.
Jared Powell:
So there's an argument that, that pain is more of a quantum physical of a okay. Which is inherently unpredictable.
Andrew Lock:
Seriously. What's they gotta do with the Mo arm in a lift.
Jared Powell:
No, nothing. I'm I'm I think we're getting a little bit confused yet.
Andrew Lock:
No, it's I just point out they're very different things. Didn't I?
Jared Powell:
Yeah. Yep. Totally. Greg, do you have anything daddy, mate
Greg Lehman:
No, I, I tried to stay in the mechanical world just, uh, just to avoid dance, but, but that is, that is the crux here. I, I think Andrew led with that, that he wanted to talk about injury. Yeah. And so, I mean, that's, that's the crux like the, these, maybe these bio mechanical variables are very important for tissue injury, but the would be is like, um, what percent of the disability is really like that this epidemic that we have of low back pain is due to these injuries. You know, like I maybe, maybe that's an area where you're living and the people you are seeing there, you are seeing lots of true injuries. I don't know if that's that's true or not. Um, but I, I would just question if that's really what's going on in the world is that, that the people who are suffering and who are disabled with low back pain, it's because there's actually like a massive tissue or not massive that there's some, uh, tissue injury that's contributing to that, that sensitivity.
Greg Lehman:
And I, I don't wanna, um, straw man, Andrew, cause I know that he, he would say it's, the tissue would just be part of it and the other things are going on as well. So I, I, you know, so like we got caught up on the disc there for a bit, you know, and I like I'm cur like what percentage of low back pain is caused from the disc? Like, I'm not even sure we can say that, you know, like the, what we, we have the Peterson and Lali paper that only says we're, we can diagnose it if there's centralization, right. Or the directional preference there, but that doesn't tell you what percent of like the, the number of people who have low back pain throughout the world. Uh that's you know, driving that. And again, I, I, again, I, I reject the hypothesis that it's, that peak spinal that's causing the disc injury.
Greg Lehman:
Even you mentioned, oh, did you say the Parkinson Callahan study or the goers and Cal, you said goers. Cause the Parkinson one, along with the Wade study and the virus, they, they kind of show like neutral, really isn't protective, uh, for disc injuries. Like they don't really, they occur at the 30%, you know, the lower loads that's right. Just don't I kind of reject this idea that we know what loads, even if we stay in the injury world, our are causing injury. I just, I just know that's sort of what I think that's the crux and where we'll, where we probably won't find common ground here, which is, which is difficult. Cause I think we'd find common on ground. If we said, we all need to train smart, you need to like, not jerk the hell outta your weight. You need to slowly build up.
Greg Lehman:
When you're having rough, you know, psychosocial weeks, maybe don't beat the out of yourself in the weight room. You need to be smart. You need to recover. I don't think we'll disagree there mm-hmm and I think that's where we should be putting our emphasis or working with a coach like yourself, where if performance is your goal, I'm probably not the person you wanna work with where you, you wanna get into the positions that allow you to lift the most weight. And I'm totally comfortable with biomechanics being important. There I'm just less comfortable saying like that is a movement pattern. That's gonna cause an injury. I just, I, I just have trouble saying that's a poor moving pattern cuz when I try to peel it back and go back to the first principles here, I, I just, I don't see the research for it or I see such conflicting work.
Andrew Lock:
I think your point with beautiful Greg is why, Hey, it might be population. Let's
Greg Lehman:
Cut it right there. It's beautiful. And put it,
Andrew Lock:
Put on, put it on the cup. Right? You said it, we might see different populations. Huh?
Greg Lehman:
I think so. Absolutely.
Greg Lehman:
And I think that's when people think like they get confused when it looks like Stu McGill and, and uh, Peter Sullivan are so, so different and they're both like, you know, excellent researchers and have so much to offer people. I do wonder if they're, I would, guessi sees endurance Gors people who need to back off, modify their technique to let calm down. And I guess that O Sullivan is seeing like a lot of avoidance Gors and that's why he's be like, we need to get exposure and deflection. And then unfortunately I think people get too tribal and they run with that and they misrepresent what both of those two thinkers say. And they, they pigeonhole them a bit too much.
Andrew Lock:
That's great. That's what we see. We have a population bias. It's um, it's evident anyway, it's gonna happen because that's, that's what we see. That's what we deal with. I get the ones that's not the Mo under the bear that's of injury. It's not in their head gonna be the technique. I see the high performing individual who has a tissue loaded issue and got injured by it. I'm gonna see lots of those.
Jared Powell:
So Andrew you've quoted Peter O. Sullivan a few times his old work. What do you think about his radical change in, in beliefs about lifting and backbone?
Andrew Lock:
I haven't read anything of your latest work at all.
Jared Powell:
Okay. You're just deliberately avoiding it or what? No, I
Andrew Lock:
Agree with it. I'm probably, I'm probably the 10 times, most busiest man in the world. I've got commitments. Absolutely everywhere. I've got so many businesses.
