The Fast Food Guide

Ever find that you’re on the go, and haven’t planned your eating well? So you decide to eat out. If you’re trying to maintain your body composition or lose fat, eating out can absolutely destroy your results if you decide to go on the “see-food-eat diet.”

There’s always a loophole though. There are ways to still eat healthy while eating out at “unhealthy” restaurants. Just to make sure my readers understand, I do not suggest eating out should be a regular occurrence. This is just some information you can use when you find yourself in a bind. I will go over a few adjustments you can make to your food choices. I will also go over some specific items that you can select when you find yourself in a fast food restaurant.

When eating in fast food restaurants, you will want to try and avoid eating sugar at all costs. If you are trying to reduce body fat, keeping out the sugar and the starchy carbs would be your best bet.

Here is a list of fast foods, drinks and condiments which contain sugar and starch:
• Soft Drinks – Iced Tea is included! Just because it says tea on it doesn’t mean it’s not full of sugar… It has slightly less sugar in it than any other pop that they serve.
• Buns – they’re usually made with white bread.
• If your burger, sandwich or salad is sweet, it’s because it has some sugar- based sauce on it. If you absolutely have to use sauce, try and keep it to a minimum. You can also ask for the salad dressing on the side, so you can control how much you consume.
• Breaded chicken. Yes, chicken is a great source of protein. When they’re breaded and deep fried, the garbage content goes up and defeats the whole purpose of eating chicken… Which is that it’s a great lean source of protein, it has little to no fat, and 0 grams of carbs. Chicken McNuggets have more carbs and fat per serving than protein. Ew.
• Fries and condiments • pretty self-explanatory here. Breaded carbs deep fried in fat, is incredibly tasty. Your heart and blood vessels will thank you for staying away from fries in the long run. Go easy on the ketchup, mayo and other sweet sauces too.

So what does this leave us to eat? Mainly meat. I suggest eating as much meat as possible when you go to these types of restaurants. Carb sources should be kept to a minimum, seeing as most of the carbs you can get at fast food restaurants are all part of the list above. As for beverages, water is always a good choice, har-har. Artificially sweetened drink(s) are also acceptable. I’m not a huge fan of milk, but you can usually get milk from these types of places too.

I’d like to briefly go over artificially sweeteners. There’s a lot of conflicting information out there. Personally, I don’t drink diet pop. My whey protein is favoured with artificial sweeteners though, so I do have it on a regular basis. Here are two studies, that have completely opposite results, this study says that artificial sweeteners won’t make a difference on daily calorie intake. The subjects drinking an artificially sweetened beverage would still ingest the same amount of calories in an entire day that would ingest if they drank a regular sucrose containing drink. This study concluded that participants in the study would not compensate by eating more after consuming artificially sweetened beverages.

In my opinion, if you are drinking artificially sweetened drinks, yet getting the compensated calories from healthy foods, I don’t see a problem. I would rather you get calories from actual food and not high-fructose corn syrup. I would like to again reiterate that drinking water or green tea would be a much better choice, but I know a lot of people won’t listen to that advice.

If you have high blood pressure or cholesterol issues, you may want to avoid the beef patties. They usually pack a fair amount of sodium and tend to have an equal amount of saturated fat to protein content! For a normal person, this isn’t much of an issue. Just know that the patties will usually have ~ 25 grams of protein and ~25 grams of fat per patty. This amounts to 325 calories per patty. A grilled chicken breast will have somewhere around 25 grams of protein, 3 grams of fat and 0 carbs. This comes out to 127 calories.

Salads are another great option. However, try to stay away from the salad that include) breaded chicken. If it says “ crunchy” or “crispy”, this means it’s breaded and deep-fried. Go for “grilled or “steamed.” Try and choose a salad where the salad dressing isn’t full of sugar too. Also be weary of creamy dressings, they tend to be pretty high in fat. Vinaigrettes would be the best option here. Pretty much any salad is going to better than a burger, fries and pop. So don’t feel too bad if you choose the sweetest one. You can get away with it if you have good insulin sensitivity.

Tim Horton’s has some pretty decent sandwiches on its menu. Their sandwiches all have a low amount of sugar and reasonably low amounts of fat. Their bread is quite dense though; you could always eat the sandwich open faced to lower carb and calorie content. Their soups are decent. Most of them are far too chintzy on the meat. The exception is the chili, which has a pretty good nutritional profile: it backs a good amount of protein and carbs. It’s also packed with sodium too, so if you have high blood pressure you may want to rethink your options.

