Please know I am deliberately playing the Devil's Advocate. Read below.
Having read and responded to many questions. I've learned that many take the position that crunches are a no no and many have referenced researchers such as Stuart McGill to support their position. Here's the scenario:
What exercises or movements would you use with a client who presented with an increased lumbar curve? Let us all assume that this is a healthy client, all assessments have been done and he/she doesn't have thoracic kyphosis or osteoporosis. Is a crunch also known as spinal flexion a no no? Too, in your experience as a personal trainer, do you encounter more people with excessive anterior pelvic tilt or posterior tilt? As you have been doing, please use science to support your position.
as I have never been afraid of the devil, I'll give it a try.
I believe that crunches are neither a 'no no' nor a 'oh yeah'. Ultimately, we want our clients to healthy and pain-free through a proper choice of exercises for them.
When I train clients, I regularly move them through all possible movements of the spine, spinal flexion included (such as seated circles on a ball). When I want to strengthen the core abdominal muscles, I tend to gravitate towards exercises that do that in a neutral spine position. This is based on the observation that just about all people I deal with are true experts at spinal flexion as they assume that position all day long. They would love to do crunches in that position but I do not want to reinforce strength in a locked-short position.
As far as the person you are describing: healthy but an excessive anterior pelvic tilt. Yes, I probably would do spinal flexion in an effort to move the pelvis into better alignment.
First I'll address your scenario, then I'll share some information for both sides and let you make up your own minds.
"What exercises or movements would you use with a client who presented with an increased lumbar curve? Let us all assume that this is a healthy client, all assessments have been done and he/she doesn't have thoracic kyphosis or osteoporosis. Is a crunch also known as spinal flexion a no no? Too, in your experience as a personal trainer, do you encounter more people with excessive anterior pelvic tilt or posterior tilt? As you have been doing, please use science to support your position."
I would have this client start in a supine position and initiate the drawing in maneuver while pressing the lower back to the floor. This is to retrain the body to have proper alignment through the Lumbo-Pelvic-complex while relearning to activate core musculature.
then maintain core position while learning to integrate limb movement
This is best paired with glute bridges and Iso-Prone Abs(plank).
Glute bridge is to retrain the glutes to fire instead of the hamstrings. Some people will have cramps in their hamstrings doing this because of the disadvantaged length of the hamstrings. This can be eliminated by placing the feet in an external rotated position and positioned wider than hip width, upon raising the butt push the knees out. This will help the Glutes to fire and disengage the hamstrings.
back on bench feet on floor (decreased lever arm)
back on floor feet on floor
back on floor feet on ball
back on floor single leg on floor
back on floor single leg on ball
Iso-Prone abs will help to stabilize the LPHC in the proper alignment as per-positioned with the drawing in exercise.
Plank raises - this is just lifting the body off the floor to a plank holding for 3-5 seconds and returning to the floor, do these for reps.
Plank static holds
Plank static holds with alternating hip extension
plank static holds with alternating arm leg raise
The main point of this program is to progress from learning proper LPHC position to firing the correct muscle to stabilize the core then to stabilizing while moving the extremities. This is a basic progression.
As a side note to this, as pointed out to me by somebody in a recent discussion it is ok to crunch to retrain somebody who has been ambulatory and is learning to get up on their own again. The crunch is a risk reward question more than anything, because we all know it works but so do other exercises with less risk.
I am now going to post a recent article that has renewed some interest in the subject of crunches.
con crunches:recent McGill interview addressing previous study
I suggest if we want to continue to discuss this topic that we all take the time to educate ourselves to both positions.
When Pigs Crunch - A Commonsense Approach to Abdominal Training... perhaps all we need in this area is a bit more of that, commonsense!
I echo your position on the importance of choosing the correct exercises for our clients.
As always thank you for the stimulating interchange.
Personally I prefer to utilize planks and lateral leans with most (apparently healthy, w/o sports specific needs) clientele. And, as always, a good dose of transverse abdominal holds, timed and with convergence. (Gotta make sure they aren't holding their breath ;} )
Honestly, I don't see a point in favoring crunches in the traditional sense as an exercise for this client. I don't have a problem with crunches. I don't have a problem with how many or how often people want to do them (within reason, obviously). The important thing to me is that you're balancing out any movement or combination of movements with a proportionally appropriate amount of opposing movements.
Depending on the muscular endurance and to a lesser extent, mucular strength, of the abdominals, hip flexors, erector spinae, and multifidi muscle groups, I may or may not wish to favor a certain group of exercises over others. I might even go so far as to consider what role, if any, the Psoas Major and Psoas Minor muscles might have to play here. In this instance, it's important to determine whether the client's anterior pelvic tilt is a result of structural damage to the spinal column or if the problem results from tight muscles or a muscular imbalance. A referral might be necessary.
