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4 Ways Hypermobile Clients Can Improve Their Training

Today's guest post comes from Cressey Sports Performance coach, Laura Canteri.

From super tight to super loose, people can fall at any point on the laxity continuum. Most women fall under the more hypermobile side of things, but there are a surprising amount of women who are nonetheless unaware of their extreme laxity. As a hypermobile female who learned the hard way, I want to share my knowledge and experiences with you to help improve your training and long-term health in four simple steps. While I'll focus my attention on females in particular, the overwhelming majority of these lessons hold true for hypermobile males as well.

1. Create Self Awareness.

What is Hypermobility?

Each joint has a certain amount of laxity and can be either congenital (you were born with it; thanks, Mom and Dad) or as a consequence of repetitive activities (e.g., swimming).  It shouldn't be confused with instability, which would result from an injury that leads to excessive, uncontrolled range-of-motion. With that said, hypermobility is excessive laxity at a joint. If you often feel “tight” and don’t think that this article pertains to you, I encourage you to keep reading.

How Do I Know If I’m Hypermobile?

At Cressey Sports Performance, we like to use the Beighton scale to assess joint laxity and hypermobility. The screen is scored out of nine points in which there are five tests (see below). Unilateral tests should be scored on both sides with each positive test counting as one point. The higher the score, the higher the laxity.

1. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
2. Flex the thumb to contact with the forearm (left and right sides)
3. Elbow hyperextension > 10° (left and right sides)
4. Knee hyperextension > 10° (left and right sides)
5. Toe touch with knees straight, touch the palms flat on the floor

Beighton_Score

2. Remove Static Stretching From Your Routine.

From youth to college basketball, I had my fair share of injuries - from sprained ankles to dislocated shoulders -but despite having such loose joints, I would always feel “tight.” I couldn’t touch my toes, clasp my hands behind my back, or do any “cool” tricks. So, I incorporated static stretching before and after every game/practice to decrease my risk for injuries. Good news: I was eventually able to touch my toes and clasp my hands behind my back. Bad news: I continued to have even more shoulder instability issues, which resulted in surgery.

So, what gives? I wouldn’t feel “tight” if I was hypermobile, right? Wrong. Let me explain. When other structures aren’t working properly (i.e. your ligaments and tendons) to support a joint, the surrounding muscles work overtime to stabilize and protect it. This mechanism is known as "protective tension" and is the reason why someone who is hypermobile may feel “tight.”  Our body creates trigger points as a strategy to create stability where we don't have it. It may feel good to stretch in the moment, but stretching muscles around an already lax joint capsule will only lead to more instability and greater risk for injury.  It's like picking a scab; you feel better in the short-term, but wind up with longer term problems.

Long story short, if you're looking for a quick reduction in tightness, get rid of the static stretching and grab yourself a foam roller instead - and then follow that work up with some good stability exercises.

3. Stay Away From End Ranges.

Women who have a lot of joint laxity tend to stand, sit, and train in extreme end ranges (see pictures below). When joints are constantly loaded beyond normal range, the ligaments will continue to become more lax and the joint will experience more wear and tear overtime. Here are a few examples:

Hyperextended Elbows During a Push-up

elbowhyperextension 

Hyperflexed Lumbar Spine and Hyperextended Cervical Spine During Sitting

IMG_4273

Hyperextended Knees During Standing

IMG_4274

Hyperextended Knees and Right Hip Shift During Standing

IMG_4275

Whether you are sitting behind a desk at work, attending a yoga class, or lifting weight, it is important to be aware of your body position and stop just short of end range.

4. Improve Motor Control.

Generally speaking, women have greater Q-angles (measured from hip to patella along femur) and a higher predisposition to joint laxity compared to men. Looser joints require more stability and motor control; therefore, learning better movement patterns is critical for improving long-term health and joint integrity.

For example, if you are experiencing discomfort in the front of your shoulder, one exercise you could incorporate is the standing external rotation. This is a great exercise for hypermobile individuals to increase posterior rotator cuff strength, increase shoulder stability, and improve motor control by learning how to keep the ball centered in the socket.