So take this information and see if you can apply it to your day-to-day living. It will make you healthier and leaner. Isn’t that the goal for most of us?

Heavy Lifting Not Required

Even The Mouse Can Smell The Bull@#$t
I hope the title of this entry makes you laugh as much as it did for me. It’s the title of an article from The Province last month. Written by two doctors, no less. It’s trash articles like this that makes me question the sanity of some of the professionals out there. It makes me wonder what is worse: unintentional ignorance, or intentional ignorance. What I mean by that is some people read something and then seems to defend it with grand zealousness, completely ignoring the truth. Then there are others who don’t know squat about something, yet defend it to the death even though they have no facts backing it up.

Basically the article said to lift 30% less weight to receive the same benefits of lifting “heavy.” The authors said the light lifters gained as much if not more than the heavy lifters. That’s exactly what we need, more people lifting pink dumbbells for a 100 reps, thinking they are going to PROGRESS.

I believe this study is the one they are referring to. Unfortunately it seems the authors followed the unintentional ignorance route with this study. It would be interesting to know if either of these doctors have touched a weight or have ever resistance trained in their life. I wonder if the authors thought about what the long-term effects of training in this manner would be?

The study did biopsies on the subjects at 4 and 24 hours post resistance training. So the study doesn’t even look at the long-term effects of “light” lifting. The long-term effect of training in this manner is that your body lookis the exact same way it did when you started, very small amounts if any muscle accumulation, and pretty much zero gains in strength.

This study also ignored any hypertrophy (muscle size) gains. It focused on muscle protein synthesis, anabolic signaling, and myogenic gene expression. I’m not refuting the studies results, if protein synthesis increased, that is excellent. Unfortunately muscle takes a while to grow, so it would’ve been more interesting if the study showed how this increase in protein synthesis affected muscle and strength gains over an extended period of time.

The authors of the article go on to say “that’s especially good news for people who risk injury using heavy weights – newbie’s, older exercisers, and folks doing rehab.” (Oz, 2010) I agree for older people and rehab, light lifting would most likely be the way to go. A newbie doesn’t need to do 20 reps, unless they want to waste their time. A newbie certainly needs to be careful with lifting at a high intensity when starting. They don’t need to fully ignore training intensely for fear of injuring themselves though. It’s like a child learning to ride a bike, the training wheels need to come off at some point. So a newbie could lift in the 12-15 rep range for a while, then take a leap into lower rep ranges.

The study was also performed on the leg extension machine. I always find it odd that when performing studies on muscles, they choose this crappy exercise. I suppose it’s due to its ease of instruction, and its’ safety. I just think there are a tons of better options.

I guess I just get frustrated with all the shitty information there is out there that is taken as fact. I’m all for research, but when the study has a bunch of holes in it, which happens often (ever wonder where the whole ‘high-carb’ craze came from?), it just annoys me. This is why I’m very careful with where I get my information. I get the best information from coaches who fuse real world experience with scientific backing.

A great example is the shift towards more stabilization type training for the core. Stuart McGill’s research put together in !i!Low Back Disorders!endi! has shown most of the best coaches how dangerous flexing the lumbar spine can be. So now most of the top-notch coaches have thrown crunches and the like into the trash. I will admit, that for quite a while I didn’t see any problem with crunches, now that I’ve read the research, and read about what other great coaches are doing, I too have switched to stabilization exercises for the core.

I’d like to conclude by saying that the doctors who wrote this article probably wrote this article with the best of intentions. It would have been nice if they maybe did a little research on the benefits of lifting heavier. It really doesn’t take too long to figure out that a program prescribing 24 reps, isn’t going to work long, if at all. So hopefully, my blog entry can give you some clarity into some of the fallacies portrayed by the media.

References:

McMaster University (2010, August 12). Building muscle doesn’t require lifting heavy weights, study shows. ScienceDaily. Retrieved November 26, 2010, from http://www.sciencedaily.com/releases/2010/08/100811125943.htm

Oz, M., Roizen, M., (2010, October 18). Heavy lifting is not required. The Province, ppB9.

Random Friday

Another random friday for you. I will most likely expand on a couple of these topics in the next couple of weeks. Enjoy!

