THE HEAVY HIP THRUST IS RUINING OUR BACKS AND THIS INDUSTRY
The Heavy Hip Thrust is Ruining Our Backs and this Industry
For over a decade, I have dealt with my fair share of spinal issues to the point where I have had a number of surgeries to try to alleviate myself of pain and get back to better function. As a coach, I would never want one of my athletes going through a similar experience. This is one of the many reasons I pay extremely close attention to detail in the exercise selection of my athletes' programing.
It is this attention to detail which has led me to question the fitness trend of maximally-loaded barbell hip thrusts, that has become the newest craze. This phenomena has little to do with under the bar experience, and more to do with social media hype. The jury is still out on whether this "new lift" is the root of all evil. But we are starting to see more injuries from maximally-loaded barbell hip thrusts versus its lower intensity counterpart, the glute bridge.
This article will explain why I believe that, while it is a good lift when performed in the proper context, the barbell hip thrust becomes a problem when it is used as a max-effort test. The barbell hip thrust cannot be utilized similarly to the powerlifting triad: bench, squat and deadlift. Nor is it an Olympic movement or lift. The maximal barbell hip thrust should not be treated as a measure of strength.
A study conducted on a rugby team in New Zealand showed that maximally loaded hip thrusts could be conducive to improving 10 and 20 meter sprint times. This would be in accordance with the force-vector theory, meaning if you do an exercise that focused on hip extension in the same plane as sprinting, it would translate to hip extension, like in the acceleration phase of a sprint. While I think this is true, I don't believe the barbell hip thrust is the best means to accomplish this goal. It is very limited in its capabilities and offers a diminishing return with continued load progression.
I am a big proponent of sport-specific training done properly, and have an even greater focus on training movements for strength that transfer to sport. However, understanding the body and how it is meant to move is extremely important when selecting exercises. The glutes gain most of their hypertrophy through slow, high-rep movements and have proven not to respond as well in maximal-loaded, low-rep ranges.
The greater the load placed on a movement, the more likely you are to see problems within the movement. By exaggerating the hip thrust through a heavily weighted barbell, we have been able to expose issues within the lift. When the lift is performed at submaximal levels the same problems are not apparent. Thus, the exercise is not detrimental to the athlete, just poorly utilized. By using maximal weight, athletes try to put more force into the bar, which can result in hyperextension of the back. Spinous processes compressing on each other, possible disc protrusion through repeated hyperextension and weighted pelvic posterior tilt at the bottom could also cause spinal problems and ligament laxity.
We have come to this conclusion by leveraging three different resources. One group is composed of athletes, coaches and lifters. These lifters are also practitioners and able to observe themselves and their athletes on a daily basis. Next are the chiropractors, physical therapists and doctors of physical therapy. They are seeing SI joint pain, lumbar spine issues and have to perform major lower spine adjustments with lifters who are performing max effort hip thrusts. Lastly, the third group is spine specialists and orthopedic surgeons who are taking a closer look under the microscope with MRIs and X-rays to see the external problems people are discussing.
All three groups are noticing issues, which has been eye-opening and forced me to take a step back. I do not want to cause hundreds of thousands of dollars of life changing interventions with these athletes because they need an orthopedic solution. Especially if it's due to me just jumping on a bandwagon and not worrying about taking care of my athletes first. For me, the light switch turned on when I thought about how we are so focused on how we load the patterns of these competitive lifts. We make sure every detail is correct, yet there is only one way to load the hip thrust.
Not only is there just one way to load the barbell hip thrust, but it's also very painful. The bar is going on part of the hip that does not have a lot of muscle tissue or fat bellies to protect the bone. Outside of telling my athlete to put on fat, there is no way to improve that buffer. Even for the heavier athletes I work with, this is still not a good position. You're able to see the discomfort from the athlete having to roll the bar on top of themselves and then off again. If we are unable to load this pattern in a safe manner then why is our end goal heavier weight?
While there's been equipment designed to help fix this problem, I have always been one to believe that the less equipment needed for a lift, the better. The less I need to have a consistent pattern, the more likely I can load it to develop power. This cannot be done with the barbell hip thrust and leads me to question whether or not the body was meant to move that way with heavy loads.
In order to perform this lift you will need a bar, a bench and a pad. You also need your athlete to be able to maneuver their body underneath the bar in order to begin the lift. What happens if my athlete is too big to fit under the bar? Now I need to put the bar on top of blocks. What if the blocks are too high compared to where my athlete should be starting? Now he is in a bad position from the start and I have to worry about them getting under and out from underneath the bar in a safe manner.
The hip thrust also goes against the strength curve. The hardest point of the strength curve is the top portion of the lift, but this is not the case with the hip thrust. It is actually easier to lock out at the top than it is to begin the movement. Until we get three-quarters of the way up, we aren't seeing proper loading position because the bar isn't moving straight up, it's moving at an angle away and then coming up. This leads to a lot of shear in the lower part of the spine because you're loading in a horizontal position as opposed to vertical amongst the discs. The body isn't meant to have a lot of horizontal pressure in the lower part of the spine. You cannot fully lock out the bar due to the loading position being on the actual hip, which needs to get into extension. If you did fully lock out the weight, you'd be dealing with a lot of hip issues.