In order to answer the question, let's say the problem is tight muscles that are acting on the lumbar spine, the posterior iliac crest, and the sacrum. We'll go with the Multifidi and the Erector Spinae. My common sense as a trainer tells me to design a program for this client that focuses on developing the endurance of the abdominal muscles with emphasis on the LOWER rectus abdominus. I'm a firm believer in balance. I recognize that too much encouragement of muscle growth in the opposing mucsles (mainly the rectus abdominus) has the potential to result in another muscular imbalance. Proper stretching needs to be emphasized for the tight muscles in the back acting at the lumbar spine, the posterior iliac crest and the sacrum. For sample stretches, I would begin with ones that the client could refer to when they leave the gym. See LIVESTRONG:
In the end, sure, crunches could be included in the routine to correct the anterior pelvic tilt. Crunches, in my opinion, tend be effective and are associated with a low risk of injury. However, I think that one of the best exercises I could include in this client's routine would be the following:
An additional note on the ^^^reverse crunch inclusion: For this client, I would elevate the pelvis in the starting position. This could be done by having the client simply rest the top of the tailbone on his/her hands to give a little extra elevation and support so that that "flat back" will be accomplished in the starting position. This exercise has the potential to aggravate the condition if there is overextension of the lumbar spine, so the amount of flexion on this exercise for this particular client will be especially limited until more abdominal control is achieved. It's logical to me that this exercise will strengthen opposing muscles while lengthening the tight muscles.
I'm not a corrective exercise specialist, but all of this is my best analysis of the situation thus far. Bottom line, the best program for this client, in my opinion, is one that emphasizes muscular endurance and flexibility in the muscles that stabilize the spine.
Is that a fair assessment? Am I on the mark or do I need some serious readjustment? I'm open to criticism.
As far as which pelvic tilt I've seen most often, I can say the anterior pelvic tilt seems to be more common among people (judging by friends and family and clients), but I haven't had a large enough client base yet to get a representative sample.
The crunch (or Curl-Up) was also examined in that study and was found to compressive loads of 2009 N and 1991 N with Curl-Up feet anchored and Curl-Up feet free, respectively. The activation of the Curl-Up was 87 and 67% maximum voluntary contraction.
Now your scenario you mention.
Increased Lumbar Curve
If a client or patient has an increased lumbar curve they are experiencing a lot of length and tension discrepancies within muscle structures surrounding the trunk. To determine what structures are of tightness -assessments should be conducted. However, the goal should first to be to attain a neutral spinal curve to alleviate any posterior shearing and poor tension relationships. Training proper alignment through establishing a neutral posture should be the first goal. Having them understand through visual demonstration and verbal cueing should be of initial priority. Once a foundation of a better spinal alignment is evident is when progression to exercises to reinforce this new motor learning pattern. This is where McGill’s research can be beneficial. Understanding the risk and benefits of the exercise is key to its prescription. Obviously, certain exercises will have a larger activation than others. Comparisons of EMG activity and compressive forces upon L4/L4 should both be considered. Also, many other factors come into play here such as training status, goals, etc.
Note: Whether performing a sit-up or crunch the alignment of the spine is of high importance. The lumbar spine should not be flattened to the floor that will stress the passive tissues. Rather, a nice neutral spine alignment (initial training goal) is what should be maintained throughout.
Why are Sit-Ups/Crunches performed? Intention of developing abdominals or in hope of alleviating back pain? (Literature does not strongly support this). The rectus abdominis does not hypertrophy to the extent which can develop large cut abdominals or “6-Pack”. Most already have their 6 pack yet it is hidden beneath layers of subcutaneous fat. As far as alleviating back pain or solving imbalances within multisegmental tissues around the core (back vs. abdominals). There is not conclusive evidence to support this theory in its relationship to back pain. I try to incorporate core work with other dynamic exercises to avoid compressive loads from sit-ups/curl-ups.
I would also use a mirror to show the client his/her posture
I like working on "all fours" and extending right arm and left leg, alternating, I also like trunk flexion on all fours, opposite hand or elbow to knee.
I like controlled bicycles, sometimes on a roller. I also would do a partial roll up, with the concentration being on form and tempo
I think "crunches" are not the best exercise for anyone, really.
Usually I'd say going along with what the client feels what they can do, but if theres a definite problem try to steer clear of it. Because they cannot do crunches doesnt mean they are completely contraindicated from working out.
There are plenty of moves they can do that would use the abdominal and spine/back as a synergist or stabilizer and still give them a workout.
I do not jump to conclusions on newly presented research or on the latest trends. I will modify movements to accomodate each client. I exclude things that I see no practical value in doing. I need to feel very sure that something works or is of reasonable benifit to myself or my clients before I begin to include it in my program designs. None of my clients ever perform an exercise that I have not done personally and evaluated with them specifically in mind. There are some trends in fitness with people doing some fairly excessive loading of the spine (such as overhead barbell press combined with walking) that I consider to be far more dangerous than an ab curl. You will never see me instruct a client to do something so unnecessary and with so little practical application. It may take a while, but I believe a number of these trends will be proven to be bad ideas for most exercisers.