!bul!
CNN released an article last week, in which a man lost 27 pounds in two months eating mostly junk food. Not only did he shed of those pounds, he also lowered his LDL (bad cholesterol), raised his HDL (good cholesterol) and lowered his triglyceride levels. It was also revealed that he had a protein shake and a few types of veggies along with his diet.

Personally, I think it’s an interesting test. However, he was in a caloric deficit of about 800 calories per day. So yes, he is going to lose weight with such a large caloric deficit. The article doesn’t say anything about his change in body composition. Did he lose 27 pounds of fat? No way, he would’ve lost some lean mass as well, due to his low protein intake. It’s also common for people to lower LDL and triglycerides as well as raise HDL as a byproduct of fat loss. So it would’ve been interesting to see how his cholesterol and triglyceride levels would change the longer he was on the diet. I’d imagine his HDL would lower, LDL and triglycerides would go back up, but who knows.

!midbul!
I think all ladies and most men should be doing Hip Thrusts. This exercise will hypertrophy your ass (literally) as well as provide strength across the board in lower body exercises. The glutes are a sleeping giant in most individuals, so strengthening them will not only make you more aesthetic but can improve anterior pelvic tilt. Bret Contreras is the Glute Guy and you can check his blog out here

!midbul!
I’d like to make a point to some of my female readers. Training heavy won’t turn you into a she-male! Bret Contreras and Tony Gentilcore are two great coaches who are on a mission to help the ladies get the bodies they want through lifting hard and heavy. Here is a clip of one of Bret’s clients, I’d say she’s got a great body AND is strong. Look at female sprinters, I don’t think they’re chubby or soft. These athletes have a combination of strength and aesthetics that isn’t seen in the general populace. Why is this? They train hard, heavy and consistently.

!midbul!
I’d like to share something with you that has me vexed. I see personal trainers with their clients on treadmills and bikes etc. way too often. I’m not hating on running, but there are so many other low impact exercise options that can be used to burn fat and get your heart rate up. Besides, do you need to be paying a personal trainer 75$ of your hard earned money to talk to you while you’re on a treadmill? If a client is obese, than treadmills, recumbent bikes etc. can be used. Just do yourself a favour: if you’re unsure how to use the equipment ask your trainer. After that, save your money and do it on your own time.

!midbul!
Check out the abstract of this study. The point of the study was to observe the effects of feeding during watching television on boys. The boys were given a drink containing artificially sweetener or carbohydrates (most likely some form of juice) 2 hours after eating breakfast. They then had the boys eat pizza while watching TV and not watching TV. The boys who watched TV ate an average of !b!228!endb! kcal more than the no TV group. The conclusion from the study: “TVV* while eating a meal contributes to increased energy intake by delaying normal mealtime satiation and reducing satiety signals from previously consumed foods.” So eating while not distracted by TV or other distractions may reduce caloric intake. Interesting…

*TVV = Television Viewing

Weight Training Injuries

A close friend of mine suggested I write on a few injuries that can occur from resistance training with poor form. I think it’s a great topic, as I’m sure many people get little kinks from weight training. These small things, if not addressed properly may lead to bigger issues down the road. I’m sure most people don’t want to be confined to a wheel chair because they couldn’t check their ego at the door when they were younger.

What sorts of injuries can occur from resistance training? There are a more than I can name, but I will briefly go over more common injuries that occur. Inflammation is a big one: bicep tendonitis, tricep tendonitis, patellar tendonitis (around your knee), lateral epicondylitis (outside of elbow) and medial epicondylitis (inside of elbow) are the common ones. Fish oil is a powerful anti-inflammatory and is a supplement I believe EVERYONE should be using. Resting and icing the inflamed area can deal with inflammation.

Overtraining isn’t really an injury but something that can cause lost training time. It really isn’t as prevalent as everyone thinks, but it does occur. Overtraining occurs when an individual trains beyond the bodies’ ability to recover. If you are weight training 6x per week for 2 hours a day, you may eventually begin to over train. There are numerous symptoms of overtraining: sudden drops in performance, depression, lack of enthusiasm, increased incidence of injury, decreased immunity. These are just a few of the more major symptoms. Good programming, and de-loading (a de-load is basically when you decrease the total reps you lift for an exercise as well as decreasing the load) weeks are good ways to prevent over training.

