Tag Archives: physical therapy

Elite PT and Sports Performance Exercise of the Week – The Whip Snatch

I wrote this article for my SportsRehabExpert.com site a few weeks back, and figured it would be good to share here as well just to give you an idea of some of the more advanced strength and power methods we use here at Elite Physical Therapy and Sports Performance.

 

I picked up this exercise from strength coach Paul Longo at Central Michigan University about 8 years ago (and now at Notre Dame). This was one of his favorites since it was so simple to teach and really hard to do incorrectly. I’ve used this exercise over the years with my more advanced athletes, and they’ve really like it so thought I would share.

Couple prerequisites here:

1) Deadlift is first and foremost. As you’ll see in the video, a great hip hinge is a requirement so the athlete must be technically sound in the deadlift.

2) Swings are a favorite of mine and I really just see them as deadlifts for speed and power. The athlete must demonstrate a perfect hip hinge, good power as they drive the hips into extension, and also must be able to stop the kettlebell on a dime and throw it back down. The last point here just shows me that the athlete has the ability to coordinate and stabilize through the entire body in an instant. This is important to me now that they will be going overhead with a bar.

3) Hard Style Overhead Presses are also important, not just for upper body strength, but also for that ability to learn how to stabilize the entire body while driving a weight overhead. It’s one thing to press a weight, and an entirely different thing to catch a weight overhead. I want to know my athletes are rock sold with their arms overhead.

Now on to the Whip Snatch:

Teaching Tips:

1) I don’t get real technical with measuring for grip on the bar for this lift. Have the athlete get their hands at just the right width that the bar sits at the level of their hip crease.

2) Push the hips back with the bar as far as possible. I will have them just do reps of this hip hinge initially.

3) Jump and shrug!

4) Catch overhead.

I find that if we have the start position correct and we’ve worked through the progressions, the rest of the lift usually falls in place. The only other cue I find I need at times is ‘elbows to the ceiling’ after the jump shrug to keep the bar close to the body.

The whip snatch is a great power move and one that falls in line with many of the other lifts we talk about here on the site. Definitely one to give a try!

Shoulder Rehab Part I

Physical therapy of the shoulder using traditional rotator cuff exercises really gets me fired up, so I should probably warn any physical therapists, chiropractors, or physicians reading this to buckle up!  Actually I’m not going to try to offend anyone, I just like to challenge conventional thinking and ask questions – especially when it comes to dogma like rotator cuff exercises.

If you’ve ever been to physical therapy for a shoulder rehab then you’ve probably seen this one:

Shoulder External Rotation

and this:

Shoulder Internal Rotation

These are just 2 of many exercises that supposedly target the rotator cuff that are commonly provided by your health care provider.  In fact, many of you have probably been handed 2-3 pages of these and told to do 3 sets of 15 up to 3x daily.  Ever heard of the shotgun approach?  Your health care provider is hoping and praying that one of these might just work and make you feel better.

Now here is the reality of the rotator cuff:  It’s job is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket)

The 4 Muscles of the Rotator Cuff

What most health care providers are going on are EMG studies that measure how hard a muscle can fire in isolation during a specific activity.  There is certainly great evidence that the rotator cuff muscles are firing during these exercises.  The problem as I alluded to before is that these muscles do not function in this way in real life.

These smaller rotator cuff muscles are stabilizers, not movers (like the larger deltoids, pecs, lats, etc).  The traditional rotator cuff exercises train the muscles like ‘movers’ which is not their true function.  I’m not going to argue that someone can’t show increased strength over time within these exercises, but I will argue is that there is no transfer to improved function (i.e. lifting, reaching, carrying, pushing/pulling, etc).

The reality of the rotator cuff again is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket).  It performs this task reflexively meaning it happens without you having to think about it.  All four muscles quickly fire and relax in a specific sequence (depending on the activity) to stabilize the shoulder joint.  They never work in isolation like you have been trained in the past.

So what are the best ways to fire the rotator cuff reflexively?

  • Compression – this means putting weight through the arm.  Examples would include exercises that involve hands or forearms on the ground holding your body weight, any type of pressing, holding a weight (on your back with the shoulder flexed 90 deg. – think top of a bench press position; or with a weight overhead) just to name a few.
  • Distraction – this would include anything that pulls downward or outward on the shoulder (think traction).  This would include carrying weight by your side, pull-ups, horizontal rows, lifting from the floor, etc.