"If you do things to aggravate your pain triggers, then you deserve your pain"
When you set up with the bar you are fine and on the way up there might be some positional issues, but as you come down we notice you're usually not stable. The coccyx and the hip position are getting a lot of small jolts that are creating microdamage. This problem is not fully realized until you stand up. We will see people stand up after the lift and turn to the side, then try to perform these minor adjustments on themselves. It's mainly due to the soft tissue stress, which could later contribute to spine damage by a spasmed muscle pulling on the spine. The next day they will be dealing with major SI joint issues and their hips are an even bigger issue. As we know with most athletes in general, the hips are usually problematic to begin with. Our stance is to proceed with caution and attain as much research as possible to see what the possible implications are.
We tested 100 of our athletes and 40 of them had a history of either back surgery or were pre-exposed to back pain. We split those 100 athletes into four different groups: 20 athletes who had a history of back pain/injury and who performed a heavy barbell hip thrust, 20 athletes who had a history of back pain/injury and who did not perform a heavy barbell hip thrust, 30 athletes with no history of back pain/injury who performed heavy barbell hip thrusts, and 30 athletes with no history of back pain/injury who did not perform heavy barbell hip thrusts.
The athletes with a history of back pain or surgery had documentation of X-rays and MRIs presenting many differing cases. Some with spinal fusions, artificial disc replacement or arthroscopy of the hip because of labral issues. The athletes who did not perform the heavy barbell hip thrust had very little problems in terms of pain in their lower back. Those athletes that did perform the heavy barbell hip thrust, even the one's with no history of back pain or injury, were having issues shortly after finishing with this specific lift.
It is now important to look at disc space, any sort of degeneration, placement, or anything else that is changing inside the body. There are a lot of factors to consider when we receive immediate negative feedback in the manifestation of pain from athletes due to heavy hip thrusts. We did not see any issues with a pull-through exercise, whether they used bands or cables. Their feet are fixated on the ground, hands on the bands or cables, and the entire spine is able to maintain proper alignment throughout the movement. This is because with the pull through you can get a full lockout, unlike the hip thrust. With a pull through, the weight is driving down without putting sheer force on the spine. You have your feet on the ground and hinge at the hips, which is the way the body is suppose to move. That can't be done with your body on the ground because the body doesn't move that way.
Another area of focus is from those who are receiving regular chiropractic visits. They are getting X-rays to see if the problems are being resolved or merely mitigating the issue based on adjustments and physical therapy. When we visit chiropractic and physical therapy centers, we start noticing athletes with similar issues. When we revisit the issue, they can usually be traced back to what they have done at their gyms, high schools, private training centers, or even in our building. We want to take ownership and fix the problem before it becomes more severe.
The last factors are the MRIs and imaging, so we can get a clear picture. We want to be respectful of what those images show. I don't think there's a single drill that is causing all of these problems, it's probably a collection of things. It could be a lack of technique, lack of preparation or readiness for the specific drill. It is our job to figure out what that is and how to work around it.
We have already made adjustments to our program. The first being observation. We should not make an adjustment or knee-jerk reaction here. We must be aware. Before we make our athletes go through the lift, we need to make sure their technique is on-point. We must make sure we follow the guidelines from those that have published research on this drill to make sure we have a consistent way of performing the lift and manage the athlete by their body type. We have kids who are 6'7" in our gym, so they cannot be at the same angle as another athlete who is 5'10".
The second thing is to document loading. We need to make sure we know where they feel the pain and how much weight is being lifted. We have to know if the pain was at a certain rate of load. My athletes have not experienced pain at lighter loads with controlled movement. However, the pain experienced with heavy load is not standard, because some of smaller athletes have no complaints. I have girls that can use 225 pounds for the barbell hip thrust with no issue, but guys that can squat 500 pounds struggle with 50 pounds. If just 5% of your athletes have a negative feedback to a certain exercise, why would you continue to implement it in your program design? With the banded and body weight controlled movements, I am seeing no issues.
It is when you start loading for a one-to-three rep max that the issues occur. However, with banded hip thrusts we see no issues. How could this be if they are essentially the same lift? The only adjusted variable is the loading mechanism. When we increased the load, the group with back pain saw their issue quickly exposed. Even the non-back pain group began experiencing discomfort and major hip displacement. They wound up needing more chiropractic or physical therapy work.
It all comes down to the load, placement of that load and the tempo. If the speed and tempo are controlled, you are able to contract the glutes in the proper manner and engage the lower part of the body without the negative side effects. This is also effective with those who have had back issues because they are able to engage parts they may not be able to with other lifts. They are otherwise unable to do so when there is a maximal load placed upon them. I am a big fan of banded hip thrusts because the load is not heavy when we are in our most vulnerable position and they are strongest at the top. We strongly believe if we can control these movements, we will receive solid return without the risk.
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