Poor training can exacerbate muscle imbalances, due to 21st century living. Most people spend their days sitting down in front of a computer. As you can see from the picture above, this gentleman’s upper back is kyphotic (rounded), his cervical spine (neck) is flexed and his shoulders are rounded. Not to mention that his hip flexors are most likely shortened because they are constantly in a shortened state.

I could go into detail about how these things are bad, but I think it would bore you to death. Just know that this posture can cause a lot of pain in the upper body. Strengthening and stretching the proper muscles and making small changes in your workday can contribute to a healthier, pain-free posture.

Plantar fasciitis, heel spurs, and shin splints (medial tibial stress syndrome) are common injuries in runners. Running in general can cause these ailments as can running on a treadmill. Plantar fasciitis is pain in your plantar fascia, which is a tendon on the bottom of your foot. It’s thought to be due to: tight calves, pronated feet, supinated feet, excessive walking in footwear that does not provide an adequate arch, and being over weight. Massage, such as Self-Myofascial Release are good treatments. Heel spurs occur when the plantar fascia is pulled away from the heel and new bone is laid down where it doesn’t belong. Shin splints compose 15% of running related injuries (Spolar 1990) and are the results of: high impact training, excessive training, poor technique, flat feet, or pronated feet (Walker, 2010).

I’d like to talk a little bit more about running related injuries because they are quite prevalent. A study by Walter et al (1989) monitored 1680 runners over a 12-month period. 48% of the runner experienced at least one injury! That’s not a good statistic. I’m not trying to discourage running, but if you run regularly I hope you have a good massage therapist.

If you’re a sharp reader you will realize that nearly all these injuries have something in common. Overuse! Now please, don’t say to yourself “wow, this Kyle guy is full of shit, he thinks I should neither run nor resistance train.” That statement couldn’t be farther from the truth. What I do believe in is a good balanced program, and being smart about injury treatment.

I’d like to share with you my case of medial eipcondylitis. When I was around 18, I started lifting weights regularly. I would try to bench press and my elbow absolutely killed! I went to physiotherapy and he told me I had medial epicondylitis. I did certain exercises and stretches, in all honesty my elbow just wasn’t getting better at that time. I decided I would just tough it out. I can’t tell you why, but the pain eventually just went away and I haven’t had an issue with it in years. I know the reason for this was probably because I was 18 and recovery abilities tend to be excellent at this age up until the mid 20’s.

Now when I get aches and pains I will usually take it easy for a week or so until the pain subsides. I know that in the long term, this will allow me to lift for a longer period of time while being pain-free. I’m sure that anyone who loves lifting weights has that same goal.

References:
Spolar, Chris (1990-07-10). “Shin Splints: the Result of Overused Muscles”. The Washington Post : p. Z18.

Walker, Brad. “Shin Splints and Shin Splints Treatment”. The Stretching Handbook. The Stretching Institute. Retrieved 19 October 2010.

Stephen D. Walter, PhD; L. E. Hart, MB, BCh, MSc, FRCPC; John M. McIntosh, MSc; John R. Sutton, MB, FRCPC Arch Intern Med. 1989;149(11):2561-2564.

Habit-Based Nutrition… Why It Works

I’d like explain to my readers about habit-based nutrition and why it works. Habit-based nutrition is something I learned during my Precision Nutrition Certification. I’ve talked to many people about how their trainers would guide them into dieting. Usually they tell me “my trainer made me eat Special K” or “they gave me this sheet that tells me what to eat and how much to eat.” These blueprint-type methods rarely work.

I remember when I first started helping my friend (we’ll call him Tony) lose weight. He went from around 290 to 225 in 6 months. He is probably the most motivated person I have ever worked with. I probably could’ve given him a complete blueprint to follow, and I have no doubt that he would’ve followed it to a T. However, most people don’t work this way. You tell someone to completely alter everything they eat; it might work for a week. Then the wheels will fall off.

In The Essentials of Sports and Exercise Nutrition, John Berardi mentions Leo Babauta’s book, The Power of Less. Basically, Babauta says that if you give someone one habit per month, their success rate will be around 80%. Increasing to only two habits per month brings the success rate down to a paltry 20%! For most people who are new to living a healthy lifestyle, one small habit every month will suffice. This means 12 new habits per year. Believe me, these small changes in your habits can have huge implications on your health and body composition.