Regardless of what exercise you perform, in order to improve motor control you must:

a. Be present:  Eliminate distractions (e.g. texting, Facebook, etc.). If you are not focused, you will naturally fall back to your compensatory movement patterns

b. Maintain a neutral spine: It is common for hypermobile women to overextend their lower back and rely on bony stability; therefore, learning how to execute and maintain a neutral spine is important in every exercise in order to set a foundation for better alignment

c. Slow down: Perform each rep in a controlled manner, and emphasize quality over quantity.

d. Train in non-fatigued state: Be aware of how you feel, as fatigue will negatively affect your ability to learn new movement patterns

Conclusion

My personal experiences have led me to believe that hypermobility, especially for women, is more common than one might think. Creating awareness for yourself or your clients is the first step in the right direction. As Eric always says, “Assess, don’t guess.”

Happy training to all my hypermobile readers out there!

About the Author

Laura Canteri (@LC_Canteri) heads up strength camps (group training) at Cressey Sports Performance – Florida. She completed her master’s degree in exercise physiology at Florida Atlantic University, and also is Precision Nutrition certified. In addition to her work at CSP, Laura works with folks from all walks of life through her distance-based consulting. You can reach her at l.c.canteri@gmail.com. 

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4 Rules of Posture

Today's guest post comes from Physical Therapist Chris Leib. Enjoy! -EC

chrisl

Recently, there has been plenty of discussion regarding the efficacy of the idea of posture and whether attempting to improve it is a useful tactic for decreasing pain. This discussion has been perpetuated by research indicating that there is a surprisingly poor correlation between pain and posture. The evidence seems to be pretty damning on this topic, which raises questions about whether looking at pain as an outcome measure actually makes sense when discussing posture. Moreover, even more basic questions still need to be asked regarding the very definition of posture.

When discussing these inquiries, it’s important to understand that the current research has demonstrated that pain is far more complex than previously thought, and that a single model of physiological stress will not be sufficient to demonstrate why some people experience pain and some do not. A discussion of pain science is too complicated to be brushed over in the present discussion; however, it must be understood:

[bctt tweet="Just because proper posture hasn’t been highly correlated with pain doesn’t mean it’s not important."]

When looking deeper into the studies cited above, it becomes clear that there is not a consensus definition of posture. Instead of looking at the constantly changing nature of posture, many of these studies defined posture by using various markers of static structure. Taking this fact into consideration, one must ask the following question: If no agreement is reached as to what proper posture is, how can it be well studied?

In my experience over the past decade as both a strength and conditioning professional and physical therapist, my own definition of proper posture has evolved considerably. Utilizing these years of clinical experience and the current research, I would like to set forth the following 4 Rules of Posture.

Rule #1: Posture May Not Cause Pain, But Improving Posture Can Help to Decrease Pain.

Although there is poor evidence that various definitions of poor posture are associated with increased pain, it’s obvious through clinical assessment that a change in posture can decrease pain when it is present. Go to any physical therapy clinic and you will find patients in pain getting education regarding postural changes that improve their symptoms on the spot. Pain can be a great indicator of what the body feels is a stable position. Often, immediate positive changes are made just by getting the person into a different position.

A common example is the individual with neck pain who has pain when sitting slouched with his or her head forward. Frequently, a combination of education and ergonomic adjustment can abolish this excruciating pain in shorter order. Now, this isn’t to say that the quick fix always “cures” the problem, but it does gives the person more feelings of control over making change with regard to their pain, which actually goes a long way. This sense of control has been demonstrated to be a positive indicator of recovery from and the ability to cope with chronic pain .

Rule #1 is the only rule in which we’ll discuss pain. As I noted, the research on pain indicates that the science is far too complex to discuss isolated associations. Clinically, pain can be a good feedback indicator of postures and positions that a person’s body finds unsafe. This feedback helps determine the best positions for the person to train in and, with time, adopt.

The subsequent three rules will discuss posture in relation to functional and physical performance-based movement quality.

