Dr. Carmine Gangemi is my chiropractor. He works out of Venice and is a Doctor of Chiropractic, a Certified Strength and Conditioning Specialist, a Certified Personal Trainer, and I hold a B.S. in Exercise Science/Adult Fitness.  His office is perfectly located  directly behind Gold’s Gym, the Mecca of Bodybuilding. Convenient huh!

Pauline: As a chiropractor you treat a lot of people who are wearing their joints out in the gym by using improper form when training. What would you say is the most common overuse injury that could easily be prevented with proper exercise technique?

Dr Carmine: I think that it’s important to recognize that proper technique goes beyond weight training. When performing common movements, even like walking, correct form needs to be applied. With that said, cardio exercise get’s a lot of people in trouble with their knees. Poor form on the treadmill or the elliptical machines causes unnecessary stress on the knee joint and can lead to injury. Usually what happens is as a person becomes fatigued they start to compensate with poor form. They start to turn their legs out to use their hips to “shuffle” verses keeping their feet pointed ahead and pushing. Remember that in this case you are performing the movement hundreds of times in one session instead of dozens of times as you would with weight training. Another factor that needs to be mentioned is overtraining. You need to allow recovery to occur with any exercise program. This may be in the form of grouping certain movements or body parts on specific days, varying the intensity of your training, and scheduling rest or active rest days.

Pauline: From a chiropractor’s point of view, what is the perfect squat technique to prevent injuries as well as getting as strong as possible? How deep? What stance?

Dr Carmine: Instead of a “chiropractic perspective” I’d prefer “mechanically sound perspective. I say this because Chiropractic is a broad philosophy with some doctors never setting foot in a gym. With that said we need to recognize that there are various techniques employed with this exercise. Some of the approaches are safer than others. One squat technique that I favor includes the following: Your stance should be just wider than your hips with your feet turned out slightly. The bar should be placed high on your shoulder blades across your traps but not so high that it’s on your neck. Your chest should be up slightly, shoulder blades pulled in towards each other, and your head should be in a position to slightly elevate your eyes. Your lower back should maintain its natural curve throughout the movement. Don’t hyperextend but do keep yourself from falling forward excessively. The bar should remain over your ankles or just in front of them through the exercise. As you descend, slightly transfer your weight to your heels and outer portion of your feet (but NOT completely), and allow your thighs to slightly roll out. As you begin your ascent, start to transfer your weight to the balls of your feet and allow your thighs to slightly roll in. Keep your chest up and finish the movement. Again, the bar should be in line or slightly in front of your ankles. The depth of the movement could approach the point where the front of your thighs is parallel with the floor. Do not twist your neck or torso when performing this movement. In regards to strength development, keep in mind that strength is a relative thing. Do you want to be strong for one rep, four reps, twenty? Is there a specific goal to compliment your sport? Explosive power for example, could be developed with very low reps, one to three for example. Or you could develop power with plyometrics, performing multiple reps in an “explosive” manner. Generally speaking, for “strength and size”, I’d perform multiple sets and keep my reps between 5 and 8. I’d also increase the amount or resistance each set. That’s very simplified. A good strength program would require “heavy” and “light” days, etc. But performing two warm up sets with light weight followed by four to eight “working sets” with reps starting at 8 and working down to 5 would be very productive for most athletes. I’d end the squat session (or any exercise) if your form really starts to suffer as you fatigue, or of you feel any excessive strain on your joints or muscles. Be intense, but be safe. What do you recommend people do to prevent shoulder overuse injuries? Keep in mind that the shoulder joint complex is potentially the least stable of all joints in the body. This is because of the broad range of movement that it allows. Also the shoulder is made up of several joints including the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic articulation. So, stabilization exercises will benefit any shoulder routine. Internal and external rotation of the humerus helps significantly. I prefer that these movements be done with resistance in the form of Therbands because it’s safer. As you rotate the humerus, the resistance builds with the Therabands. As you return to the starting position the joint is not continuously loaded with weight. Therefore, no additional stress on the joint occurs with the Theraband. I often see people attempt theses movements with a dumbbell while lying on their side. This isn’t the safest nor is it the most effective approach to this exercise. The weight from the dumbbell stresses the joint at the bottom position and the body attempts to overshoot the resistance of the dumbbell as you raise it. In a sense it’s easy to cheat on this and almost throw the weight. With the Theraband you can attempt to overshoot the resistance BUT the band reacts with more resistance. You can also use the Therbands in the upright position. This would allow you to work both shoulders at the same time, especially with external rotation exercises. The added benefit would be a gentle stretch applied to the opposing muscles.