There are also different levels of nutrition. For instance most people are at level 1. This means their body composition has room for improvement; they don’t understand eating healthy very well; their kitchen isn’t set up for success. Deciding at which nutritional level the client is functioning helps the consultant understand what needs to be done to help the clients reach their goals. I wouldn’t need to make the same changes to a level 2 client as a level 1 client because there is a good chance they’re more knowledgeable about eating healthy.

Let’s examine one of my clients (we’ll call him John). John was the first client that I’d used habit-based methods with. He lost around 29 lbs in 3 months. The coolest thing about this weight loss though, is that he has stayed at the same weight AFTER working with me. So he was able to change his habits to such a degree, that his results stayed with him. He didn’t revert back to his old eating habits.

The key to losing weight is finding your limiting factor(s) that are holding you back from your goals. !i!The Essentials of Sports and Exercise Nutrition!endi! define a limiting factor as anything that makes it more difficult for a client to achieve optimal results. A limiting factor can be that the client has 6 cans of coke a day. That turns out be something like 840 calories a day. So I’d start off by trying to limit that coke to four cans a day. This would cause calories to be reduced, which would eventually induce weight-loss. Now if I told that person to stop drinking coke entirely, chances are it wouldn’t adhere.

Another potential limiting factor might be that the client goes to Starbucks and eats a zucchini walnut muffin and a latte every morning. That muffin contains 490 calories, their lattes range between 100-400 calories. That’s a combined 600-900 or so calories per breakfast! So for their first habit, I might suggest they find a muffin, which contains less calories, and maybe consume a drink containing less calories (green tea would be perfect here).

A lot of diets just don’t seem to work. In !i!Best Weight!endi! by Yoni Freedhoff (MD) and Arya M. Sharma (MD, PhD) they say, “a patient’s best weight is therefore whatever weight they achieve while living the healthiest lifestyle they can truly enjoy.” So if someone told you, you needed to completely alter your eating habits, do you think you would enjoy it? I know I wouldn’t enjoy that. This is why I feel that slower, habit-based changes are the way to go. I work with my client to find out what they enjoy eating and implement that into their lifestyle. That way they are much more likely to maintain the weight loss, rather than regress to the weight they were before working with me.

My Training For The Week

I figure some people might be interested in what I personally do for training. I won’t go into too much detail in terms of mobility or self-myofascial release (SMR) but I will outline my weight training and goals and stuff like that.

My current goals are to drop down to single digit bodyfat. I’m not currently measuring bodyfat. I am taking girth measurements, skinfold measurements, and body weight. I’m also taking pics to see the progress. I’m also trying to keep as much as my muscle mass as possible while trying to lose only fat mass. I have leaned out before, but I did it too quickly and ended up losing a fair amount of lean mass too. This time around, I’m aiming to lose 1-2 lbs per week. This will ensure minimum losses in muscle.

I’m not a big proponent of cardio for fat loss because I feel it’s a waste of time. I guess I should re-phrase that, I feel it has a poor return on investment. I could spend 1 hour doing boring steady state cardio all the while thinking about how I would rather be watching grass grow… So say I do an hour of cardio, maybe I burn 500 calories. Instead of doing that, I just cut 500 calories from my diet. Voila! Problem solved, and I will have that hour to write entertaining blog posts for my faithful readers.

With that said, I don’t want people to think I think cardio is useless or that I’m a sloth. I don’t sit on my ass all day. I do work. In all honesty, I’d rather immerse myself in Diagnosis and Movement Impairment Syndrome by Shirley Sahrmann, then haul ass on a treadmill.

For weight training, I’m doing a pretty simple program. Here are my last four sessions:

Day 1:Incline Bench, BB Rows, Dips, DB Curls

Day 2: Back Squats, Hip Thrusts, Drag Curls

Day 3: Weighted Chins, Floor Bench, Cable Rows, Band Pushdowns

Day 4: Deadlifts, Back Extensions, Hammer Curls

Yes, there are a few isolation movements. I have them in there because my biceps need some work and I find I lose mass from them pretty quick, so I want as much stimulation as possible. The big compound lifts are still the ones I concentrate on. I’m doing a method called reverse pyramid training on 2 of my main lifts. I really like the results I’ve gotten so far.

This program is mainly for strength and size. If you keep you strength up, it’s pretty likely that you are keeping most of your muscle mass. So staying strong is important.

