Home Posts tagged "Pronation"

Lying Knee-To-Knee Stretch

What the experts are saying about The Truth About Unstable Surface Training “Unstable surface training is many times misunderstood and misinterpeted in both the physical therapy and athletic performance fields. The Truth About Unstable Surface Training e-book greatly clarifies where unstable surface training strategically fits into an overall program of injury prevention, warm-up/activation, and increasing whole body strength. If you are a physical therapist, athletic trainer, or strength training professional, The Truth About Unstable Surface Training gives you a massive amount of evidence-based ammunition for your treatment stockpile.” Shon Grosse PT, ATC, CSCS Comprehensive Physical Therapy Colmar, PA Click here for more information on The Truth About Unstable Surface Training.

cressey-flat-salespage

Subscriber-Only Q&A Q: I have a question about your 22 More Random Thoughts article from October of 2008 on T-Nation.  In the stretch for the hips found above #10, I can't tell is that athlete bridging or are the hips on the ground.  Also, can you please explain exactly what is stretched and how a little bit about how it corrects out-toeing of the feet? A: Sure, no problem. Here's the lying knee-to-knee stretch, for those readers who missed the original article:

lyingknee-to-kneestretch

First off, it's a stretch for the hip external rotators, and the athlete is not bridging up.  However, it's also useful to do the stretch in a more hips-extended position, as a small percentage of athletes will feel it more in that position.  To perform this stretch, we'll do the exact same position, but have the athlete set up atop a stability ball (which keeps the femurs in a more extended position). Poor hip internal rotation range-of-motion is something you'll see quite frequently in soccer players, hockey players, and powerlifters, as all spend a considerable amount of time in hip external rotation.  Likewise, I monitor this closely with all my baseball pitchers, as front leg hip internal rotation deficit is a huge problem for pitchers.  When the front hip opens up too soon because of these muscular restrictions, the arm lags behind the body (out of the scapular plane).  As such, it isn't uncommon for pitchers with elbow and/or shoulder pain to present with a significant hip internal rotation deficit. There is also a considerable amount of research to suggest that hip rotation deficits - and particularly, hip internal rotation deficits - are highly correlated with low back pain.  There was a great guest blog post at Mike Reinold's blog recently that highlights all this research; you can check it out HERE.  My personal experience with hundreds of people who have come my way with back pain overwhelmingly supports this "theory" (if you can even call it that).  It's my firm belief that this is one of the primary reasons Mike Robertson and I have gotten so much great feedback on our Magnificent Mobility DVD from folks who have seen a reduction (or altogether elmination) in back pain.  Teach folks to move at the hips (particularly in rotation) instead of the lumbar spine, and whatever's going on in their low backs calms down.

mm1

Our goal is a minimum of 40 degrees of hip internal rotation.  This is measured in the seated position (hips flexed to 90 degrees). In addition to the classes of athletes I mentioned earlier, we also need to watch out for hip internal rotation deficit (HIRD) in the general population because of what happens further down the kinetic chain.  We all know that overpronation at the subtalar join is a big problem for a lot of folks.  This can occur because of a collection of factors, from poor footwear (too much heel lift), to muscular weakness (more on this in a second), to mobility deficits (particularly at the ankle), to congenital factors (flat feet). To understand how pronation affects the hip external rotators, you'll need to listen to a brief synopsis of subtalar joint function... During the gait cycle, the subtalar joint pronates, to aid in deceleration.  Basically, the foot flattens out to give us a bigger base of support from which to cushion impact, and from there, we switch back over to supination to get a rigid foot from which to propel.  The picture below shows what our foot looks like when we have too much pronation.

pronation

Here's where our hip gets involved.  Physical therapist John Pallof once called the subtalar joint a "torque converter," and it really stuck with me.  What that means is that while the subtalar joint allows motion in three planes for pronation/supination, it converts this motion into transverse plan motion where it interacts with the tibia.  And, as you can imagine based on the picture above, when you pronate, you increase tibial internal rotation. This, in turn, increased femoral internal rotation.  Taken all together, we realize that increasing pronation means that there is more tibial and femoral internal rotation to decelerate with each step, stride, or jump landing. The hip external rotators are strong muscles with a big cross sectional area, so they can take on this burden.  However, over time, they can get balled up from overuse.  As a result, the hip will sit in a more externally rotated position all the time - and the feet simply come along for the ride.  That said, as I wrote HERE, it isn't the only cause of this foot position, so be sure to assess thoroughly and individualize your recommendations. Also, a quick side note, be careful using this stretch with individuals who have previously experienced medial knee injuries, as the valgus stress can be a bit too much for some folks. New Blog Content Random Friday Thoughts For High School Pitchers, No Grace Period Doga?  Seriously? CP Athlete Featured at Precision Nutrition I encourage you to check out this Precision Nutrition Athlete Profile on Cressey Performance athlete and Oakland A's minor league pitcher Shawn Haviland.  Shawn completely changed his body this off-season and had a nice velocity jump from 87-89 to 91-93mph - and he's off to a good start for the Kane County Cougars. A lot of this can be attributed to him making huge strides with improving his nutrition. Have a great week! EC
Read more

Random Thursday Thoughts: 7/3

Hey Gang, With the 4th of July falling on a Friday, we won't have any Random Friday Thoughts this weekend. However, that's not to say that we can't bump up my senseless digressions to Thursday just this once... 1. I made my ESPN.com debut this week – but it’s not for the reason you might think! Check out DJ Gallo's column. I'm actually pretty honored that he even gave me the mention, as I've been reading Page 2 for quite some time now. 2. I am headed to Maine (my old stomping grounds) with Tony Gentilcore and our girlfriends for the 4th of July. Geek that I am, I am taking about 15 journal articles on shoulder dysfunction with me to read on the beach. I'll be at Cressey Performance on Sunday night, and then it's off to Delaware for four days for some more continuing education with respect to the overhead throwing athlete. Dr. Craig Morgan and his colleagues at the Morgan-Kalman Clinic have been gracious enough to extend an invitation to see them in action. To say that I am excited would be an understatement, as these guys have worked with a lot of messed-up arms - many of them worth millions of dollars. I'll also spend some time in the clinic with Shon Grosse, a great PT in Philadelphia. So, it'll be seven days of shoulders. 3. Congratulations to Dave Robertson on his Major League Debut. Dave spent some time with us at Cressey Performance this past-offseason, and he made an appearance at Shea Stadium on Sunday for the Yankees. Dave is a great guy and a really hard worker; he deserves all the success that comes his way. 4. Worst. Sign. Ever. 5. Here is a simple, yet effective stretch for those of you who are locked in hip external rotation. This is really common in soccer, hockey, and powerlifting athletes. When performed correctly, you should feel it in your glutes. It's also a common problem spot for people who over-pronate, as subtalar pronation leads to more tibial and femoral internal rotation - which causes the lateral rotators to work overtime with respect to deceleration. Soft tissue work on these areas works best, but some basic stretching can help as well. 5. DId a 545x3 deadlift and hit a 32.5-inch vertical jump today. Not a bad day at the office... Have a great holiday!
Read more
Page
LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series