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Physical Therapy

The Ideal Morning Routine for Joint Health

Morning Routine, CARS

Often at our office, we get asked by patients, what are the best stretches to perform first thing in the morning prior to starting their day? While the answer may differ for every person depending upon their specific age, injury history, and goals, for those with no significant injuries who want a general program, our #1 recommendation is to perform CARs (Controlled Articular Rotations) for every joint, each morning. 

CARs are active circulation rotational movements of the joint at the end range, meaning that you are taking your joint through all its respective ranges of motion, as far as you can go without compensation. 

Here are 8 benefits of performing these movements every morning as part of your self-care routine:

 

1. Prevent the loss of joint range of motion over time

One of the “effects of aging” that many individuals fear is the loss of joint range of motion such as turning the head or being able to sit down into a squat. The truth of the matter is that these losses of motion are not “age-related” but rather related to lack of movement over time. When you do not use a particular range of motion, your body will adapt and decrease your usable range over time. By moving your joint through a full range of motion regularly, you can prevent this loss of motion over time.

2. Allows you to screen the health of your joints on a daily basis

Before you experience pain in a joint, your body will likely give you clues that there may be an issue present in your body in the form of closing angle pain and decreased joint motion. Most individuals are not aware that they have a joint dysfunction until they are in significant pain and need to heal the injured area. By screening your joints daily via controlled articular rotations, you are able to stay ahead of and address these injury predictors before they develop into a more serious problem.

 

3. Bring nutrition and fluid to your joints

In order for joints to remain healthy and move properly, they require adequate blood flow and synovial fluid. The most optimal way for joints to receive proper nutrition and hydration is through movement. When joints do not move on a regular basis, they lose nutrition and degenerate over time. By moving your joints through a full range of motion daily, you can ensure that your joints move smoothly and healthfully long-term.

4. Increase the number of movement options

Many fitness enthusiasts claim that they would love to participate in activities such as Crossfit, tennis, skiing, or mountain climbing, but their body doesn’t allow them to do so. Oftentimes, joint range of motion is what dictates which movements you can and cannot participate in safely. By maintaining a full range of motion in your joints, allows you to partake in a wide variety of activities and have enough movement options to perform them safely and effectively.

 

5. Decrease Likelihood of injury

The equation for injury is simple when the demands on your body exceed your capacity, you are more likely to become injured. Therefore if you have a large capacity in the form of available joint range of motion, then you are able to undertake more demand without the likelihood of injury. Likewise, when your capacity exceeds demand, this leads to adaptation and improved performance.

 

6. Allows for Comprehensive Joint Training

Most exercise training that individuals undertake involves single joint or mid-range motions. For example, cycling and walking are mid-range exercises, the lower body is never taken all the way to the end range. Gym exercises such as bench press, pull-ups, and lateral raises all work specific motions of the shoulder joint but do not take the shoulder all the way to the end range of motion. By performing controlled articular rotations, you are able to effectively train your joints into the ranges that are not regularly trained by conventional gym exercises.

7. Improve healing post-injury

When tissue is injured, it is not simply enough to let the tissue rest and be immobilized for a significant period of time. The tissue will heal in the direction that it is prompted to heal. If you do not move an injured joint, then the new cells being laid down into connective tissue have no input as to how to heal properly. This can ultimately lead to scar tissue formation and a disorganized foundation of connective tissue at the site of the injury. By moving your joints through a pain-free range of motion during the healing phase of an injury you can increase the likelihood of an organized healing process and restoration of joint range post-injury.

 

8. Prepare your for life

Life can be unpredictable and may throw unexpected challenges at your body. For example, stepping off of a curve or reaching to catch a falling glass. Oftentimes injuries occur during these unexpected and reactive moments. By performing CARs on a daily basis and moving your joints through end-range, you are able to better prepare yourself for the unexpected difficulties life throws at you.

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How to Structure a Knee Rehabilitation Program

knee injury

Knee injuries can be very frightening and debilitating if not rehabilitated properly. Before commencing a rehabilitation program for any musculoskeletal injury, we advise that you get assessed by a healthcare professional that is able to diagnose your injury, explain the mechanism of your injury and prescribe you a well-reasoned rehabilitation program.

The specifics of every rehabilitation program are going to differ for every individual and will depend upon the actual tissue that is injured as well as the severity of the injury. This article is designed to give a rough outline of the important characteristics and priorities of most knee rehabilitation programs regardless of injury as well as some specific examples.

 

Knee Rehabilitation Phase 0

The Goal of Phase 0 is to reduce the initial bout of inflammation following the knee injure. During this phase, it is advisable to spend as much time as possible not bearing weight on the injured leg and keeping the knee elevated. It is also advisable to wear a knee brace when it is necessary to walk and bear weight on the knee. The emphasis should be placed on icing the knee and reducing inflammation through supplementation, over the counter medications, or prescription medications. This phase will generally last 3 days to 2 weeks depending upon the severity of the injury.

Length of Time: 1-2 weeks

Priority: Reduce Initial Inflammation

Training Modifications: No Physical Training at this time, focus on film study or reading.