I wasn’t able to do dips last week because I hurt my shoulder incline benching. My floor bench a few days later suffered as well. My shoulder feels around 100% now, so I’ll be good for next week.

My diet is intermittent fasting. I wrote about it in my post titled Feeding, Satiety and Fullness, which can be found here. If you’re too lazy to read that last article I will summarize IF’ing for you. I have an 8 hour feeding window, and then fast for the next 16 hours. This is daily. On days that I train my caloric intake is at maintenance levels. Off days, they are below maintenance levels.

I’ve been slacking a bit on my blog posts. I will give you a few good ones next week. I’m attending Mike Robertson’s seminar this weekend on Bulletproofing Your Clients Lower Back and Knees. Cannot wait to hear him speak as everything he says is golden.

Thoughts On Conventional ‘Ab’ Training

I mentioned in another blog entry that I thought that crunches are a crappy exercise. In this article (scroll down a bit to Endless Crunches For Fat Loss). I would like to explain to my followers the reasons for that statement. There are two main reasons that crunches, sit-ups and pretty much the majority of trunk flexion exercises are crap. First, repeated spinal flexion has been shown to cause disk herniation. Second, when most people perform crunches, they are exacerbating their kyphotic thoracic spine.

Let me begin by explaining to you what I mean by ‘trunk flexion.’ The trunk refers to the body aside from the appendages and head. So if you could imagine what you looked like with no head, arms or legs, that would be your trunk. Flexion is a bending action. Stand up with your arms fully extended at your sides, now bring your hand up towards your shoulders by bending your elbow. This is elbow flexion. Trunk flexion is the bending of your trunk.

Let’s briefly discuss how trunk flexion can cause disc herniation. The word disc refers to intervetebral disc. These discs are wedged between our vertebrae, allowing our spine to bend and rotate. A herniation occurs when parts of the disc are pushed out of their normal position. This can cause back pain, leg pain and weakness of the lower extremities. During a sit-up, our lumbar (lower) spine is repeatedly flexed, placing large amounts of compression on our discs. It is this repeated disc compression that can cause the disc contents to spill out of the disc causing the problems listed above. See this video for a look at how pig spines react to lumbar flexion.

Young people usually feel immune to injury. I will admit, that I too sometimes feel that way, even though this is obviously not true. According to Adams and Hutton (1985) disc herniations are more likely in younger individuals because younger people’s discs have a higher water content and more hydraulic behaviour. So young people are at an even greater risk of disc herniations than older folks.

Dr. Stuart McGill, the world-renowned back specialist, has concluded that our bodies only have a limited amount of flexion cycles before a disc herniation becomes imminent. He puts the number around 28,000. So keeping lumbar flexion to a minimum is very important for a healthy back.

Now let’s examine how these trunk flexion exercises can exacerbate kyphotic posture. Kyphotic posture is basically an excessive rounding of the upper back. Have a look at Quasimodo for a bad case of kyphosis. Now, traditional ab training shortens the rectus abdominus (RA). The RA originates at the pubis and inserts on a few of our ribs and the xiphoid process of the sternum. By shortening this muscle, the ribs get pulled down. Stand up and do the crunching motion so you can see your profile view in the mirror, your upper back is rounded right?

You may be thinking “if I can’t do any type of crunch, then what the hell am I supposed to do for my core?” Well, there is a simple solution for that. There are far too many texts and studies that have shown that the core needs to be trained more as a stabilizer. There are a few different movements that should be utilized in a core training program: leg flexion with neutral spine (ball jackknifes), anti-extension (bridges), anti-lateral flexion (unilateral farmers carry), and anti rotation (pallof presses). I stole the movements from above from Mike Robertson; he’s one smart guy. You can pick two different movements and put them in each training session for your core training. So your core training for day one may look like bridges and pallof presses, day two could be ball jackknife and unilateral farmers carry.

I hope I can convert someone to stop doing ‘traditional’ ab training and start training the core in a safe and effective manner. Trust me, it’s still hard, and you will gain strength in your core. It will carry over to your other lifts and increase performance for sports as well.

References:
Adams, M.A., and Hutton, W.C., (1985) Gradual Disc Prolapse. Spine, 10: 524

McGill, S., (2007) Function Anatomy of the Lumbar Spine. Low Back Disorders: Evidence-Based Prevention and Rehabilitation.