In any of the above activities, the brain immediately recognizes the need for stability and reflexively fires the cuff to prevent bad things from happening like dislocating your shoulder or falling on your face.  Now obviously I’m not trying to actually do these things to you, but forcing muscles to fire reflexively always works better when there is some sense of urgency.

I’ll leave you with a few of my favorites below, and in part 2 I’ll tackle more of the dogma of shoulder rehab.

Arm/Leg Diagonals – a.k.a. the Bird Dog – Shoulder Compression for Reflex Stabilization

Farmer’s Walk – Shoulder Distraction to elicit reflex stabilization

 

Kettlebell Arm Bar – The goal is reflex stabilization of the glenohumeral joint through compression (using a kettlebell) while performing thoracic rotation.  Lots of great things happening here!

Feel free to email any comments or questions to me:  joe@elitepttc.com

 

 

Ankle Rehab Update

So last week I posted this message on Facebook:  “Limited ankle mobility is a very common reason for nagging foot, knee, hip, and back pain in runners. Unfortunately not too many PTs or doctors are looking there. Maybe it’s time to call us and rid yourself of that pain for good!”

In the past week I have been asked 3 separate times about what is the best way to check your own ankle mobility and then how to improve it.  So to bring you up to speed on why it is so important to have great ankle mobility I refer you to a previous blog post title “Movement Proficiency and the Ankle” which you can find here:  http://www.elitepttc.com/blog/?p=20

Now for the measuring and correcting!

The first video below shows how I measure ankle mobility in the clinic with the foot on the floor and controlling the ankle to prevent pronation (arch flattening out):

To measure your own ankle mobility, simply assume the kneeling position shown in the video.  Rock your knee over the foot to touch the wall measuring how far your big toe is from the wall with a simple tape measure.  The heel must stay down and arch not allowed to collapse.  The goal is 4 inches!

The next video demonstrates how you can quickly address the soft tissue component of the limitation.  Be sure to measure again as we did in the video as this is the only way you are going to know if it is effective or not.  Always follow the rolling with stretching.

If this does not result in an immediate improvement in ankle mobility, you may have a joint restriction that will not be resolved with rolling or stretching.  Another sure sign of joint restriction is pain or pinching in the front or side of the ankle during the testing.  This can often be resolved quickly with ankle joint manipulation and/or mobilization and certain taping techniques that I employ here at Elite Physical Therapy (in other words it’s time to call the professional).

If you have any further questions feel free to contact me:  joe@elitepttc.com

 

 

 

Does Gaining Range of Motion Really Have to Hurt???

Not all physical therapists are created equal, nor does gaining range of motion have to be extremely painful!  I know there is this idea amongst the public that PT has to hurt to effective, but in most cases nothing could be further than the truth.  Sadly enough there are plenty of PT’s out there who also believe ‘No Pain, No Gain’ to be true.

Here is why it does not have to hurt:

–  When the brain starts feeling ‘stress’ it goes into protection mode.  Pain signals coming in to the brain result in signals back to muscles, fascia, and joint capsule to literally tighten down to protect the painful structure.  So the entire time your PT is cranking on your new Total Knee Replacement, or you are cranking on it at home per their instructions, your brain is busy fighting back.  The result is lots of pain and minimal progress.

– Pain fires up your sympathetic nervous system, the part of the system that handles ‘fight or flight’ situations.   My good friend and physical therapist/strength coach Charlie Weingroff has been consulting with Nike and their athletes on this very topic.  What they have found is that athletes who are in this sympathetic state even at rest exhibit increased stress hormone levels that result in poor sleep patterns and poor recovery from workouts and games.  This elevated level of stress over the long term can have some serious effects not only on athletes, but on the rest of us as well.

Balance is good!

The moral of the story here is that increased pain and stress levels can delay healing and recovery.  Some pain is going to be present when you’re dealing with an injury or surgery, but your therapy should not be making you consistently feel worse  Not what you want when trying to recover from an injury or surgery, and certainly not an ideal situation for someone trying to gain range of motion, strength, and returning to work or athletics.

At Elite Physical Therapy and Sports Performance, we recognize that there are a number of soft tissue and joint mobilization/manipulation techniques that can improve range of motion and quality movement without creating excessive pain.  Some techniques may be a bit uncomfortable at the time of application, but what little pain there is should go away quickly with an obvious increase in joint motion and overall movement quality.

Graston Technique can be used to break up scar tissue and improve range of motion of the knee.

