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PARTICIPANTS Jonathan L. Glashow, MD Lenox Hill Hospital, New York City Jim Ramsay Team Trainer for N.Y. Rangers

I'm joined by two of the fittest guys we could have in the studio. On my left is Jim Ramsay. He's the Athletic Trainer for the New York Rangers hockey team. So he's used to working out with some pretty big, world class athletes.

Sitting next to Jim is Dr. Jonathan Glashow. He's a sports medicine orthopedic surgeon at Lennox Hill Hospital in New York. He's also a consultant to the aforementioned New York Rangers, as well as numerous olympic athletes. Guys, thanks for joining us here on the webcast.

I mentioned we're dealing with form at the gym. How important is perfect form and good form when you're working out?

JIM RAMSAY: Well, David, more and more people are getting involved in weight training. It seems to be the "in" thing in most fitness facilities today. When you go in there you'll notice a lot of different people using a lot of different forms. We try to stress with our athletes that form is important before technique and basically the two are intertwined. Proper form reduces the risk of injury and maximizes your workout.

DAVID FOLK THOMASJonathan, can you further what Jim said right there? You're sort of on the operating side, maybe after people have messed up. But you also can tell them what to do.

JONATHAN GLASHOW, MD: Both before and after, the position and technique have a great deal to do with any result one wants to get out of the gym. While Jim has direct contact with athletes on a day-to-day basis, I often see numerous athletes who come in who've done things the wrong way and then wound up in trouble. So a little bit of prevention and proper form and technique goes a long way to prevent injuries down the road, specifically in the knee and shoulder which I happen to see a fair bit of.

DAVID FOLK THOMAS: Jim, for example, let's say a health club in New York City or anywhere, if you walk in there and you look around, are you noticing that there's a lot of bad form going on there? Do you take note of that?

JIM RAMSAY: I think a lot of fitness facilities today have hired excellent staff. Certified strength and conditioning people that are nationally certified work with individuals in the gym, or persons coming in off the street for the first time getting involved in weight training. A lot of gyms will set them up with a personal trainer for their first couple of sessions. So that person automatically is learning proper technique, proper form, and what's going to maximize their workout, what's going to allow them to get to their goals.

DAVID FOLK THOMAS: I know we have some video and one of the most common exercises at the gym is the bench press. I usually think everybody likes to go to that because you're lying down. "Oh, I can lie down in between reps." But we're going to take a look at some video right here you see rolling. We have an unidentified man bench pressing there. Why don't both of you guys take turns commenting on his form there?

JIM RAMSAY: One of the main things we try to stress with our athletes is a neutral spine. Basically what that is, David, is it's contracting the abdominals and the low back and trying to keep the abdominals in a contracted position. It puts the spine and your pelvis in neutral, reduces the risk of back injury and at the same time, while you're doing any exercise it's going to condition those muscles. This individual is arching his back off the bench. You can actually see daylight coming through underneath his back. So he's not maintaining a neutral spine and that can lead to injury in his low back and actually reduce his ability to lift the proper weight and lift it properly.

DAVID FOLK THOMAS: Jonathan, what's your take on this video?

JONATHAN GLASHOW, MD: Well, just to start with, I think the bench press is probably a horrible exercise for most day-to-day people. I think everybody loves to do it and loves to do it too aggressively, and I wind up seeing a lot of injuries brought on by that one exercise.

DAVID FOLK THOMAS: What kind of injuries?

JONATHAN GLASHOW, MD: I think people over-challenge themselves and they tend to lift too much and when doing so, going back to what Jim was saying earlier, their form is slightly incorrect and the shoulder is in a very precarious position in the bench press. Now with the Rangers and with supervision like Jim gives them, that's great. But for most athletes who walk into the gym off the street for the first time and the first thing they happen to see is the bench press, all their buddies ask them, "How much can you bench press?" So it's a natural attraction to that machine.

The truth of the matter is, it's probably not a great exercise for your chest unsupervised, and there's a lot more you can do with a lot less risks. So what Jim just said I think is absolutely true. In strengthening the core muscles of the body seems to be the lead in what most athletic organizations are taking to strengthen their central, or core muscles.

But if you had to critique what was going on I think it's very true that when one arcs their back, for instance, it may lead to trouble down the line. What arcing, or putting a slight arc in the spine, does to the shoulder, however, it tends to stabilize the scapula, or the wing bones. In doing that, it may reduce some of the injury pattern to the shoulders in and of itself. But again, there's a plus/minus with the changes that one does. In general, I keep people away from the bench.

DAVID FOLK THOMAS: Let's look at the video one more time. I guess this is a better way for overall, but maybe not as good for the shoulder as you were just mentioning. What's different here than what we watched before is that his back is flatter. Is that the difference?

JIM RAMSAY: Right. He's more in a neutral spine. So he's basically creating a pelvic tilt motion which contracts the abdominals, contracts the low back and maintains the spine in a neutral position. So it's reducing his risk of injury and allowing him to lift properly. Again, Jonathan brought up a good point in terms of reducing the stress on the shoulders. Of course, his specialty is shoulder injury. But basically, I agree with him.

DAVID FOLK THOMAS: If he wants to stay in business he should be promoting the wrong way.

JIM RAMSAY: But he brought up an excellent point in terms of shoulder mechanics and shoulder injuries that can lead to by doing the wrong positioning on the bench press or trying to do too much weight, and creating the beach body where people walk along the beach, having a larger chest and the big guns, big biceps and triceps. So there are other ways of attaining that.

