REBUILDING MILO by Aaron Horschig, Kevin Sonthana

• To develop strength, you must strike a balance between stress and recovery.
• To progressively develop more and more strength, the demands of your training must not exceed the adaptive capabilities of your body.
• When you train hard and don’t give your body enough time to recover, the stresses of training begin to accumulate.
• There is always a reason for pain. It doesn’t develop out of thin air.
• When a radiologist sees a bulging disc on an MRI scan, they have no way to determine whether it is due to a recent event (a wound) or is 20 years old (a scar).
• Your body is resilient to injury when the power generated at your spine remains low.
• if you want to lift heavy weight (placing load on the spine), it is best not to move your spine and keep it within the neutral zone. Lock it in place and keep it stiff while you move at the hips.
• Every spine has a breaking point, and the quickest way to find it is to load your spine with a ton of compression and perform rep after rep with poor technique.
• If given time to adequately recover after being overloaded during a heavy training cycle, the body can adapt and replace a microfracture with stronger bone.
• While your hip joint is meant to move under load, your spine is not.
• Working every day to improve ankle mobility should be a priority if you wish to return to deep squatting pain-free!
• Learning to stiffen your trunk anytime you move a load (picking up a box off the ground or squatting a barbell) needs to be your first priority.
• Stiff hips affect the role of the joint complex directly above: the low back.
• Poor mobility in either the thoracic spine or the shoulders often causes the low back to move excessively as compensation when the arms are raised overhead, such as when placing a box onto a high shelf, pressing a barbell, or performing a snatch.
• Understanding how your injury presents will help you figure out what you need to do and what you need to avoid in the short term to decrease your symptoms.
• Nearly all back pain can be controlled and altered by changing the way you move.
• While exercises like Russian twists, sit-ups, and back extensions from a GHD machine may be great at increasing strength, they do little to increase core stiffness.
• To enhance the quality of stiffness, you must train the core differently. This comes through the second approach of using isometric exercises built to enhance muscular endurance and coordination.
• The definition of stability is the ability to limit excessive or unwanted motion.
• One key to fixing injured backs is to use exercises that enhance stability but place minimal stress on the spine while the exercises are being performed.
• This group of exercises has become known as “the Big Three”: • Curl-up • Side plank • Bird-dog
• Before you begin core stability training, I recommend addressing mobility restrictions at the hip and/or thoracic spine.
• After addressing mobility restrictions in those areas, Dr. McGill recommends that you perform the cat-camel before the Big Three to reduce low back stiffness and improve motion of the spine. Unlike other stretches for the low back that can place harmful stresses on the spine, this exercise emphasizes mobility in a spine-friendly manner.
• Unlike training for pure strength or power, the endurance component of stability requires the body to perform many repetitions of an exercise to see improvements.
• As this rep scheme becomes easier, increase the number of repetitions rather than the duration of the holds to build endurance without causing muscle cramping.
• The McGill Big Three has been highly effective since I started using it with my patients who come in for low back physical therapy.
• The side plank is a unique exercise because it activates the lateral oblique and QL muscles on only one side of the body, making it an excellent choice for addressing weak links in stability while placing minimal force on the spine.
• Stretching the low back stimulates the stretch receptors deep inside the muscles, giving the perception of pain relief and the feeling of less stiffness.
• Most of the muscle pain and stiffness you feel in your back is a consequence of a chemical reaction called inflammation that occurs from the real injury located deeper in the spine (disc bulge, facet irritation, etc.). 76 This underlying injury is what causes the secondary contraction or spasm of the surrounding muscles.
• Stretching the low back only treats the symptoms and does not address the true cause of the pain.
• No rehabilitation plan or corrective exercise program will truly fix your pain and restore your body in the long term if you are too stubborn to deviate from a training plan that is creating pain.
• One of the most common reasons for developing back pain is an inability to use the hips properly.
• As you work through each exercise, be cautious of how quickly you increase load. An efficient rehab program slowly applies load to the body.
• When attempting to lift heavy weight, I recommend taking a large breath in and then holding that breath throughout the entire repetition. When you combine this breath with a strong bracing of your core, your trunk will instantly become more stable and capable of handling tremendous weight.
• Many athletes who develop back pain when deadlifting do so because they fail to use their legs sufficiently and end up relying too much on their backs.