 

Graston Technique is also very effective for treatment of tendinopathies – in this case treating the posterior rotator cuff.

In most cases, there are better ways to gain range of motion and strength than trying to push through restrictions and pain.  If you’ve got any questions concerning our soft tissue and joint manual techniques, feel free to contact us.

C1-2 Thrust Manipulation – this one is money for headaches!

Trigger Point Dry Needling – Coming Soon!

 

Michael Phelps talks Graston Technique and Training

This article was sent to me yesterday, and I found it not only very interesting, but also validating what I do at the same time.

http://on.details.com/PLYA8S

Michael discusses the benefits of Graston Technique (GT) on relieving pain and freeing up his shoulders and back for swimming.  This is only his subjective report but who is more in tune with how they are performing and functioning than an elite Olympic athlete?  There is plenty of research being done on GT with great evidence based outcomes so I’m very confident that the benefits are real.

One more thing I do want to mention concerning the use of GT in the article, and Phelps’ comments on the pain and bruising that go along with treatment:  the research indicates that GT is just as effective without the pain and bruising.  Of course there will be some pain as you are trying to break up scar tissue, but there is no need to be ultra-aggressive and bruise.  The majority of my patients will tell you they have some mild to moderate discomfort during the treatment, but are rarely all that sore afterward.  The pain relief and improved motion following the treatment is well worth it.

On the subject of training, Michael talks about how his focus this time around has been on developing more power.  He specifically mentions performing the Olympic lifts and pulling/pushing sleds, both of which are mainstays in our sports performance programs.

At first glance you may wonder why in the world a swimmer would need to do power cleans and run with a sled?  Especially when he’s not even on his feet more than a split second to push off the platform.  Many of the benefits of this type of training are for the nervous system and the speed at which muscles can contract.  Training for power means moving a certain weight as quickly as possible.  The faster you can move it, the more powerful you are.  Strength is different in that time doesn’t matter, only how much weight can you move.  Strength is very important, but in swimming and pretty much every other sport out there, its the speed at which you can generate that force that is most important!

Here is a great example of a power clean (one of the Olympic Lifts – this from my buddy Cal Dietz at the University of Minnesota)

Aaron Studt Cleans 400lbs

Anyway, I hope you enjoy the article.  I can’t wait to see how he does this summer.

Plank Exercise Progressions

If you’ve mastered the front and side plank basics that I’ve discussed on here previously, now you’re ready for some challenging progressions that I feel really carry over to athletics and can get you closer to your training goals.

Each of the following plank progressions add hip motion to the equation so you will be supported on one limb for a period of time.  It’s the support leg that is most important for stability and will be working the hardest.  With all of these exercises, you must maintain a stable core.  So in other words, when you lift a leg your trunk should remain motionless.  If you have to lift your butt up or it sags down then either it is too much for you or you are getting fatigued and need a break.  Perfect reps, nothing less.

The other great thing about these exercises is that they give you a chance to look at symmetry.  By this I mean how does your right leg compare to your left leg when doing a front plank, or how about right and left sides when performing a side plank?  It should be just as easy or difficult on both sides.  Right-Left asymmetries are a huge predictor of injury so work to limit these.  Typically I will have patients or athletes perform an extra set on the weaker side to bring that side up to par.

Alright, done with the lecture.  Check out the plank progressions below.

Prone Plank with Hip Extension -alternate lifting legs about 4-6 inches off the floor.  Nothing moves but the hips.  Shoot for 10 solid reps each leg without losing form.  And if you’ve been paying attention in previous posts, hold the leg up long enough to cycle a breath, then set it back down.  That will be the true test of your inner and outer core working together.

Plank with Hip Extension

Side Plank with Hip Abduction – I really like the side planks as they test your entire lateral kinetic chain for stability.  Post up through the forearm by pressing it ‘through the floor’.  Now lift the top leg keeping the hips high.  Shoot for 10 quality reps with proper diaphragmatic (belly) breathing throughout.  When you can achieve that, now hold the leg at the top and cycle a breath before bringing it back down. 

Side Plank with Hip Abduction

Side Plank with Hip Adduction –this is another great variation that I think gets overlooked.  The bottom leg will be off the ground in this case so the adductors (inner thigh muscles) of the top leg will be carrying more of the load.  Breathing is crucial again so get it right.  Start with 10 second intervals if necessary shooting for 30 second holds ultimately.  If you’ve achieved that, then progress the exercise by moving that bottom leg back and forth.  It should look like a running stride – flex the hip up and then extend it back.  Adding the front to back movement will make your core have to work that much harder to remain stable.  I’ll shoot for 10 reps here again as well.