Jared Powell:
Okay, cool.
Andrew Lock:
I would love to, I would love to have another one of me who could sit down and spend all the time reading as much evidence as possible. Great. What it wonderful world. But I'm dealing with, I said, I've got a worldwide waiting room. I'd get people who are piled up on zoom calls all day from all around the world because that's thanks
Jared Powell:
For fitting us in. Thanks for us
Andrew Lock:
In, in the morning. Wasn't too bad, you know. Good.
Jared Powell:
All right. So can we move to some con concluding comments from the both of you, if you want to 30 seconds to a minute, uh, Greg, if you, if you wanna start mate
Greg Lehman:
Again, like I just, I know I'm, I'm, I'm such a on fence person, but I, I really, I think we're focusing in the wrong area when we get caught up on like spinal fluction. That's why that we were talking about here that, and, and same with biomechanics when it comes to the disability and suffering of people as low back throughout the world, I think biomechanics are incredibly, uh, useful when it comes to performance. I think they're useful to teach someone to move differently, to help them temporarily when they have pain. Uh, I just don't think that we can make strong conclusions about, uh, that there's certain principles, technique principles when it comes to specifically to the lumbar spa, uh, that, that tell us what tissues are more likely to get injured. I, I, I think that could happen in the future, but I think when you look at the totality of the evidence, uh, and read a lot of different researchers, you should come away with it, like shaking your head and being like, oh cow, this is impressive, complicated. And you should feel pretty humble. That's all
Jared Powell:
Andrew. Yeah.
Andrew Lock:
Look, I think it's, it's important that we understand that off the lifting technique we'll understand it does not meet a single technique. Right? We'll understand. We're talking about a set of principles that go particular individual. And that's pretty much like Sebastian Arab has said to coach the world's strongest man. I can give two very different lifters, the exact same set of cues and the movements might look quite different, but I'm still applying the mechanics principle to both lifters to make their movements look as efficient as possible. And that's pretty much where it comes from. I've had three professional athletes who, when they hurt themselves, deadlifting now when I assess their mechanics, I mean, that's very small population of people who are back to eventually said, you should never lift that bar in nine inches off the floor. Cause your hip sockets are really brutally deep.
Andrew Lock:
You are actually accommodating very much actual back to my go for that. But if I put the bar 12 inches, you can deadlift quite well. And safely in regard to the back issue, you've had problems with now. Cause those athletes like Greg was saying about run a short step, cause it's not their profession to deadlift, but they use it in their training. Fine. I've adapted the position to the person. And that's what it's about. It's adapting to, to the person, but we have parameters. We work with, look, see surgeons, don't use butcher's nose. They use scalpels. And I think as clinicians, we should be about the same way. We need to be able to pull things apart. Very specifically regarding the individual. Now I'm always talking about the injury component here, but that's behavior as well. Listen, it, it is just as specific to the individual. So that's how it all comes together. Without exception, successful clinicians, we determine specifics. And that's what we do, Greg, you, me, whatever we are talking about specifics. And realistically we don't do this with generalities. So I decided there's no such thing as a nonspecific lifting technique. There's no such as thing as a specific human being. That's pretty much where I go to
Jared Powell:
Cool surgeons use scalpels and yet surgery still doesn't work. So there you go. All right.
Andrew Lock:
Some sometimes it does.
Jared Powell:
I'm just joking. Thank you. Thank you both for, for coming on and being vulnerable and having this conversation, I really enjoyed it and I'm sure everyone else will. I really wanted viewers and listeners to, to look at the evidence and viewpoints that you both presented and actually scrutinize their own beliefs a little bit and try and challenge their own beliefs on both sides of the debate. Honestly. So I think the profession will, will benefit from you both honestly and openly discussing this complex topic. And after all, listen, this kind of the aim of scientific professions is to put your ideas out there. Put your theory is out there into the world and have them scrutinized. And if they survive the Severt of scrutiny, then maybe you're onto something for just a little while until it gets falsified eventually. All right. Thank you Greg layman. And thank you, Andrew luck. This has been fun. I'm sure everybody's gonna love it. And I'll see you all next time in Melbourne or in Canada, cheer guys. You
Andrew Lock:
There magic.
Jared Powell:
Thank you for listening to this episode of the shoulder physio podcast with Andrew Locke and Greg Lehman. If you want more information about today's episode, check out our show notes at www dot shoulder, physio.com. If you liked what you heard today, don't forget to follow and subscribe on your podcast player of choice and leave rating or review. It really helps the show reach more people. Thanks for listening. I'll chat to you. Soon. The shoulder physio podcast would like to acknowledge this episode was recorded from the lands of the Yu, Uganda people. I also acknowledge the traditional custodians of the lands on which each of you are living, learning and working from every day. I pay my respects to elders past, present and emerging and celebrate the diversity of Aboriginal and Torres Strait Islander peoples and their ongoing culture and connections to the lands and waters of Australia.
