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Rebuilding Milo

Rebuilding Milo

A Lifter's Guide to Fixing Common Injuries and Building a Strong Foundation for Enhancing Performance
by Aaron Horschig 2021 400 pages
4.56
637 ratings
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Key Takeaways

1. Back Pain: More Than Meets the MRI

Results on imaging show poor correlation to symptoms of pain.

MRI limitations. Relying solely on MRI scans for back pain diagnosis is flawed. Scans often reveal "abnormalities" like bulging discs that may not be the source of pain, as many asymptomatic individuals have similar findings.

Context is crucial. A skilled clinician must conduct a thorough examination to understand which specific movements, loads, and postures trigger pain. This context is essential for interpreting MRI results accurately.

Treat the person. The focus should be on restoring optimal movement through subtle improvements in strength, mobility, and coordination, rather than solely targeting anatomical abnormalities. This approach addresses the cause of pain and promotes long-term healing.

2. Decoding Back Injury Anatomy: Power = Force x Velocity

If you want your spine to move, you want to move it under minimal load.

Understanding the spine. The spine is a complex structure of vertebrae, discs, and facet joints, designed for movement within a "neutral" zone. Injuries often occur when the spine is loaded outside this zone.

Power equation. Spinal injuries often result from the equation Power = Force × Velocity. High force (heavy lifting) combined with high velocity (spinal movement) significantly increases injury risk.

Minimize spinal movement. To protect the spine, prioritize either minimal load with spinal movement (as in dance or golf) or heavy load with a locked, stable spine (as in powerlifting). This approach minimizes power generation at the spine and reduces injury risk.

3. Screening Your Back: Find Your Pain Trigger

There is always a reason for back pain.

Kinesiopathologic model. The key to fixing back pain lies in identifying the movement problems that led to the injury. This approach focuses on the "why" behind the pain, rather than solely treating the affected tissue.

Self-assessment. The screening process involves a detailed self-analysis of activities, movements, and postures that trigger pain, as well as those that can be performed without pain. This helps classify the injury as flexion intolerance, extension intolerance, rotation intolerance, or load intolerance.

Screening tests. Posture assessments, movement assessments (squats, RDLs), and load testing (weighted front raises, heel drops) provide further insights into individual pain triggers and movement dysfunctions. These tests help pinpoint specific postures, motions, and loads to avoid or modify.

4. Classifying Back Pain: Flexion, Extension, and Load Intolerance

During recovery, what you don’t do is often just as important as what you do do.

Movement diagnosis. Classifying back pain based on movement patterns (flexion, extension, rotation, load) is more useful than focusing solely on anatomical diagnoses. This approach guides treatment by addressing the specific triggers of pain.

General guidelines. Based on the movement diagnosis, specific guidelines are provided for activities like sleeping, sitting, standing, and lifting. These guidelines aim to minimize pain triggers and promote healing.

Individualized approach. It's crucial to remember that there is no one-size-fits-all approach to fixing back pain. Everyone responds differently, and the key is to identify and modify individual pain triggers.

5. Rebuilding Your Core: Stability is Key

It is the stiffness that is important for stability.

Core stability defined. Core stability refers to the ability to limit excessive or unwanted motion of the spine. It's achieved through the coordinated contraction of muscles surrounding the spine, creating stiffness.

Isometric exercises. Isometric exercises, which involve muscle contraction without joint movement, are superior to dynamic strengthening exercises for enhancing spinal stiffness and stability. These exercises improve muscular endurance and coordination.

The Big Three. The McGill Big Three exercises (curl-up, side plank, bird-dog) efficiently address all core muscles without placing excessive stress on the spine. These exercises enhance stability, muscular endurance, and coordination.

6. Bridging the Gap: From Rehab to Performance

Eliminating symptoms and building your body to become more resilient to injury requires a different and more active approach.

Three-stage approach. Resolving pain requires a three-stage approach: eliminating the cause of pain, addressing weak links, and rebuilding the body's capacity to handle high demands. This approach ensures long-term healing and injury prevention.

Hip hinge. Learning to move from the hips and keep the spine stable (a hip hinge) is essential for those with flexion intolerance. This movement pattern should be adopted for all daily activities, from picking up objects to performing barbell lifts.

Progressive loading. Rebuilding the body involves a gradual progression of exercises, starting with spine-friendly core stability work and progressing to exercises that challenge stability in multiple planes of motion. This approach ensures a safe and effective return to high-performance lifting.

7. Hip Pain: Anatomy and Individual Variations

The deeper the hip socket, the less the femur can move and rotate.