Side Plank – Hip Adduction

Three great ways to challenge yourself!  Remember to play close attention to those side-to-side differences.  Cleaning those up will bring the greatest benefits.

 

Exercise of the Week – Side Plank

I’ve spent quite a bit of time on the front plank in the first few posts on the blog (you can find those here:  http://www.elitepttc.com/blog/?p=97 ).  Now I went to spend some time on another excellent plank variation that can provide some great core strengthening results when done correctly.

While the front plank emphasizes the ‘anterior’ core (front of the trunk), the side plank will emphasize the lateral core and hips (the sides of the trunk).  I’ve seen this exercise done many different ways but there are a few major technical aspects I want to address here to make sure you are getting the most benefit.

Alignment

The side plank is a challenging exercise so I see a lot of poor alignment in general, and even more so as the athlete get fatigued.  You should be able to draw a straight line from the ankles through the knee-hip-spine-shoulders-ear.  The biggest mistake I see are the hips lagging behind that line.  Check out the picture below:

Lacking Hip Extension

To keep the spine straight (and safe) and hips working to their full potential, think about pressing the hips forward when you lift up into the plank position.

You’ll also notice the more challenging it becomes to hold the position, the more your hips will tend to sag to the floor.  Keep the hips high throughout.  If unable, then the set must be over.  It does you no good to try to stay up any longer.

Breathing

I’ve ranted about this previously, but the way you breath is so important.  Diaphragmatic breathing, or belly breathing, is the key to firing up the inner core musculature that is responsible for segmental stabilization of the spine.  When the inner core unit is firing appropriately, you also move better and are capable of generating much more strength and power.  Take the time to get this right with all of your exercises.

Neck Alignment

Notice the alignment of the head and neck in the first picture – perfectly aligned with the rest of the body and looks strong.  It is strong!  The body goes where the head and eyes go so get that neck lined up and even chin tuck slightly (another inner core trigger).

Now look at the second picture where my hips are lagging behind – my neck and head are out of alignment and sagging downward.  It’s funny how when one thing goes, so do the others.

Hold Times and Reps –

Unlike what you’ll read most places, you don’t have to try to hold a side plank for a minute or more.  Start out performing 10 second holds, with 10 second rest breaks in between.  Perform as many perfect repetitions as possible.  When you can perform 6 perfect reps of 10 seconds, try 4 reps of 15 seconds.

The point is to work up to one minute with perfect alignment and breathing.  If you are doing the exercise right you should be smoked at one minute.
Next blog post I’ll discuss a few progressions for the front and side plank to make them more full body exercises, and much more challenging for athletes and those just looking to get into shape.

 

Exercise of the Week – Front Plank

I’ve discussed the front plank here previously as a way to demonstrate the mistakes many people will make when performing ‘core’ exercises.  The most basic mistake is allowing too much lumbar extension (excessive inward curve of the spine).   In this position, the spinal joints are compressed and providing the stability.  This is a great way to hurt your back over time!

In that post I wrote about achieving a more neutral spine position by trying to pull the belly button to your nose.  This activates the abdominals and rotates the pelvis backward slightly bringing the spinal curve to a more neutral position.  Check out the examples below.

Too much extension

Neutral spine posture

You can see in the second picture that a straight line could be drawn from her hips through her spine to her shoulders.  That straight line should also extend through the neck to the ear, but I’ll talk more about that in a moment.  The neutral spine position is the first correction that must be made, but once you’ve mastered that here are a few other  techniques to get the most possible benefit from the front plank exercise:

1.   ‘Breathing behind the shield’ – this is a cue used by the RKC (Russian Kettlebell Challenge) to improve spinal stability and strength in the plank and other kettlebell exercises.  When breathing appropriately, you should feel the abdomen expand circumferentially (see the picture below).  The chest will expand slightly but definitely do not want to feel the shoulders rise toward the ears.

Using the diaphragm appropriately during any activity triggers the deep muscles of the core that are responsible for segmental spinal stability.  This is the most basic level of stability in the spine and what keeps our vertebrae in proper alignment.  This is a must for injury prevention and optimum performance.  We all breathed this way when we were younger but most of us lose this ability especially when challenged.  Check your breathing right now.  Do you feel your abdomen expand when you inhale?  Or do you feel the expansion in your chest?  Worst of all are your shoulders rising when you inhale?  Pathological breathing pattern can contribute to all sorts of orthopedic ailments and reduces your ability to exercise efficiently.

