For
the purpose of this blog I’d like to highlight what I would consider a missing
link within most people’s training plans, that being accessory work. Firstly,
let’s define what accessory work actually is. To me it is supplemental work
which aims to increase the strength of the supportive structures within the
body. These supportive structures help to stabilise joints and improve strength
and endurance when performing movements with the larger muscle groups. These
stabaliser muscles are found deeper within the body and also occur within the
trunk, all of which provide a solid foundation for us to lift heavy, safely. If
neglected, we can develop imbalances and asymmetries which often lead to
halting performance as well as pain and discomfort. Within this blog I am going
to highlight common areas of weakness and pain, and ways in which you can
assess the strength of your stabaliser muscle groups and begin to perform
corrective exercises to improve your situation.
Common areas of pain and discomfort:
Commonly, people will present with pain across the major joints within the
body. These major areas of concern are usually the shoulders and upper back,
the lower back and hips and the knees. Whilst I have listed only major areas,
it can also be common to see pain within the elbows, wrists and ankles; but for
the purpose of this post I am going to stick with the 3 common areas mentioned
above. Whilst trauma can occur at these sites, I am going to keep the focus of
this blog to pain and discomfort associated with weaknesses, tightness,
imbalances and compensations. It is with this focus that we can begin to test
and implement accessory work to help alleviate symptoms and hopefully increase
performance long term.
Shoulders and upper back:
It is common for the shoulders and upper back to present with pain and
associated weakness/immobility and this can be for a number of reasons.
Lifestyle and working conditions can often affect these areas, but so can a
poorly designed resistance training program, so our approach needs to be multifaceted.
To firstly assess these areas, we need to have an understanding of the
movements which we’d like to be able to perform pain free, and then assess what
ability we have with both the left and right sides. When looking at a shoulder,
I like to look at the neck, upper and mid back as well as the shoulders
themselves. We must remember the movements of these joints and what full range
looks like, and assess accordingly. From there we can compare left to right and
also begin to develop an understanding of how we got to a point of limitation.
Once checking off our 3 key areas (neck, upper/mid back and shoulders) we can
begin to develop a plan involving specific accessory work. Below is a list of
exercises which will be a good start when implementing shoulder and upper body
specific accessory work. These exercises should be context specific and not all
used at once.
Bottom up KB press – Shoulder
stability through full range.
Prone Y and T – Mid back stability
focusing on scapula motion.
Standing banded Y – Mid back and
shoulder stability, focusing on scapula and humerus rhythm.
Scapula pushups – Scapula rhythm and
Serratus strength.
Z press – Ribcage positional strength
within overhead pressing movements.
These movements vary in difficulty and will be specific to the needs of the
person. They will all be performed without weight initially and then gradually
adding light loading. As we are more concerned with the ability to perform a
movement, rather than the load lifted, we must take it slow initially. For
reference, I am not saying that these are the only tools in the tool box nor
are they a guarantee for success, but they will definitely help most people.
Lower back and hips:
I think throughout their lives, most people will develop some form of lower
back pain. Quite often this can also include some discomfort within the hips
and glutes, and can present for a number of reasons. My go to for addressing
lower back pain is usually hip function/mobility when assessing the lower
limbs, as well as checking upper back and overall spinal mobility. This sounds
like a lot to digest, but basically what I want to know is how well the entire
spine flexes and extends, how good is the upper back rotation, what amount if
any hip internal and external rotation we have and lastly, how tight are the
hamstrings. Once we have an idea of where we are at movement wise, it is
usually quite obvious why there may be pain within the lower back. To address
this, I like to include the following exercises targeting increasing range of
motion first, and then strength and stability. This list is lengthy but worth
noting.
Active Straight Leg Raise (ASLR) –
Isolated hamstring length.
Incline board forward flexion –
Hamstring/calf length with lumbar flexion.
90/90 stretch as well as transition –
Hip internal rotation dynamically.
Elevated Pigeon stretch – Hip
external rotation.
Cat camel – Dynamic spinal flexion
and extension.
Book opening – Thoracic rotation.
Jefferson curl – Loaded spinal
flexion/extension.
Fitball hip lock – Hip adduction
(dynamic hip stability / glute med strength).
Single leg RDL – Loaded single leg
hip adduction / flexion / extension).
Decline board deep squat – Hip
external rotation / improve glute and adductor length.
Deadbug and Birddog – Lumbopelvic
control through core and glutes.
Fitball rollout – Deep abdominal
control.
Knees:
Much like the lower back, knee pain is something a lot of people have or will
experience throughout their lifetimes. There can be many causes to knee pain,
but for the purpose of this blog we are going to look at over use as well as
instability / weakness as a primary cause. Identifying single leg stability
issues early such as using a single leg balance task will give us an
understanding of how the hips and knees are interacting with one another. This
is a key in finding weaknesses and points of tension. Quite often the glutes
will present as tight, but are actually weak. We can see this when single leg
stability tasks are put in isolation, as the hip falls out laterally and
highlights glute weaknesses. A lot of the time, the knee then ends up in a valgus
position which puts additional strain on the medial aspect of the joint.
Another common cause of knee pain can be hamstring tightness / weakness. As the
hamstring tendons insert behind the knee, it is important to check the
tightness of hamstrings to see if this additional tension could also be adding
additional strain to the posterior knee joint. In order to address the common
causes of knee issues, we must lengthen the associated muscles as well as strengthen
them appropriately. Some common go to movements are as follows.
ASLR – Specific hamstring
lengthening.
Elevated Pigeon stretch – Hip
external rotation / glute lengthening.
Supine L sit plus band – Hamstring
and calf lengthening.
Banded step over or crab walk –
External rotation plus abduction at the hip.
Box step down – Hip flexion /
extension with single leg stability element.
Box step up – Glute / Quadriceps
strengthening.
Bulgarian split squat – Glute /
Quadriceps strengthening.
Decline board goblet or barbell squat
– Full ROM quadriceps / glute strengthening.
The aim for the above mentioned exercises are always to increase range of
motion first, subsequently decreasing tension within the quads and glutes. From
here it is all about isolating single leg strengthening exercises that take the
knee and hip through large ranges of motion to help solidify these new and
improved positions. By tolerating loads through the largest range possible, we
build strength throughout all fibres and ensure there is as little asymmetry
left to right as possible. This increased stability will allow the knee and hip
joints to track and fire correctly, and improve positions through high stress
tasks such as running, jumping and changing direction.
Take home points:
The main take home points from this blog post are to first understand the
movements which a joint should be capable and comfortable performing and then
assess to find any limitations. Assessments should be both passive and active
in nature and should include positions in which somebody is currently not
comfortable being in, in order to find out what their current coping mechanisms
are. Tailoring a program to improve range of motion, stability and overall
strength will more often than not lead to a decrease in pain and compensation,
and an increase in performance and pain free tasks. Do not be in a hurry to
enforce progressions, as undoing bad habits and coping mechanisms will take
time.