Dr. Michael Hartle
Medical Committee Chair
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Trunk Stabilization Concepts and Exercises
by Michael A. Hartle, D.C., D.A.C.B.N., C.C.N., C.C.S.P., C.S.C.S., E.M.T.
Part Four of Six
To Belt or not to Belt - that is the question!!
No, I am not talking about punishment tactics here. I am talking about the use of the traditional weight training belt used in our gyms, our warehouse companies, even some delivery companies. The thought process behind this is to protect our lower back from injury and possibly also to be used as a performance booster for athletes that use them. The question is: do they really protect our back? Can it make us lift more? Right now 35-40% of the population suffer from back pain every year and up to 70% of the population will suffer some form of back pain at least once in their lifetime. These people are usually under the assumption that wearing a brace/belt/corset will give them relief and maybe even keep the scalpel away.
One segment of athletes that do not wear belts under large loads are the Olympic weightlifting athletes from Europe, especially Eastern Europe. At the recent 2000 Summer Olympic Games, in the SuperHeavyweight Class, I noticed only one lifter wearing a weight belt and that was during the clean & jerk. All others were beltless. Pretty amazing considering they were snatching over 200 kg (440 lbs) and clean & jerking over 260 kg (573 lbs). At the 1997 International Powerlifting Federation's Men's World Championships, I witnessed a lifter from the Ukraine that squatted 400 kg (881 lbs) and deadlifted 365 kg (804 lbs) with no belt!! And he was 43 years old!!
One of the reasons for the prevalent use of the belt is the long history of corset/brace use in the medical field for back injury. This dates back to the early 1900's for the treatment of scoliosis and back pain. With this type of use, it is no wonder that a lifter puts on a belt to try and help protect their back when they are lifting.
In our genetic make-up, we have been given a natural weight belt. When not used properly, it becomes abused. We then have to rely on an artificial one. It has been discovered that we have two major stablizer systems of the human body: an inner unit and a outer unit. Our natural weight belt is the inner unit. It is composed of the transversus abdominis (TVA), some fibers of the obliquus internus (OI), pelvic floor muscles (PFM), the multifidus and the diaphragm. The TVA appears to be the dominant player in this unit. The outer unit is composed of several muscles such as the obliquus externus, obliquus internus, erector spinae, latissimus dorsi, gluteus maximus, adductors and hamstrings. These all work in concert with the inner unit musculature and fascial systems. Unfortunately, most people, especially those with back pain, suffer from an imbalance between the inner and outer units.
The inner unit is part of a system of stabilizer mechanisms, all of which are dependent on the integrated function of all the inner unit muscles. How does the inner unit create stability in the body? To answer this question, an analysis of various proposed mechanisms of stabilization is warranted.
1. Thoracolumbar Fascia Gain
2. Intra-Abdominal Pressure
3. Hydraulic Amplifier Effect
One of the reasons belts are so popular is the use of them is sometimes based on fear and emotion. Fear: the users want it to protect their back without the chance of injury. Emotion: if you tell someone they can improve their performance at the same time being able to reduce their pain, they will use it. There are several studies that indicate that the use of back belts/braces reduces the chance of injury, and improves performance and endurance. However, there are many, if not more, studies indicating these same belts/braces are damaging and can cause further problems by creating dysfunction in the user. Even popular training books offer reasons why the use of the belt is proper and justified.
WHAT HAPPENS WHEN WEARING A BELT
When you pull that belt tight around your waist, surface receptors in the skin are stimulated. The sensory nerves serving the cutaneous tissue beneath the belt have a sensory-motor relationship with the muscles under the skin. This relationship is explained by Hilton's Law, which states, "The nerves which supplied the muscles and controlled the movements of the part (joint) also served the skin and other sensory surfaces which were connected with that part". Davis' Law is demonstrated and well known by physical therapists who treat neurological injuries: stimulating the surface of the body produces stimulation of the muscles served by the same nerve root. Therefore, repeatedly "pushing outward" against the belt, which is encouraged by the belt through sensory-motor stimulus, is likely to develop and perpetuate faulty recruitment patterns. These faulty recruitment patterns need to be changed as soon as possible. If left unchanged, these patterns will continue to perpetuate and worsen, possibly causing other problems or injuries. This in turn can and will lead to the demise of an athlete from their sport. The dysfunction of the deep abdominal wall needs to be removed and proper recruitment patterns must be restored. There are various forms of biofeedback that can be used. They will be discussed later.
An interesting item to note is a correlation between athletes that wear belts and have experienced hamstring injury, which is supported by research. Lander et al. found that while using weight-belts, there was increased EMG activity of the vastus lateralis and biceps femoris (4). This is logical when considering the close relationship that exists between the biceps femoris and the TVA via the thoracolumbar fascia system as an integral part of what is called the "deep longitudinal system" by Gracovetsky (5, p. 243-251; 6, p.58). If the TVA is weak and inhibited because of wearing the belt, the biceps femoris could be recruited more strongly in order to help stabilize the thoracolumbar fascia. This is possible because of its close relationship with the thoracolumbar fascia via the sacrotuberous ligament. I have noticed that athletes that perform in sports requiring powerful, explosive movements show a strong correlation between sensory-motor dysfunction of the deep abdominal wall, an inability to stabilize the lumbopelvic region and biceps femoris injury.
Next Issue...FIX IT!!...
Michael A. Hartle,
USA Powerlifting Executive Committee Board Member
Chairman, USA Powerlifting Sports Medicine Committee
Chairman, USA Powerlifting Drug Testing Committee
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