Treatment Plan Example:

  • Ice Applied 3-4x/day for 15 minutes
  • Anti-inflammatory medications
  • Keeping injured knee elevated
  • Staying off of affected knee as much as possible

 

Knee Rehabilitation Phase 1

Knee Rehabilitation Phase 1 should begin when you are able to bear weight on your affected leg with minimal pain. During phase 1 of rehabilitation, you are going to begin training the other joints of your lower body (Hip, Ankle, Foot), as well as the core, and stretching the muscles that cross the knee (Quadriceps, Hamstrings, Calves). It is also important during this phase that you begin low-intensity cardiovascular exercise on a bicycle. This will improve blood flow to the injured knee and improve healing times. At this point low-intensity sport, specific drills can be performed (ex. Shooting free throws, Boxing on a heavy bag).

Length of time: 2-4 weeks

Priority:

  • Restore Range of motion
  • Train non-injured body parts (Upper Body, Core, Hips)
  • Regain Balance

Training Modifications:

  • A protective Knee Brace should be worn during exercise
  • Avoid running, sprinting, jumping, and cutting
  • Perform low intensity, sport-specific drills
  • Focus on Upper Body exercise

Treatment Plan Example:

  1. 10 minutes on the stationary bike
  2. Standing Quadricep Stretch, 3 sets of 30 seconds
  3. Standing Hamstring Stretch, 3 sets of 30 seconds
  4. Deadbug, 3 sets of 10 per side
  5. Glute Bridge, 3 sets of 15
  6. Single leg stance, 2 sets of 20 seconds per side

Knee Rehabilitation Phase 2

Phase 2 of rehabilitation is focused on transitioning into lower body stability and knee-dominant exercises. During this phase, unilateral lower body exercises are performed to enhance balance, stability, and strength in the affected leg. Additionally, knee-dominant exercises such as leg extensions and leg curls are used to strengthen the muscles around the knee. Joint training such as CARs and PAILs is used to continue to restore range of motion in the knee and hip of the affected leg. During this time, low-intensity sport-specific drills and running can be introduced as tolerated.

Length of time: 2-4 weeks

Priority:

  • Single leg Exercises (Lunge, Squat, Step-up)
  • Single Joint Movements (Leg Curls, Leg Extension, Calf Raises, Hip Extension)
  • Joint Training (CARs, PAILs/RAILs)

Training Modifications:

  • Moderate intensity running/jogging, ease back into Sports drills.

Treatment Plan Example:

  1. 20 minutes on Stationary Bike
  2. Seated Leg Curls, 3×20
  3. Seated Leg Extension, 3×20
  4. Walking Lunges x100 total steps
  5. Knee Flexion PAILS/RAILS x2 minutes
  6. Standing Hip CARs x5/side

 

Knee Rehabilitation Phase 3

Phase 3 of rehabilitation is the final phase and as such can last anywhere from 4 weeks to multiple months. During this phase, there should be very minimal pain in the knee, and the range of motion should be at least 90% restored. Bilateral strengthening exercises such as squats and deadlifts should be introduced into this phase as well as plyometric exercises to ensure the knee is stable enough to withstand ballistic forces. If there is still a limitation in active mobility in the lower extremity, passive range holds and end range lift offs should be used to expand the range of motion. During this phase, it is also appropriate to introduce live sports drills if applicable while wearing a knee sleeve to improve sensory awareness of the affected knee.

Length of Time: 4-12 weeks

Priority:

  • Bilateral Strength (Back Squat, Trap Bar Deadlift, Leg Press)
  • Plyometrics (Box Jump, Broad Jump, Olympic Lifts)
  • End Range Joint Training (Passive Range Holds, End Range Lift Offs, Eccentric Neural Groove)

Training Modifications: Return to live sports drills at moderate intensity, stay cautious of activities that continue to aggravate the knee.

Treatment Plan Example:

  1. Seated Box Jump 7×3
  2. Hang Power Clean 5×2
  3. Back Squat 3×8
  4. SL Leg Press 3×12
  5. Swiss Ball Hamstring Curl 3×15
  6. Knee Flexion Passive Range Holds

If you are currently dealing with a chronic injury and would like an assessment and custom-tailored rehabilitation program, we would love to help!

 

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6 Ways to Keep your Shoulder Healthy and Functional

Shoulder Health Physical Therapy

1. Move Through a Full Range of Motion DAILY

Joints love to move. Moving your joint through its full range of motion on a regular basis helps maintain joint mobility and allows for adequate nutrition and blood flow to be supplied to the joint. The shoulder is one of the most mobile joints in the body with a variety of muscular, ligamentous, and capsular attachments, making it even more important that each motion (ex. flexion, adduction, internal rotation) is performed on a daily basis.

For some daily Shoulder Motion to Practice for Mobility Click Here

 

2. Pull More than you Push

Resistance training is an excellent way to keep your shoulders strong and healthy. Performing Pushing Exercises for the chest and deltoid, Pulling Exercises for the upper back and lats as well as shoulder exercises for the lateral/posterior deltoid and rotator cuff are integral for long term shoulder health and function.