Hip joint complexity. The hip joint is a ball-and-socket joint with significant anatomical variations that influence movement and injury risk. These variations include the shape and orientation of the hip socket and the angle of the femur.

Anatomical assessments. Simple tests, such as assessing hip rotation range of motion and performing Craig's test, can provide insights into individual hip anatomy and potential movement limitations. These assessments help tailor training and rehabilitation programs.

Individualized technique. It's crucial to adapt lifting technique to individual hip anatomy. Forcing a specific technique without considering anatomical variations can lead to pain and injury.

8. Knee Pain: Beyond the Anatomy-Based Diagnosis

There is no one-size-fits-all approach when it comes to knee pain because there is no one universal movement that equally stresses all of the muscles that surround the spine.

Movement-based approach. Instead of focusing solely on anatomical diagnoses like patellofemoral pain syndrome, it's essential to identify the movement problems that contribute to knee pain. This approach allows for targeted and effective treatment.

Screening process. The screening process involves assessing movement patterns (squats, single-leg squats), mobility (ankle and hip), and load tolerance. This helps classify knee pain as a biomechanical dysfunction, mobility deficiency, stability deficiency, or load intolerance.

Rehabilitation strategies. Based on the classification, specific rehabilitation strategies are implemented, including mobility exercises, stability exercises, and load management techniques. This individualized approach ensures a comprehensive and effective recovery.

9. Shoulder Pain: Balancing Mobility and Stability

The shoulder is the most dynamic and intricate joint in the entire body.

Shoulder complexity. The shoulder is a highly mobile joint that requires a delicate balance of mobility and stability. Injuries often result from imbalances between prime movers and primary stabilizers, instability, or poor movement technique.

Screening process. The screening process involves assessing movement patterns, mobility (thoracic spine, lats, pecs), stability (rotator cuff strength), and technique. This helps identify the specific factors contributing to shoulder pain.

Rehabilitation strategies. Rehabilitation strategies include mobility exercises, strengthening exercises for the rotator cuff and scapular stabilizers, and movement re-education. This comprehensive approach aims to restore balance and function to the shoulder complex.

Last updated:

FAQ

What is "Rebuilding Milo" by Aaron Horschig about?

  • Comprehensive injury guide: "Rebuilding Milo" is a lifter’s manual focused on fixing common injuries and building a strong foundation for enhanced performance, especially for strength athletes like weightlifters and powerlifters.
  • Movement and pain understanding: The book emphasizes understanding the root causes of pain, focusing on movement dysfunctions and load intolerance rather than just anatomical diagnoses.
  • Science-based, practical approach: It integrates the latest research and clinical experience, empowering athletes to self-assess, screen, and rehabilitate their injuries effectively.

Why should I read "Rebuilding Milo" by Aaron Horschig?

  • Expertise and experience: Aaron Horschig combines his background as a physical therapist and competitive Olympic weightlifter to offer evidence-based, actionable advice for lifters.
  • Empowering and practical: The book teaches readers how to perform self-assessments and understand their pain triggers, putting them in control of their recovery.
  • Tailored for strength athletes: It provides individualized approaches and test-retest methods to injury rehab, helping readers shorten recovery time and prevent re-injury.

What are the key takeaways from "Rebuilding Milo" by Aaron Horschig?

  • Movement-based diagnosis: The book moves beyond traditional anatomical labels, focusing on movement quality and biomechanical dysfunctions for more effective rehab.
  • Progressive overload and adaptation: Drawing inspiration from Milo of Croton, it highlights the importance of gradually increasing training demands while balancing stress and recovery.
  • Active rehabilitation focus: Emphasizes core stability, movement re-education, and load management over passive treatments like rest or painkillers.

What is the story behind the title "Rebuilding Milo" and its significance?

  • Inspired by Milo of Croton: The title references the ancient Greek athlete who built strength by carrying a growing calf daily, illustrating the principle of progressive overload.
  • Symbol of grit and science: The story embodies the blend of hard work, consistency, and scientific understanding necessary for building strength and recovering from injuries.
  • Progressive overload principle: The book uses this story to stress the importance of gradual, adaptive training in both performance and rehabilitation.

How does "Rebuilding Milo" by Aaron Horschig recommend diagnosing and addressing low back pain in lifters?

  • Movement dysfunction over imaging: The book stresses that MRI findings often do not correlate with pain; movement patterns and load intolerance are more critical.
  • Screening and self-assessment: Athletes are encouraged to identify pain triggers, perform self-tests, and classify pain by movement dysfunction.
  • Core stability and technique: Emphasizes strengthening and coordinating core muscles to create spinal stiffness, protecting the back during heavy lifts.