DAVID FOLK THOMAS: We also have some video of leg pressing. Jim, what do you see here?

JIM RAMSAY: This is very bad positioning. Basically, you can't really make it out, but his legs look like they're a little bowed out, so his feet aren't in a neutral position, pointing straight forward. That's going to put a lot of stress on the knees. As well, he's going way, way back too far. His knees are coming in to his chest. It puts a lot of stress on the low back and that can lead to low back injuries again. You basically want to create that neutral spine. We can't emphasize that enough for the player or the individual in the facilities doing a pelvic tilt, neutral spine, it reduces lower back injuries as well as working those core spinal muscles at the same time.

DAVID FOLK THOMAS: Now Jonathan, I think now we may have our same fitness guy doing a different version. Is he doing any better here?

JONATHAN GLASHOW, MD: Absolutely. Back to what Jim said, without a healthy spine you can't really do any extremity exercises, and by stopping at the 90 degree or right angle with his knee as he just did, he protects the lower back and he protects the kneecap. When you bend the knee beyond that 90 degree mark you put a tremendously increased force across the patella, the kneecap joint.

Those dreaded chondromalacia patella, or patella femora problems that a lot of young people have are accentuated by the exercise when it's done improperly. But again, if you injure the spine and you have a sore low back, it throws the entire lower extremity mechanics out. So I think Jim's proper re-emphasizing again and again that if you don't do the core strengthening exercises it doesn't pay to do the peripheral exercises. Start from the center and build out.

DAVID FOLK THOMAS: So basically the pelvis and the spine, everything else has to come from there. If you just go and start flailing with barbells you're going to mess yourself up.

JIM RAMSAY: Exactly. What we try to emphasize is, core strength first. Then work into stabilizing muscles, which are basically the larger muscle groups of the shoulder and the legs. Then we go into the muscles that actually look good, the biceps and triceps and things like that. But we can't emphasize enough in terms of core strength, that it is becoming a major focal point in sports medicine and fitness facilities.

DAVID FOLK THOMAS: So Jonathan, what would you advise someone who's out there in the gym. Maybe they're either staring out or somebody who's been doing it not the proper way. How do you start? Do you do a lot with the abdomen and with the back and then get more into the other stuff? How would you advise that?

JONATHAN GLASHOW, MD: That's a good question and I think it frequently goes unanswered or unaddressed. I think that people have to have a plan when they go in. Most people like to go in and do guns or biceps and triceps, and walk out all pumped up and go out for a drink. That's a setup for failure and there's no achievement down the road with that. I think one has to identify the areas of weakness, either by history of having back pains or stomach pains, and work on those particular core muscles, the back muscles and the stomach muscles, the abdominals.

Make them strong first under the supervision of somebody who's got training, an athletic trainer or a certified trainer, and be placed in a program that works for them. Well into that program, then develop a regimen of exercises that start with the larger muscles, the more proximal or closer muscles to the center, meaning the shoulder girdle muscles, the upper thigh muscles. Then extend down to the biceps, forearm, triceps. Then down to the calf muscles. Start from the center and build out. But without a strong center -- it's like building a foundation for a house -- a weak foundation. One gets nowhere with the third story when the foundation isn't strong, and it's similar in the body. You have to address it that way, with a plan. I think few people go in with a plan if I may add.

If you look at people at the health club -- and I consult to some of these health clubs -- and you look at what happens to most people in time, they don't change their body or their athleticism very much at all because most people tend to do the same thing over and over. They don't have a plan.

DAVID FOLK THOMAS: They get in a rut.

JONATHAN GLASHOW, MD: They get in a rut and they just don't challenge their body. If they come up with a plan and a goal, every once in a while they should readdress that and decide if they meet that goal. Are they suffering fewer injuries with the sports they want to do? Are they getting stronger? Are they building more endurance? Then they've gotten somewhere. In the Rangers, in a professional organization, it's done for them. But on a day to day basis for the average athlete in New York City, for instance, I don't think they actually look to see what they're gaining from their gym's training. Maybe if they did that and became a little more introspective that way, they could identify for themselves or with the help of a trainer, their weak points.

DAVID FOLK THOMAS: Jim, final thoughts again about the core? Building from the core and also finish up by saying how does somebody out there -- we mentioned trainers -- finds somebody to help them get in the right direction? I assume you're not available for all of them.

JIM RAMSAY: I wish I could be. But I think a key element when you walk in the fitness facilities now is, and this might be a different topic, the physio-ball. The giant balls that you're seeing in different gyms. People are being trained in facilities to work with the physio-ball and the physio-ball is a key component in building core strength. There are tons of different exercises that you can do and it creates excitement in people's workouts. So I guess when you go into a fitness facility the physio-ball you're going to notice, and when you see that you're going to know that facility is up to date and into core strength. The certified strength and conditioning individuals, professionals, are in the facilities. People should look for facilities that basically employ those people. Those people have been trained properly, educated properly in terms of allowing people to set goals and how to attain those goals safely, professionally, and basically creating an exciting environment to do it.

DAVID FOLK THOMAS: I want to thank both of you for sharing your expertise on the subject. Jim Ramsay and Dr. Jonathan Glashow, and for those of you watching this, remember, don't go into the gym like the Tasmanian devil. Just start slow. Core muscles. Abdomen and back. You'll do fine down the road. Thanks for watching the webcast. I'm David Folk Thomas. See you next time.