In order to weight train appropriately without over-taxing your shoulder joint, you should be performing 2-2.5 times as many pulling exercises (pull-ups, rows) as pushing exercises (bench press, pushups).

For more specific exercises to strengthen the shoulder safely see our “Upper Body Training” Playlist on our Youtube channel Here.

 

3. Train your Shoulder Mobility

Many of you train to become stronger, faster, lose body fat, etc. But do you train for mobility? Mobility is a physical capacity just like strength and speed are, it must be trained deliberately on a regular basis to see a noticeable improvement.

Performing the Shoulder CARs variation seen above is a great starting point but there are also a number of ways to improve range of motion and motor control long term without excessive stretching and soft tissue therapy.

At our clinic, we use a system called Functional Range Conditioning in order to work with patients to improve usable mobility long-term.

 

4. Show your Shoulder Blades Some Love

We cannot have a conversation about shoulder health without talking about the shoulder blades. The Shoulder Blade (Scapula) is intimately connected to the shoulder both structurally and functionally. If the shoulder blades do not move properly and the muscles connecting the shoulder to the shoulder blade are not engaged, the shoulder will never be able to express its full range of motion.

The Scapula, Humerus, and Cervical Spine (Neck) work together to allow for clean and efficient movement of the upper extremity. When working on shoulder health… Keep your Scapula strong and mobile!

 

5. Strengthen the Small Stabilizers of the Shoulder

“The Rotator Cuff” has gained a lot of attention over the years as it is an area that is frequently injured and deconditioned. The Rotator Cuff is a group of muscles made up of the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. The role of the “Rotator Cuff” is not only to rotate the shoulder but also to stabilize the shoulder during motion and should be trained in both functions. 

Additionally, the muscles of the rotator cuff often become tight and overworked in individuals involved in powerlifting, Olympic weightlifting, boxing, tennis, golf, and baseball. For these types of issues, we often use manual therapy techniques such as Active Release Technique to resolve the tightness and poor tissue quality of these muscles.

 

6. Develop Adequate Thoracic (Upper Back) Mobility

The era of technology and long work hours has caused many of our upper backs to become immobile and excessively rounded (flexed). Regular Motion of the thoracic spine into extension and rotation is critical for upper body and shoulder health. Here are a few variations on training Upper Back Extension and Upper Back Rotation.

The shoulder is most comfortable moving with a neutral or extended upper back, so be sure to get your upper back adjusted regularly to keep a strong posture when moving the shoulder!

Be sure to follow our “Shoulder Series” to gain valuable insight on shoulder health! We will be sharing practice tips to improve in each of these areas on our Instagram.

These are general guidelines that may not apply to you. If you are experiencing any shoulder pain we recommend that you are assessed by a health care professional.

If you or someone that you know is currently dealing with shoulder pain and would like an evaluation and customized treatment plan, please reach out! We’d love to help you.

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Grapplers Guide to Injury Prevention: Closed Guard

Jiu Jitsu Closed Guard

The Closed Guard

The Guard is arguably the most fundamental position in Brazilian jiu-jitsu during which you, the guard player, are on the ground and your opponent is above you looking to pass your guard. Though there are many variations of the guard, the position can be fundamentally broken into two parts: closed guard and open guard.

The Closed guard is a position in which your legs are wrapped around the hips or torso of your partner. From this position you, as the guard, player are likely looking to perform a sweep and gain top position, or submit your opponent from the bottom. 

First, we are going to look at the major sweeps from the closed guard and what physical capacities are necessary to perform these sweeps effectively and safely. The specific technique of the sweep will not be address in this article because every professor teaches their variation, but generally, there are enough commonalities amongst how these sweeps are taught for us to analyze the biomechanics.

Second, we will analyze some of the common submissions from closed guard and talk through the proper execution of these submissions from a biomechanical standpoint.

For each major sweep and submission from closed guard covered below, there will also be a video covering a specific exercise that can be used to improve the quality of execution of these fundamental jiu-jitsu movements.

 

The Scissor Sweep: 

The Scissor sweep is one of the first taught sweeps in a beginners jiu-jitsu class. This sweep involves opening the guard and kicking your opponent with the top leg while chopping with the bottom leg. This “scissoring” action coupled with proper upper body grips will force your opponent to one side with no base. 

While this sweep is basic in its execution and does not require as much mobility as other sweeps, it doesn’t require the ability to quickly shift your hips from square to your opponent into a position where your hips are perpendicular. If you do not have appropriate coordination between your core and hips as well as dexterity, you could potentially excessively rotate through your lower back during this sweep.

 

The Pendulum Sweep:

The Pendulum Sweep is another fundamental sweep in Jiu-Jitsu. Relative to the Scissor Sweep, the pendulum sweep has more set up and mobility requirements. While there are several ways to execute a pendulum sweep, the general premise is that you take away your opponent’s base-arm on the side of the sweep and use the momentum up a full-body pendulum to knock your opponent in that direction.

While the sweep itself involves a scissoring motion similar to the scissor sweep, the momentum behind a pendulum sweep coming from your mobility in your hamstrings and adductors as well as your ability to contract these muscles from end range.