What are the "Big Three" core stability exercises in "Rebuilding Milo" and why are they important?

  • Curl-up, side plank, bird-dog: These exercises enhance core muscular endurance and coordination without excessive spinal load.
  • Isometric focus: Isometric exercises improve spinal stiffness, crucial for injury prevention and performance.
  • Foundation for rehab: Daily practice of these exercises builds a resilient core, reduces pain, and supports safe return to heavy lifting.

How does "Rebuilding Milo" by Aaron Horschig approach knee pain screening and rehabilitation?

  • Movement screening: Uses bodyweight and single-leg squats to identify biomechanical dysfunctions like knee valgus or instability.
  • Mobility and load tests: Assesses hip and ankle mobility, muscle strength, and load tolerance to pinpoint weaknesses or restrictions.
  • Five-step knee stability process: Focuses on correct squat technique, glute activation, single-leg strength, balance, and neuromuscular training to restore knee health.

What are the key concepts in shoulder injury and rehabilitation from "Rebuilding Milo"?

  • Dynamic and static stability: The shoulder relies on both passive structures and active stabilizers (rotator cuff muscles) for proper function.
  • Impingement and instability: Pain often arises from imbalances, mobility restrictions, or instability, not just structural damage.
  • Movement-based screening and rehab: Emphasizes assessing movement quality, mobility, and strength imbalances, and prescribes targeted exercises for rotator cuff and scapular stabilizers.

How does "Rebuilding Milo" by Aaron Horschig address hip pain in strength athletes?

  • Complex anatomy and causes: Hip pain can stem from muscles, tendons, joint issues, or even referred pain from the back.
  • Movement-based diagnosis: Advocates classifying hip pain by mobility restrictions, strength imbalances, or poor technique rather than just anatomical labels.
  • Targeted rehabilitation: Recommends soft tissue mobilization, joint mobilizations, isometric strengthening, and movement re-education tailored to the athlete’s deficits.

What is the continuum model of Achilles tendon pathology in "Rebuilding Milo" and how is it managed?

  • Three overlapping stages: Describes reactive tendinopathy, tendon disrepair, and degenerative tendinopathy, each with distinct characteristics.
  • Pain and load tolerance: Pain mainly arises in the reactive stage; injury occurs when training load exceeds tendon tolerance.
  • Rehab progression: Outlines a phased approach—starting with isometrics, progressing to heavy slow resistance, and then plyometrics—while managing load to promote adaptation.

Why does "Rebuilding Milo" by Aaron Horschig advise against icing injuries and soreness?

  • Inflammation is essential: Inflammation initiates healing by recruiting immune cells and growth factors; icing delays this process.
  • Swelling removal needs movement: Swelling is cleared by the lymphatic system, which depends on muscle contractions; ice can trap swelling and delay recovery.
  • Research-backed advice: Studies show icing delays muscle regeneration and can reduce strength and hypertrophy gains; active recovery is preferred.

What are some common misconceptions about injury rehab that "Rebuilding Milo" by Aaron Horschig challenges?

  • Over-reliance on imaging: The book argues that MRI findings often do not correlate with pain or dysfunction.
  • Passive treatments are insufficient: It challenges the use of rest, painkillers, or stretching as primary solutions, advocating for active rehabilitation.
  • Belts and stretching myths: Explains that weightlifting belts and hamstring stretching are not cures for pain, but tools to be used appropriately within a broader rehab strategy.

Review Summary

4.56 out of 5
Average of 637 ratings from Goodreads and Amazon.

Rebuilding Milo receives overwhelmingly positive reviews, with readers praising its clear, practical approach to injury prevention and recovery for weightlifters. Many appreciate the detailed explanations of joint mechanics, self-diagnostic tools, and rehabilitation exercises. Readers find the book invaluable for addressing common lifting-related issues and improving overall performance. Some highlight its usefulness for both professional athletes and recreational lifters. While a few suggest additional content could be beneficial, most consider it an essential resource for anyone involved in weightlifting or strength training.

Your rating:
4.71
41 ratings

About the Author

Aaron Horschig is a highly respected expert in sports rehabilitation and injury prevention, particularly in the field of weightlifting. He is known for his work as the founder of Squat University, a popular online resource for athletes and fitness enthusiasts. Horschig's approach combines his expertise as a physical therapist with practical experience in strength training. He emphasizes understanding the root causes of injuries and addressing them holistically, rather than focusing solely on symptoms. Horschig's teaching style is praised for being clear, accessible, and backed by scientific evidence. His work has gained a significant following among both professional athletes and recreational lifters, establishing him as a trusted authority in the fitness community.

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