Rule #2: Support Yourself Actively and Passively.

This rule will illustrate the difference between passive and active postural stability, as well as the appropriate balance that’s needed between the two. Let’s get some definitions out of the way first.

Generally speaking, passive stability is using something other than balanced muscular effort to adopt and maintain a desired position. Passive stability can either be anatomical or external in nature. Anatomical passive stability utilizes one’s passive stability structures such as joint capsules, cartilage, and ligaments to find stability in a position, while external passive stability utilizes an external item for extra support when attempting to maintain a position. When dealing with passive stability of any type, the common denominator is finding a stable position while decreasing relative muscular effort.

Active postural stability, on the other hand, refers to the use of muscles to maintain a desired position. In order to optimize muscle activity during static and dynamic postures, the attachments of the muscles must be positioned so that the muscles contract in a balanced way. In addition, the position should minimize energy expenditure against the pull of gravity.

For clarification on how best to determine optimal positioning based on the above definitions, let’s illustrate a common static and dynamic example.

i. Static postural stability: Sitting in a chair

No matter what, this common static position will never be ideal for postural stability due to the severe muscle imbalances inherent to sitting with your hips and knees in 90 degrees of flexion. However, sitting with the head and shoulders substantially in front of the line of gravity makes a bad situation even worse. The further forward the head and shoulders travel out in front of this line, the more effort the muscles that hold up the head and trunk must exert. More importantly, because the muscles in this case are overstretched and in a poor position to function in a balanced way, less resilient structures such as ligaments and joint capsules/cartilages are forced to pick up the slack.

Thus, the most optimal default position in sitting is the one that minimizes the effort of your muscles and stress to your other more passive structures by allowing the head and shoulders to balance effortlessly in the line of gravity. (Feel free to take this opportunity to observe your own posture. Are your head and shoulders neatly stacked or forward like the pass from the 2000 Music City Miracle?)

NeckPosture

ii. Dynamic postural stability: Deadlifting a heavy load from the ground

In this dynamic example, the muscles of the hips, lower back, abdomen, and thorax will be in the most balanced position to lift the load when the pelvis is in a neutral position. That is to say, the lower back should neither be flexed nor extended. In this position, the muscles of the lower back are well balanced with that of the abdomen, and the hip extensors have a better opportunity to contract during the lift.

If the lift were initiated with the lower spine in an extended position, the position can still indeed be stable; however, the stability would come from passive anatomical structures such as the lumbar facet joints and ligaments of the anterior spine. This position increases compressive forces to the lower back and decreases the contractile ability of both the abdominals and hip extensors, as both of these muscle groups are now in an over-lengthened position.

DL posture

Therefore, the optimal position for the dynamic movement of deadlifting is the one that allows for the hip/trunk flexors and hip/trunk extensors to work in the most balanced fashion (see video below). Moreover, setting up the movement and transitioning the bar in such a way that the load stays as close to the body as possible minimizes the downward pulling effects from gravity much like the head and shoulders staying over the midline of the body in the previous sitting example.

When attempting to understand how best to balance active and passive stability within a specific task, we must take into consideration four factors: (1) the available tissue mobility in order to get into the position required; (2) the external objects manipulated or used for positioning; (3) the duration of the task; (4) the intensity of the task.

Let’s return once again to our two examples:

i. Static postural stability: Sitting in a chair

For static sitting, we must first assess ranges of motion like thoracic extension, shoulder internal/external rotation, and scapular retraction/depression/posterior tilt. In doing so, we’re able to determine whether the desired position can be assumed without pain or excessive compensatory muscle effort. Moreover, we must know the type of seat the client will be utilizing and what activities he or she will be doing while sitting (i.e. typing, driving, etc.).