Below is an end-range training variation we use with outpatients to improve hamstring and adductor output for grappling as well as striking motions.

 

The Hip Sweep:

The Hip Sweep is another common sweep variation taught in beginners jiu-jitsu classes. This sweep does require rotation of the thoracic spine in addition to the bracing and hip dexterity requirements of other closed guard sweeps.

During this sweep, you will first look to bring your opponent’s hands down to the mat and then will post on your same-side elbow or hand while turning your torso and hips over your opponent, ideally ending in mount. Proper stability of the arm, shoulder blade, and spine is required to execute this sweep efficiently and safely. Having a stable upper body foundation allows you to build the base for your hips to finish the sweep.

Below we will look at a DNS 10-month transition that can be used to train the mechanics of this position and develop the proper body mechanics for a technical and well-executed hip bump sweep.

 

In addition to sweeping the top opponent, closed guard players are also generally looking for an opportunity to submit the opponent inside of their guard from the bottom. Again, there are several variations in how these submissions are taught, but we will use the common principles of these submissions to break down the mechanics.

 

The Armbar:

The Armbar from guard is one of the most fundamental jiu-jitsu submissions and is generally taught early in the beginner’s curriculum. As with other jiu-jitsu submissions, the specifics of the execution will likely vary from school to school depending on the preference of the professor but the fundamentals of the armbar and generally consistent across techniques. 

The traditional armbar from guard requires holding onto your opponent’s arm followed by a shift of the hips to the opposite side followed by a clamp made by your legs on your opponent’s torso and neck. From this “finishing position”, the bar is extended over the crease of the hip/groin for the submission.

One of the most unique characteristics of the mechanics of the armbar is the briding of the hips into the arm combined with the clamp. Performing this movement safely and effectively requires control of the lower abs and the ability to properly activate the posterior chain (glutes and hamstrings) without overextending the lower back. Below is a drill we use to practice proper lower ab activity with glute and hamstring activation.

 

The Triangle:Jiu Jitsu Triangle

The triangle is another fundamental jiu-jitsu submission that has several unique biomechanical and anthropometric (leg length, etc) requirements to be effective. The requirements to execute a triangle from guard are similar to those of the armbar. The technique involves bridging the hips up and locking your legs around the neck and one arm of your opponent. This position is where the leg length and hip dexterity become important.

The finishing of the Triangle choke itself requires pulling one leg horizontally across the back of your partner and locking the opposite knee around the shin. This requires a high degree of hip external rotation to properly execute this submission without excessive strain on your hip and back or a failed submission.

 

The Cross-Collar Choke:

The cross-collar choke is generally the first submission that is taught in a fundamentals jiu-jitsu GI class. This choke involves gripping the two collars of your opponent with opposite arms and ulnar deviating your wrist, to the pinky side. Generally, when individuals have difficulty with ulnar deviation, they will compensate by trying to complete the choke with the arms and likely fail or over-exerting the upper body. Below is a demonstration of controlled articular rotation for the wrist that we use to improve wrist mobility for grappling and other sports.

 

If you are a jiu-jitsu athlete currently dealing with an injury or would like guidance on how to stay injury-free and have longevity in the sport, book a consultation with us below!

 

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Breaking Down Weightlifting Movements: The Snatch

Athlete Performing a Snatch

The Olympic Snatch is one of the most complicated and effective weightlifting movements that is frequently used in sports performance, CrossFit, and barbell sport.

The Snatch itself involves Lifted a barbell from the ground to the overhead position in one motion. Traditionally, the snatch is caught deep in a squat position requiring a significant amount of upper-body stability and lower body mobility.

Part of what makes the snatch such a unique lift is that any small deviation from proper technique and mechanics can result in a missed lift. For other major lifts in the super total such as the deadlift, Clean and Jerk, and Squat, small deviations can be compensated for by strength and grit. This is why the Snatch is called by some “the most athletic movement in Olympic Sport”

 

The snatch itself is typically broken down into three primary phases; the first pull, the second pull, and the catch

 

The First Pull:

During the first pull, the barbell is lifted off of the ground up to the crease of the hip. Within the first pull, the knees are pulled back to make room the barbell around the knees and then return forwards as the bar is brought towards the crease of the hip.

The physical demands of this position include primarily proper thoracic (upper/middle back) extension, foot stability, and the ability to appropriately load the hamstrings

While there is much debate as to the appropriate torso height for the liftoff phase of the snatch, most coaches will agree that a rounded upper back is an efficient position to pull from, which means that some level of thoracic extension, without composing the neck or lower back is ideal.

Additionally, the ability to stabilize the arch of the foot is critical for the liftoff phase as the foot is to be in full contact with the ground and any deviation away from the balanced position can result in a missed lift or injury, particularly when the weight increases relatively to your max. Most lifters also use an Olympic weightlifting shoe designed to improve dorsiflexion capacity of the ankle, though at times at the expense of a properly centered foot and stabilized arch.

