Why I Dislike the Rear Lat Pulldown and You Should Too.

The wrong way

When I go to the gym I sometimes feel like I have to wear blinders to stop myself from seeing all the poorly executed exercises - or made-up, dangerous exercises. Let me be clear here, I don't really care if someone is doing squats and they have to wide a base or don't go to parallel, What I do care about is someone swinging a kettlebell over their head like they are Conan the Barbarian. I let it all slide because I know people don't like a random bearded man coming up to them to tell that what they are doing is probably going to end up in injury.

One thing that I have a hard time letting go is people doing the rear lat pulldown. The exercise really irks me, mainly because of people's flawed reasoning for performing it and because I think that the risks of the exercise outweigh whatever benefits one thinks it has over the front lat pulldown

The righ way
Firstly, neck position. Most of the people I see doing a rear lat pull down have terrible posture. They wrench their neck forward and slam the bar down at the CT junction. Like every other exercise, posture and spinal alignment are very important. if you're throwing yourself this far out of alignment, then it's a definite no-no.

Secondly, going along with the neck position, when somewhen flexes they neck so far forward they often times do a sort-of semi-crunch at the bottom of the movement. I cringe thinking about it, and I sort of picture Gollum from lord of the rings, with creepy bent over position.

Ok, so not everyone does the rear-lat pulldown with such terrible posture. I can hear you saying, "but I sit upright, retract my scapula and pull straight down behind my head. Why can't I do this?" Well, you can if you want to, but what benefit are you getting from doing it this way over doing the lat pulldown in front? Some people say they feel it more, or that the muscles in your back work harder, well I call bullshit. EMG studies show that the most effective position for activation of the latissimus, posterior deltoid, and teres major is the wide-grip front lat pulldown.

So even those of you with good posture are not getting the benefits you seek from doing the pulldown behind your head. What you are doing is placing your shoulder in a more externally rotated position which horizontally with horizontal abduction (a provacation test for shoulder sublaxation by the way), pinning your scapula to your back with excessive retraction during the movement, and putting added stress on the joint capsule. all this culminates to a high-risk-low-reward situation in which the only thing your increasing is the chances of anterior shoulder instability/dislocation, and impingement.

What are your thoughts? Do you still think it better to do the rear-lat pulldown? To be fair, I've seen people doing front lat pulldowns in a way that is much more dangerous (and stupid) than doing a rear lat pulldown with good posture. However, the key to any exercise is to do it as safely and as efficiently as possible, in this case the front lat pulldown wins.

Pugh, G. M. (2003). A Biomechanical Comparison of the Front and Rear Lat Pull-Down Exercise. Unpublished Masters Thesis. University of Florida.

Signorile, J. E., Zink, A. J., and Szwed, S. P. (2002). A Comparative Electromyographical Investigation of Muscle Utilization Patterns Using Various Hand Positions During the Lat Pull-down. Journal of Strength & Conditioning Research, 16(4), 539-546.   

NPTE Sample Questions

So when I was preparing to write the NPTE I wanted to get my hands on as many sample questions as a possibly could. While there are resources out there, they can be a little bit pricey. I figured that I would create a practice exam for the prospective candidates that had a little more affordable sticker price. Now, with that being said, I highly highly highly recommend scorebuilders NPTE complete study guide and the online advantage program. I found that the exams included in the study guide and the online program were very close to the format of the actual NPTE, and the study guide is very comprehensive and easy to follow. It was my main resource when preparing. Anyway, here is a sample of the questions I plan to have in my practice exam, which I hope to have completed in September for those of you taking the October Exam. 
  1. A patient presents with ipsilateral loss of proprioception and paralysis, as well as contralateral loss of pain and temperature sensation. What spinal cord injury does this describe?
    1. Anterior Cord Syndrome 
    2. Brown Sequard Syndrome 
    3. Central Cord Syndrome 
    4. Posterior Cord Syndrome