In terms of duration and intensity, sitting will typically fall under the category of a low intensity activity done for long durations. The longer the duration, the more muscular endurance necessary to maintain a desired position. If any of the above factors are not optimal, external passive support in the form of a lumbar cushion, posture shirt, or corrective tape may be necessary to enable the client to attain a more favorable posture without excessive effort.

seated

(Passively elevating the hips to decrease the effort to maintain an upright torso)

ii. Dynamic postural stability: Deadlifting a heavy load from the ground

With deadlifting, mobility limitations in the hips and trunk can often limit an individual’s ability to adopt and maintain the optimal stable position described above. In addition, the intensity of the load or duration of the set must not exceed the amount of muscular force the individual is able to generate, or else even a solid initial position will be lost.

In cases where mobility restrictions are a limiting factor, passive support can come in the form of apparatuses that decrease the range of motion of the movement (i.e. elevating the load onto blocks or a rack). When approaching maximal loads or durations, passive support may take the form of stability belts and braces in areas most susceptible to positional failure.

2DLs

3. Posture is the Product of Your Movement Variability.

Posture is often discussed as a single static element that represents one’s lack of mindfulness or genetic misfortune. Clinical experience and the current scientific literature say this belief is not only wrong, but also a harmful notion to the process of making postural change. One shouldn’t feel guilty or unfortunate that he or she is demonstrating an unskillful posture. Instead, there should be an understanding that posture is not a single static entity, but rather task dependent and constantly changing.

The secret to good posture is that you shouldn’t need to work for it when you are at rest. You see, your static postures during sitting, standing, and walking are a product of your cumulative movement throughout the day. Our bodies are built to adapt to the positions and activities we take on most frequently. If any of these positions and activities are done is excess, all our positions and movement can become imbalanced. This imbalance is what is deemed by many as poor posture, but in reality it is just the body doing what it does best: adapting.

In order to prevent postural imbalances, it is unwise to attempt to simply make ergonomic adjustments to the positions we sustain too frequently. Instead, we must consider our whole body of movement throughout the day. If we focus on proper positioning in training, it will inevitably transfer to our static postures. In this way, programming for any strength, conditioning, or fitness routine must involve a strong focus on developing positions that promote muscular balance (active postural stability) and task transference, as opposed to simply task completion.

For example, there are many ways to push yourself up from the ground when doing a push-up, but there are positioning subtleties that can either promote balanced muscular stability or feed habits of chronic positioning that we already practice too frequently throughout the day (see video below). Thus, an individual’s movement practice should be about movement quality and variability as much as about cultivating strength and conditioning.

Mindless prescription of physical activity (i.e. 30-60 minutes of aerobic exercises; 3 sets of 10 of machine based resistance exercise) prioritizes strength and conditioning capacity over movement capability and variability, hoping that by blindly improving one’s quantity of routine movements the quality of movement will also improve. Don’t get me wrong, in moderation, more movement is better than less movement. However, too much of the same movements can create similar problems as too little movement.

4. Counterbalance Your Life.

The idea of increasing movement quality and variability goes way beyond one’s time at the gym. To allow for increased ease of active postural stability, the common patterns of one’s entire day need to be understood so that behavioral change can be implemented. This is not to say that if we sit all day at work then we need to get a new job. That’s just not practical. Nor does it mean that we must be obsessed with maintaining an upright posture or “drawing our abdomens in” all day long. It simply calls for awareness — awareness of the positions that are most frequently adopted and strategies for counterbalancing them.

Guidelines for this awareness are three-fold:

i. Understand the chronic positions you adopt.

Often postural counterbalances are subtle and developing improved body awareness becomes much more important than simply adjusting your position. This improved body education can come in many forms, such as independent reading on anatomy and physiology, advice from a movement professional, or cultivation of a versatile movement practice as discussed above. It’s important to know that ultimately YOU have the best opportunity to understand your own body. It can be a gradual process to refine this body awareness, but once developed, understanding the positions and movements that are healthy versus harmful to your specific body becomes much easier.

ii. Separate times you must be stationary and times you choose to be stationary.

It’s important to have a plan of attack for positioning throughout your day. Practically speaking, if you sit all day at work, acknowledge it, and then minimize the time you sit when in the comfort of your home. Likewise, if you are on your feet all day, don’t be afraid to spend some time vegging out on the couch. One stationary position is not necessarily better than the other (i.e. standing is not better than sitting). It’s the one that you do most frequently that will usually lead to problems.

iii. Expand your positional repertoire.