The initial lift of the bar during the snatching from the ground up to the top of the knee requires a proper hip hinge during which the hamstrings and posterior chain are adequately loaded to produce maximal force and reduced the compressive load on the spine while lifting the bar. Likewise, the bar is taught to be kept very close to the body to reduce strain place on the lower back during the lift.

 

The Second Pull:

Once the bar has reached the top of the thigh or hip crease, the second pull is initiated in which the body uses triple extension (hip, knee, ankle) to propel the bar vertically. Once the bar has reached the maximal height, the lifter descends into the catch position to receive the barbell.

Athletes vary in at which point they initiate the second pull. Some athletes chose to extend just before the bar reaches the crease or the hip but the majority of weightlifting coaches teach the lifter to be patient during the first pull and explosively triple-extend once the bar reaches the hips in the snatch. An early second pull can result in an inefficient bar bath and potentially a leak of potential vertical force to propel the bar upwards.

Important characteristics for the second pull are more related to training athletic qualities and synchronizing extension of the hip, knee, and ankle. From a mobility and motor control standpoint, however, the ability to properly extend the hip while stabilizing the spine is arguably the most important physical characteristic for executing an efficient and safe second pull.

Hip Extension is not only an important motion for the snatch, but also a variety of fitness movements including the deadlift, running, bridging, and lunging. Often individuals possess very little hip extension and use their lumbar spine (lower back) to extend during a lift or athletic movement. When we can effectively address pure hip extension, through manual therapy and specific exercises, we can expand your force capacity as well as significantly reduce the likelihood of a lower back injury.

 

The Catch:

After the lifting drops under the barbell following the second pull, the catch position requires the lifter to have two feet planted on the floor and the arms locked out overhead. Once the lifter catches in a stable position and stands up to the standing position.

The “catch” phase of the lift is by far the most physically demanding in that it requires a tremendous ability to sit into a deep squat with an upright posture and lock the arms out overhead. The squat itself has numerous prerequisites that we will cover in a later installment of this series, but the difference during this lift is that the squat is required with a barbell locked out overhead. A traditional powerlifting squat has very little upper body mobility requirements beyond enough shoulder rotation to hold the bar. The front squat does require a relatively upright torso as well as upper body extensibility for the front-rack. However, neither of these compare to the demands of the overhead squat.

To catch the barbell in a stable enough position to stand up and maintain a successful lift, the shoulder complex must have a tremendous degree of overhead stability coupled with adequate upper back extension to take the strain off of the shoulder joint itself. 

Additionally, a physical capacity that is not talked about frequency is the ability of the wrist to radially deviate (bend towards the thumb side). Generally, at higher levels of Olympic weightlifting, lifters will grip very wide on the bar to both meet the hip crease during the second pull and reduce the overhead mobility requirement during the catch. Because the wrist is a small and complex joint, we mustn’t place the wrist in a vulnerable position during the snatch.

 

Common Injuries Seen in the Snatch

If you are a Crossfitter, Olympic weightlifter, or other athlete and would like a joint-by-joint injury risk assessment as well as therapy to correct these findings, please reach out to us at 754-231-8338, we would love to help you!

Want to Train for Performance? Start with your Glutes.

Athletes deadlifting

For anyone that participates in athletic training or has been through physical therapy, some phrases that might sound familiar are “strengthen your glutes”, “Turn on your glutes”, “Active your glutes”, “Your glute isn’t firing”, etc. If you are able to use the prime movers and stabilizers of your hip effectively, then you will take the strain off of the joints of your pelvis, lower back, and knee.

 

The reality is that a muscle is never on or off, and even for every given muscle strength is very specific. A muscle may be weak in one position and strong in another depending upon the position of your body.

 

It is for this reason that a lot of rehabilitation and strength training for athletic performance emphasizes strengthening the glutes. In a performance setting, this may include Weighted Hip Thrusts, sled drags, and sumo stance deadlifts. In a therapy setting, this may include exercises such as glute bridges, clamshells, and kickbacks.

 

When most individuals are referring to the “glutes”, the muscles specifically they are referring to are the glutes Maximus, our bodies most powerful hip extensor, as well as our Gluteus Medius, a hip abductor and internal rotator. The gluteus medius is also responsible for the stability of the pelvis during locomotion. There are, however, a number of other small muscles in the hip that support the larges glute muscles and provide both stability and motor control to the hip.

 

While training the glute to prevent injury and performance is a great idea, oftentimes the proper intent behind the training is lacking. The ability to use and control the hip through a full range of motion is significantly more important than being able to generate a lot of force in one exercise. Additionally, activation of the diaphragm and proper respiration builds a critical foundation for adequate hip movement and glute activation.

 

When training the glutes in a therapeutic or rehabilitation setting, it is more valuable to break down exercises into the joint being used and specific motion or function, rather than focus excessively on which muscles are working. 

 

Hip Extension: Hip extension is an important move because it is used every day during walking. Each step we take requires a slight amount of hip extension. During running or sprinting, our hip demands even more extension. 

If we do not have an adequate hip extension range of motion and control, then other parts of your body such as your lumbar spine with compensating by excessively extending during movement. Because the primary muscles of the hip extension are the glute and hamstring group, it is important that we have the ability to use these muscles functionally and independently of the muscles of the lower back.