• The inverted row, performed with a suspension trainer or gymnastic rings, has been shown in research to elicit a high amount of upper and mid-back muscle activation while placing minimal stress on the spine.
• Performing a suitcase carry with the weight in one hand is significantly harder and poses a greater challenge to your core than performing the exercise with weight in both hands.
• The upside-down kettlebell carry is one of the most challenging variations.
• Proper use of a belt involves much more than just wearing it tightly! To use a belt, you must breathe “into the belt.” If you only cinch it tight, you will miss out on the benefits it has to offer. Always think about expanding your stomach into the belt and then bracing against it.
• I highly recommend keeping belt use to a minimum.
• A belt should never be used with the goal of taking away back pain or soreness.
• For those who do not have access to a specialized machine like the reverse hyper, a kettlebell swing is a great late-stage rehabilitation exercise that emphasizes and trains dynamic hip extension in a similar cyclical motion.
• Contrary to the exercise name, I recommend performing back extensions in a very hip-centric manner.
• If you want to see significant changes in flexibility of any muscle or group of muscles, you must be consistent with your stretching.
• Mobility should always be evaluated before flexibility.
• If you want to stretch before a training session or competition, I recommend short-duration stretches (less than 30 seconds), which have been shown to have no harmful effects on muscular performance.
• I’m going to share a little secret with you: most elite athletes have abnormal traits that give them the ability to do things most of us “normal” people cannot.
• The squat is a movement first and an exercise second.
• To squat to full depth with your toes straight forward, you must have adequate ankle and hip mobility and sufficient pelvic/core control. You also must have acceptable coordination and balance.
• Research shows that knee pain associated with barbell training is often due to overuse injuries. 3 These nontraumatic injuries can become nagging and often lead to further issues down the road.
• The most common reason strength athletes develop pain around the kneecap is a lack of ability to control for rotation at the knee (i.e., demonstrating poor knee stability when lifting).
• You need to stop using ice on injuries and sore muscles.
• Ice does not do what you think it does. It does not aid the process of healing from injury; in fact, an overwhelming amount of research shows that it does the opposite! Other than temporarily numbing pain, ice delays healing and recovery.
• There is no denying that ice provides temporary pain relief. Slap an ice pack on an area of your body that hurts, and you’re going to feel better instantly.
• But here’s the deal: Just because the pain is decreased does not mean that you’re fixing the injury. In fact, you’re doing more harm than good.
• inflammation and swelling are normal responses to injury.
• Plain and simple, healing requires inflammation. It isn’t a bad thing at all; it is an essential biological response to injury.
• Placing ice on an injured area essentially puts a roadblock in front of the white blood cells trying to get to the area. You think you’re helping the healing process by placing a bag of ice on your body, but you’re actually delaying its start by preventing your body from doing what it wants and needs to do.
• Swelling is merely the buildup of waste around an injured area that needs to be evacuated via the lymphatic system. It is a natural response to injury that becomes a problem only when the waste-filled fluid is allowed to accumulate.
• Scientific research does not support the use of ice.
• Despite conventional “wisdom” telling us that ice is a good idea, research shows that icing delays muscle repair after injury and gives us direct evidence that icing can lead to increased scarring!
• swelling accumulates around an injured area because you stop moving!
• Exercises performed in a relatively pain-free manner not only accelerate the removal of swelling through muscle contraction but also optimize the healing process without causing further damage.
• While voluntary exercise is undoubtedly the most effective way to preserve muscle mass, reduce swelling, and kick-start the healing process after injury, neuromuscular electrical stimulation (NMES) devices come in a close second.
• NMES devices work by stimulating muscle contraction through electricity.
• Simply put, after injury, we want to promote movement (even if it’s as little as stimulated muscle contractions through the use of an E-stim device) to optimize healing and safely return to the sports we love.
• While you may feel less soreness after icing, you’re not necessarily recovering any faster physiologically.
• Instead of reaching for that ice pack or jumping into a tub filled with ice, I recommend using an active recovery approach.
• If you’re extremely sore the day after an intense workout, I recommended performing a few minutes of soft tissue mobilization.
• Research has shown that a few minutes of rolling on a foam roller or small ball (such as a lacrosse or tennis ball) can significantly reduce delayed-onset muscle soreness (DOMS).