The ‘shield’ refers to the braced muscles of the abdomen.  If you’ve taken the steps I’ve described above then you should feel the abdominals contacting hard.  The breath should feel like it is pressing out into the abdominals.  Many trainers and clinicians advocate drawing the belly button in toward the spine, but this only destroys the breathing pattern and weakens the deep stabilizing unit.

2.  ‘Pack the Neck’ by pulling the chin back to your spine.   The common mistakes here are to bring the chin down toward the chest or to look up.  You should be looking straight down and feel like your head moves up away from the floor.  This small movement activates the deep flexor muscles in the front of the neck which are known to be a ‘trigger’ for recruitment of the inner core muscles I spoke of in #1.  Again, anything that makes you stronger in this exercise will only help bring you closer to your fitness goals, prevent back pain, and improve carry over to everyday activities and sports.

Packing the Neck – I was unable to find a good example in the plank position – which should tell you how few people do it correctly!

3.  Increase abdominal muscle activation by pulling your elbows to your toes.  The elbows aren’t going to move, but you want to feel yourself pulling into the floor in that direction.  You will feel the abdominal contract much harder as well as the large latissimus muscles on each side of the upper back.  Once you can hold your plank using this technique, now try to pull your toes toward your elbows.  Once again you will feel everything tighten down and bring more muscles into the exercise including the abdominals.  This uses the principle known as irradiation which basically means the more muscles you can recruit the stronger you will be.

When you try these techniques you realize how hard the plank exercise should really be.  I’m not impressed by people that tell me they can hold the position for 5 minutes because they are doing it wrong.  This should be an extremely difficult exercise.  Start with 10 second holds with 10 second rest breaks.  The goal should be to hold 20 seconds per rep, rest 10 seconds in between, and then work up to 10 reps.

Feel free to leave your comments and let me know what you think.  Thanks!

PT Minute- Preventing Falls

Slipping and falling on the ice results in countless injures and fractures every winter.  Here are a couple of simple ways to improve your balance and reduce your fall risk.

When most people think of balance, they think of the foot and ankle doing most of the work, however, the ability of your hip and trunk muscles to quickly react are equally as important.

A great way to improve the reaction time of the hip and trunk is to assume a 1/2 kneeling posture, kneeling on one knee with the opposite foot out in front flat on the floor.  Stay tall and try bringing your front foot to align with your down knee.  This is a difficult move and you may need to start with a wider base of support to be successful.

Once you find a position that you can balance in, but also feel challenged, hold for 10 to 30 seconds, then switch sides.

As you improve, move to  single leg balance.  To activate the muscles of the hip and core while doing single leg balance,  pull on a band bringing hands to hips, stay tall, and balance for 10 seconds on each leg.  Bringing the knee higher increases the challenge but not to the point that your posture suffers so stop when the thigh is parallel to the floor as in the picture below.

To increase the challenge, simply face away from the band and pull forward.  Continue to emphasize a tall posture, and alternate balancing 10 seconds on each leg.  Usually 5-6 repetitions on each leg is plenty.

These are two simple, yet challenging exercises you can do right from home so take a little extra time to perfect your balance and stay safe through the ice and snow this winter.

To catch the PT minute featuring Fall Prevention and Balance, click here:  PT minute 3 – Balance

PT Minute- Snow Shoveling and Back Pain

Snow shoveling can be hard on your back, not just from moving heavy snow, but also from the postures that are used.

A rounded back places greater strain on the discs, muscles and other structures of the spine.  The safer posture is a flat back with the hips pushed back.  This is known as a hip hinge.

To work the hip hinge, simply place a stick along the spine touching the head, mid-back and tailbone.  Slightly bend your knees and push the hips back.  The stick should stay in contact with all 3 points.  Go as far as you can without losing contact.  The goal would be to feel a good stretch in the hamstrings.

 

This can be a difficulty move for many.  If so, practice the hip hinge pattern on your hands and knees first.  With a water bottle across the low back, push the hips back toward the heels maintaining a slight spinal curve.  If you lose the water bottle, you’ve lost posture.

Stay within a comfortable range of motion with perfect posture, and absolutely no pain.  Perform 10 repetitions to re-establish your hip hinge prior to taking on the snow.

Here is the link to the PT minute video:  PT Minute – Snow shoveling and Back Pain