 

Examples of exercises that will help improve hip extension include Bridge Variations, Birddogs, and lunge variations.

 

 

Hip Abduction:

 Hip Abduction is when the leg travels laterally from the midline of your body. A common compensation for this movement is the lateral bending of the lumbar spine and torso. 

If the hip does not have proper abduction range of motion and control, you will generally compensation by tilting your pelvis and using your obliques and lower back muscles to compensate. Over time, this can lead to overuse of the joint of the lower back and pelvis and ultimately pain.

Exercises that improve hip abduction included Sidelying clamshells, band walks, and side bridges.

Hip Rotation:

The ability to adequately internally and externally rotate your hip is one of the most important joint motions in your whole body. Not only does your ability to control hip rotation improve your performance in athletics, but it also is a great indicator of overall hip health.

Hip rotation is driven by smaller muscles of the hip such as the Gemelli group and the piriformis. Though these muscles are often stretched and massaged, they are underdeveloped and often neglected when it comes to training and therapy. Having adequate hip rotation will prevent excessive rotation of the lower back or knee during movements such as a golf swing, a tennis stroke, or a roundhouse kick.

Because in many cases, the active rotation of the hip may be minimal, it is best to train this motion through repeated hip rotation, isometric contractions, and end range holds.

Hip Stability Training:

In addition to the three movements described above, The gluteal muscles and piriformis also act to stabilize the hip during single-leg stance and gait. This is why single-leg training has tremendous benefit even beyond improving balance and are an important part of your overall glute and hip development.

Starting with timed single leg balances and progressing to eye-closed variation or standing on an unstable surface is a great starting point for single-leg training. Once you feel comfortable and stable in a single leg stance, you can begin to incorporate exercises such as single-leg RDLs or single leg plyometric variations.

 

Remember, if you want to perform well in the gym, on the court or on the field and keep your lower body and spine healthy, you need to train your glutes through a variety of loading patterns and planes of motion. 

 

If you are dealing with hip, pelvic, or lower back discomfort and want some direction on how to improve your function long-term, give us a call and book an assessment with one of our physicians!

 

 

The 7 Habits of a Highly Effective Shoulder

Shoulder Health

 

1. Cervical Spine (Neck) Mobility

The Neck and the Shoulder complex are intimately related due to their joint proximity as well as the number of muscles that attached to both the shoulder complex and cervical spines, such as the upper trapezius and SCM (sternocleidomastoid). If these muscles become restricted at their cervical attachment, this can put a significant strain on the shoulder and restrict motion. Individuals with poor mobility in their necks have a tendency to compensate for neck motion with shoulder motion, leading to overuse and unnecessary muscle tension and adhesion development.

 

 

2. Thoracic (Upper Back) Extension

 

In order for the shoulder to be able to express its full range of motion, the thoracic spine (upper back) but be able to extend in order to create an environment for the shoulder to work properly. If the thoracic spine does not extend and you are performing a task that requires the shoulder to lift overhead, you will be forced to compensate through lumbar (lower back) extension as well as put excessive strain on your glenohumeral joint (shoulder). Because of the intimate relationship between the scapulothoracic joint and the shoulder, a poorly moving upper back will lead to poor shoulder blade movement and ultimately will impact the entire shoulder.

 

3. Proper Diaphragm Function

 

Of all of the requisites on this list, this one may the one that is hardest to connect to the shoulder. Most individuals think of the diaphragm as an involuntary muscle associated with breathing and abdomen, how could it be related to the shoulder? A strong case could be made that in order for any joint, particularly the spinal joints, shoulder, and hip, that the diaphragm respiratory and stability system must first be intact to express proper movement. This concept of “proximal stability for distal mobility” starts with core stability and proper diaphragm function. By using the diaphragm to produce intra-abdominal pressure, you are able to lay down a strong foundation for your shoulders to move off of.

 

4. Shoulder Blade (Scapula) Movement

 

The glenohumeral joint or the shoulder cannot be talked about without also mentioning the shoulder blade. The humerus and the scapula work very intimately together to produce movement in the shoulder joint which is the meaning of the nerve” Scapulo-humeral rhythm” The shoulder relies on the shoulder blade to slide and glide for all motions of the shoulder. Even if you have a very strong and mobile shoulder if your shoulder blade does not do its part in moving and stabilizing the shoulder, you will not be able to move effectively. Be sure that when you are training and mobilizing your shoulder that you don’t neglect its partner in crime… The scapula!

5. Adequate Joint Centration

 

The shoulder joint itself is a “ball in socket” joint meaning that the humerus has a round end that fits into the glenoid fossa which is a carved out socket for the shoulder. While this type of joint is able to express a large amount of range of motion, all of this freedom comes at a cost… instability. There are numerous muscles, ligaments, tendons, and other soft tissues that are required to work in sync in order for the shoulder to move properly and safely. The function of these tissues is not only to move the shoulder but also to center the shoulder in the glenoid fossa. When the shoulder sits nice and snug into the capsule, it is most able to express its full range of motion and significantly decreases the likelihood of a soft tissue injury related to the shoulder. Joint centration can be best trained through carries, get-ups, and plank variations.