  2. A patient reports low back pain with shooting pain into both legs as far as the knee and a feeling of pins and needles that, sometimes, reaches as far as the ankle. He has been informed by his physician that he has sciatica. Which of the following does not mimic the symptoms of sciatica?
    1. Piriformis syndrome 
    2. Sacroiliitis 
    3. Spondylolisthesis 
    4. A tumor located at the spinal nerve root of L1-L2

  3. A 55-year-old patient presents with an ulcer on the lateral aspect of their ankle and has a history atherosclerosis with an Ankle Brachial Index (ABI) of 0.7. Which of the following would the patient most likely exhibit?
    1. COPD 
    2. Obesity 
    3. Poorly Controlled Diabetes Mellitus 
    4. Varicose Veins

  4. A patient’s EKG is shown in the picture to the right. What heart rhythm does the patient exhibit? 

    1. Atrial Fibrillation 
    2. Sinus Bradycardia 
    3. Sinus Tachycardia 
    4. Ventricular Tachycardia

  5. While working in a Skilled Nursing Facility, you are asked to complete an assessment on a 73-year-old patient who has been diagnosed as having a left sided CVA. Which of the following would you not expect the patient to have?
    1. Ataxic movement of bilateral upper limbs 
    2. Difficulty understanding words written or spoken
    3. Hemiparesis of the right leg
    4. Slow, deliberate movements

  6. A 65-year-old African American male patient, who admitted to smoking at least a pack of cigarettes a day, has to urinate more frequently at night, has swollen feet and ankles, and muscle weakness. Which of the following is he most likely experiencing symptoms of?
    1. Exacerbation of COPD 
    2. Left Sided Heart Failure 
    3. Right Sided Heart Failure 
    4. Sickle Cell Anemia

  7. Upon examination of a 23-year-old female patient with complaints of shoulder pain you find that the patient has a painful arc, painful palpation of deltoid tuberosity, weak external shoulder rotation, and a positive Hawkes-Kennedy test. Which of the following muscles is least likely to be a contributing factor to the patient’s pain.
    1. Infraspinatus 
    2. Supraspinatus 
    3. Teres Major 
    4. Teres Minor

  8. Which of the following responsibilities would be most appropriate to delegate to a Physical Therapy Assistant.
    1. Continuation of established treatment plan
    2. Developing an exercise plain for a patient 
    3. Mobilizing a patient for the first time
    4. Taking patient history

  9. An ABG reading shows the following values: pH 7.28, paCO2 49. The patient also has a heart rate of 110bpm. What condition is the patient experiencing?
    1. Acute Respiratory Distress Syndrome 
    2. Metabolic Acidosis 
    3. Metabolic Alkalosis 
    4. Respiratory Acidosis

  10. A 30-year-old man has burns covering his chest, abdomen, and right arm. According to the rule of nines, what percentage of his body has been burned?
    1. 18% 
    2. 22.5% 
    3. 27% 
    4. 31.5%
Answer Key
  1. B
  2. D
  3. C
  4. C
  5. A
  6. C
  7. C
  8. A
  9. D
  10. B
Please let me know your thoughts about the questions, be it about the difficulty, if you want some explanation of the answers, if they're just worded funny. It's hard to be critical of your own work.

Getting my 2.5lbs Weights!

I've been informed by the folks and Blink fitness - after my numerous suggestions - that I can expect to see 2.5lbs weight plates by mid-august. I want to take credit for the fact that they're getting the plates, but they were probably planning on it anyway. Still, it's good to think that they actually took my suggestions on board. Now if they get a couple more oly bars and a dedicated bench press I'll be super happy.

Aside from that I don't have anything really interested to add. I am planning on making and NPTE practice exam. If that's something you great people think would interest you let me know. I know when I was preparing to write the exam I wanted to get my hands on as many practice exams as possible, but those suckers can be expensive! It'll probably be a long-time in the works, but keep an eye out here for updates. 

I hope everyone is having a fantastic first weekend of August.