Pauline: In your opinion, what are the three most underused exercises you think “every sound routine” should include?

Dr Carmine: Assuming the person has no health issues or severe joint problems, I feel that the following exercises are essential to a “sound training routine”: Deadlifts, Squats, and Standing Military Presses (to the front). When performed correctly and consistently, these exercise can greatly influence strength, conditioning, lean body mass, cardiovascular conditioning, and bone density. All good stuff. If I had to do just one, I’d choose the Deadlift. All these exercises involve multiple joints and can be performed with simple equipment. The regular stifflegged deadlift with rounded back, can this be used safely in your opinion? Yes. However, the depth of the lift is crucial to it being performed safely. To explain this I need to mention the “Flexion-Relaxation Phenomenon”. Basically this refers to the fact that in humans, at the end of trunk flexion, the erector spinae muscles literally shut off. So at the bottom of the Stiff-legged Deadlift, if you descend too deeply, your lower back muscles will actually shut off. This position would place excessive amounts of stress on other areas, namely the ligaments and intervertebral discs. Also, keep in mind that fatigue of the lower back muscles will affect at what angle of trunk flexion they shut off at. The Stiff-legged Deadlift can be safe and productive. But it must be performed in a manner where you recognize proper technique at all times and avoid excessive amounts of trunk flexion. This exercise should NOT be performed to failure. Tell me your three “top/most stupid” exercises you see on a regular basis? One exercise comes to mind immediately: Seated Behind the Neck Military Presses. This movement potentially puts excessive stress on the glenohumeral joint and the supraspinatus muscle. Also, in the seated position, excessive compression can occur on the lumbar spine. Slant-Board Sit Ups is another, especially if the board is set at too high of an angle and the trunk is flexed excessively. I see people prop the board all the way up, sit on it at this extreme angle, and then come all the way up with the movement. This is not really good for your lower back and doesn’t isolate your abs. Keep the angle low and limit trunk flexion so that when your shoulder blades are off of the bench, the movement ends. I think Leg Presses are an excellent exercise. However, some people put way too much weight on the machines and perform quarter reps. For what, I’m not sure. I did have a patient that literally fractured a vertebrae in her lower back doing that.

Pauline: What is the most common problem people come to you with? And what is usually the right correction/treatment?

dr Carmine: Let me jump ahead here and say that ultimately the best way to correct most musculoskeletal problems is with proper exercise. With some injuries early care may require chiropractic manipulation, soft-tissue therapies, etc. However, a sound treatment regimen always leads to exercise. With that said, I see a variety of different people in my office. My patients include professional athletes, senior citizens, people injured in car accidents, and even seniors that are pro athletes and are injured in a car accident! So my patient base is broad. I do see a lot of shoulder injuries. Usually it’s because of overuse or poor form. Muscle imbalance and a lack of stability also cause a lot of shoulder injuries. I actually specialize in non surgical care for herniated discs, especially in the lower spine. As a result, I do see a lot of low back injuries. Disc injuries respond well to decompression manipulation. I’m certified in the Cox Decompression Manipulation Technique. This technique is safe and effective. Some other attempts at spinal decompression may not be as effective or safe. Neck problems are also common. It’s important to maintain the curve of your cervical spine to avoid unnecessary stress and compression. You can assist with this by lying on your back on a firm surface. Roll up a medium size towel and place it under your neck. Let the towel exaggerate the curve in your neck as you lie down. You can maintain this position for 15 minutes. I’d do this every night before you sleep. How important is stretching in your opinion? There are benefits to stretching and maintaining flexibility. Many athletes don’t stretch or they stretch improperly. One way to get these guys to maintain or increase flexibility is as follows. Before you start your resistance training, warm up with some form of light cardio for 10 minutes. Then, with each exercise you perform, commit at least the first set to proper form and a full range of movement. I know that sounds redundant, but a lot of people rush through their movements and only perform partial reps. Another good practice would be to stretch out whatever bodyparts you trained at the end of your workout. Use this time as a cool down period. A thorough stretching routine does take time. So, it would also be good practice to devote time exclusively to a stretching session. In other words perform a complete stretching routine two times a week separately from all other activities. Overstretching can also be a problem. So ease into the stretch initially. PNF stretching and ballistic stretching are more advanced forms of stretching that are very effective but require some experience and usually assistance. Something relatively new is the use of Whole Body Vibration devices to assist with stretching. These vibration plates appear to be very promising and will become more popular and available as a result.

Pauline: Thanks for your advice, dr Carmine!