 

6. Rotator Cuff Activation

 

When most individuals think of shoulder health, they think of the rotator cuff. This muscle group is made up of four muscles; the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles have two primary roles, shoulder movement, and shoulder stability. These four muscles play a significant role in shoulder joint centration (see #5) by stabilizing the head of the humerus in the joint during motion. If an individual does have good control and strength in the rotator cuff, they will more likely to use large muscles such as the Latissimus Dorsi and Pectoralis Major. Not only are these large muscles no designed to be stabilizers for the shoulder, but if too much is asked of them (primary movers and secondary stabilizers), these muscles can be more prone to injury and long term overuse. 

 

7. Full Range of Motion

 

As you can see from the prior 6 key factors to shoulder health, there are many joints and muscles that all act in synergy with the shoulder to ultimately lead to healthy and functional movement of the shoulder. Of course, improving your range of motion in the shoulder itself should be a priority. Regular stretching and mobilization of the shoulder is an important piece of shoulder health. If the thoracic spine, shoulder blade, and stability are all working properly, but the shoulder itself does not move well, then you will be limited functionally. Work on your shoulder range of motion regularly through controlled articular rotation and end range training. The shoulder is one of the most unique, complicated, and impressive joints in the body, treat it well and it will give you an abundance of movement options!

If you are currently dealing with any shoulder pain, discomfort, or want to improve your shoulder health long term, give us a call!

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Maximizing your Mobility while at Home

stretching mobility exercise at home

Why Focus on mobility training now?

We are currently in a state of affairs in which most individuals are working from home and exercising at home. Many commercial gyms have closed down and individuals are looking for ways to stay active during this time. While home exercise programs involving bodyweight exercises are a great option for maintaining health and in some cases, sanity, this experience we are all going through is an excellent opportunity for us to work on some of the mobility deficits we’ve all been neglecting during our busy work, social and training lives.

One of the principles that we are always reinforcing with our patients is to regularly train their mobility just as they train for strength, skill and cardiovascular health depending upon their goals. Simply warming up before activity and occasionally stretching will not result in long term gains to your range of motion and functional control of that range. Additionally, mobility training does not require any equipment and can be performed from any location including your home or outside. Regular Mobility training can prevent conditions such as lower back stiffness, shoulder pain, and hip arthritis.

 

What causes a limitation in mobility?

Mobility can be defined as the ability of an individual to control soft tissues at their end range of motion. This is contrasted to flexibility, which is the ability to passively stretch muscular, tendonous and ligamentous tissues beyond its resting length. Flexibility is, therefore, a prerequisite for mobility, and mobility is a prerequisite for efficient movement.

Stretching, yoga, pilates and other forms of flexibility training provide a lot of value both physically and psychologically to their practitioners, however training mobility is a specific form of training and needs to be treated as such. Static stretching and spending extended periods in specific positions have been shown to improve flexibility and tissue elasticity over time but do not necessarily result in improved functional mobility that will carry over to activities of daily living and athletic pursuits.

The first step in performing at-home mobility training is to break down mobility into 3 groups: upper body, spine and lower body. 

 

Upper body mobility includes shoulder, elbow, and wrist

Spine mobility includes cervical (neck), thoracic (middle back), and lumbar spine (lower back). 

Lower body mobility includes hip, knee, and ankle.

 

There are going to be areas in your joints that you feel are particularly limited, we advise that you spend some time in each of these 9 key body areas while increasing your focus to the joint(s) that feel particularly limited. After performing your “Controlled Articular Rotations”, also known as CARS, you will have a much better sense of which particularly joints may require more specific mobility training. 

The first component of mobility training we like to address is using CARS to both assess, warm-up, and train the joint. In our office, we use these exercises as one of the key indicators for overall joint function because they demonstrate all the movements of the joint as well as transitions between movements. For ball-in-socket joints such as the shoulder and hip, we will utilize full joint CARs as well as capsular CARS (movements that target the tough outer sheath that encloses the joint). For the spine, we will be using segmental motion as well as rotation motion for the cervical and thoracic spine.

For “Controlled Articular Rotations” to be effective, the technique of the movement must be the number one priority. The movements are very simple but the true benefit is hidden within the fine details of the movement. Every joint in your body, not being moved through the joint rotation, should be kept still and slightly contracted to isolate the joint being trained. The idea is to move only the joint being worked and not any of the surrounding joints. 

Controlled Articular rotations increase mechanoreceptor activity in the joints, which is how the nervous system collects information about the environment which sends signals to the joint indicating that it is safe to move. By regularly moving the joint through a full range of motion your body will lift any “neurological restriction” brought on by poor posture or lack of movement. There is also evidence to support that muscle spasm and stiffness around the joint, designed for protection, will also be lessened by regular joint movement.

If you are planning on performing an at-home workout using bodyweight, bands, kettlebells, dumbbells or other equipment you have around the house, you can perform each of the CARs variations below for 5 repetitions to warm your body up and prepare yourself for your workout. Additionally, at the end of your training, you can perform each of these for 3 repetitions to ensure that you have maintained a full range of motion throughout your exercises program and your joints will be ready for activity the rest of the day.

Another benefit of using an active exercise such as “CARs” as a warm-up/ cooldown is that this movement will increase the total volume of your workout and ultimately increase the total caloric expenditure. If you are low on equipment at home, controlled articular rotations with added resistance, range of motion or active blocking can be used as a workout in themselves. At our clinic, we regularly use ankle and wrist weights to increase the difficulty, as well as yoga blocks to keep the range of motion strict and place more emphasis on the joint you are intending to work.

Below we have attached videos of “Controlled Articular Rotations” for a few of the major body areas. Keep in mind while you are training your mobility using these movements that there are unlimited variations such as partial CARs, half CARs, and many more.

We are also uploading home mobility workouts on our Instagram as well as our youtube channel. Utilize the principles discussed in the article as well as the videos and get creative with your mobility training!

5 Things You Need to Know About Pain

Neck and Back pain

Pain is one of the most complicated and interesting topics in modern healthcare because of the unique blend of biology, neurology, and psychology behind it. No matter what condition an individual is dealing with, their pain experience is going to be inherently different. It is nearly impossible for us as healthcare providers to compare one individual’s pain levels to another because we are always working off a different scale. 

Being in pain can be frustrating and scary, so here are 5 things you need to know about your pain

1. Your Pain is real

One of the most frustrating occurrences for a patient is going to see a doctor, being given a physical exam and imaging only to be told: “there is nothing wrong with you”. Just because there are no or very few objective findings associated with your pain does not mean that it is not real. The experience of pain is a biological, neurological and psychological experience. 

For example, you may sit and watch a funny movie and forget about your back pain but while you are stressed at work your back pain flares up. Even if all variables are the same, just the fact that you are in a stressful environment increases your lower back pain. Do not ever let a medical professional or otherwise convince your that your pain “is not real” and you need to somehow just convince yourself to be pain-free. Central and Affective pain are very real and require unique treatment plans of their own.

2. Your Pain is a message from your body

When you remain in a static postural position or perform a movement and feel pain in your body, it is your body’s way of sending you a message that the particular activity your are performing does not feel safe. There are numerous reasons why the body sends a painful message including improper joint alignment, injury to soft tissue and moving outside of your controllable range of motion. Your body’s job is to protect you from serious injury. However, this does not mean that pain always means to avoid a particular movement (see the video in #5 for details).

Feeling pain does not necessarily equate to a serious structural injury, even an activity such as sitting in a static posture may cause pain after a few hours, which is your body’s way of saying “Time to stand up and move your joints”. The body doesn’t like sustained postures or doing activities beyond its capabilities. If you are unable to lift your shoulder over your head normally, then your body will send you a pain signal if you try to do so with a barbell. This is protective!

 

3. You can control your pain better than you think

Every Painful Condition has behaviors. For example, certain conditions have constant pain, others are intermittent, some respond well to NSAIDs, while others respond to movement. As pain medicine clinicians, our first take when we see a patient is to first understand their goals and then do figure out the behaviors of conditions. If we know what times of day conditions act up, which movements are pain, and which postures are relieving, we are able to not only narrow down an effective treatment plan but also closely control the symptoms.

If your pain is intermittent (meaning that there are certain times it is painful and others it is not) then you are able to control your pain. For example, if sitting causes you lower back pain, then you are able to work standing or take frequent micro-breaks to offset the hours of sitting. Additionally, we know from the medical literature that symptoms that are intermittent and activity dependant are much more likely to be resolved quickly and conservatively than those that are constant because we are able to control when and where symptoms occur.

 

4. Your diagnosis does not tell the story

Diagnoses such as “Arthritis”, “Disc Herniation”, and a number of soft tissue injuries can be very disheartening to hear and if not accompanied by proper education on the part of your clinician, can lead to a life of disability. The truth of many of these diagnoses is that they are a normal part of aging and being active. Of course, this doesn’t mean to simply ignore your diagnosis or MRI, but there are many individuals with arthritis, disc herniations, rotator cuff tears and meniscus tears that are completely asymptomatic and have had these conditions for years.

Because in some cases the diagnosis or finding on imaging may be irrelevant or may have been present long before you felt symptoms, it is a better assessment to look at movement and symptom baselines. For example, the ability of your shoulder to function during work, activities of daily living and exercise are a better indicator of shoulder health than what you MRI says. When you are being assessed for a musculoskeletal injury, we advise that you see a conservative care physician first to see if your injury is manageable without the use of invasive surgery or medication.

5. You can stay active even when in pain

 

If you are currently dealing with pain and want a thorough assessment and a treatment plan specifically tailored to you, please give us a call or book online. We are here to help!

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Disclaimer: If you are in pain, please get a thorough assessment from a chiropractor or medical doctor! These tips are not designed to replace a visit to the doctor, but rather to be educational.

 

 

Miami Spine and Performance

3325 Hollywood Boulevard. Suite 204-A.

Hollywood, FL. 33021.

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