When attempting to adopt positions different from those in which you are most comfortable, it is important to have other positions at your disposal. For example, sitting in a chair is a completely different mechanical stress than sitting cross-legged on the ground, just as standing stationary on two legs is different than weight shifting effortlessly from one leg to the other. Similar to the idea of developing more movement variability in an exercise practice, it’s important that you’re able to adopt positions besides those you do most frequently. This may be another area where the help of a movement professional is necessary so that you can become comfortable with the mobility and stability necessary to adopt different variations of sitting and standing positions.

See the video playlist below regarding positional variations for sitting (chair and ground) and standing:

In conclusion, there is plenty of disagreement and misunderstanding around the topic of posture. In my experience, this controversy is unnecessary and overblown. Any respectable strength and conditioning professional would agree that proper positioning and technique is vital when undertaking various movements in a strength and conditioning program. Why should the importance of positioning be any different in our movements throughout the day? We must understand that our bodies are constantly changing; therefore, posture should be viewed as a dynamic, ever-changing journey — not a fixed destination. Hopefully the 4 Rules of Posture set forth above allow you to better understand how to embrace this journey!

About the Author

Chris Leib of MovementProfessional.com is a licensed Doctor of Physical Therapy and Certified Strength and Conditioning Specialist with nearly a decade of experience in treating movement dysfunctions and enhancing human performance. He has written for many popular training and rehabilitation websites, and has a versatile movement background with a variety of certifications as both a physical therapist and fitness professional. Chris considers physical activity a vital process to being a complete human being and is passionate about helping others maximize their movement potential. Be sure to follow him on Facebook and YouTube.

A special thanks to Travis Pollen of www.FitnessPollenator.com for his help with this article.

References

1. Grundy, Roberts (1984) Does unequal leg length cause back pain? A case-control study. Lancet. 1984 Aug 4;2(8397):256-8. http://www.ncbi.nlm.nih.gov/pubmed/6146810

2. Pope, M., Bevins, T., Wilder, D., & Frymoyer, J. (1985). The Relationship Between Anthropometric, Postural, Muscular, and Mobility Characteristics of Males Ages 18-55. Spine, 644-648. http://www.ncbi.nlm.nih.gov/pubmed/4071274

3. Grob, D., Frauenfelder, H., & Mannion, A. (2006). The association between cervical spine curvature and neck pain. European Spine Journal Eur Spine J, 669-678. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213543/

4. Nourbakhsh, M., & Arab, A. (2002). Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy, 447-460. http://www.ncbi.nlm.nih.gov/pubmed/12322811

5. Dieck, G., Kelsey, J., Goel, V., Panjabi, M., Walter, S., & Laprade, M. (1985). An Epidemiologic Study of the Relationship Between Postural Asymmetry in the Teen Years and Subsequent Back and Neck Pain. Spine, 872-877. http://www.ncbi.nlm.nih.gov/pubmed/2938272

6. Franklin, M., & Conner-Kerr, T. (1988). An Analysis of Posture and Back Pain in the First and Third Trimesters of Pregnancy. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy, 133-138. http://www.ncbi.nlm.nih.gov/pubmed/9742469

7. Lederman, E. (2010). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies, 131-138. http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf

8. Christensen, S., & Hartvigsen, J. (2008). Spinal Curves and Health: A Systematic Critical Review of the Epidemiological Literature Dealing With Associations Between Sagittal Spinal Curves and Health. Journal of Manipulative and Physiological Therapeutics, 690-714. http://www.ncbi.nlm.nih.gov/pubmed/19028253

9. Evidence-Base for Explain Pain, Second Edition. (n.d). Retrieved October 2, 2015. http://www.noigroup.com/documents/noi_explain_pain_2nd_edn_evidence_base_0813.pdf

10. Control, culture and chronic pain. (n.d.). Retrieved October 2, 2015.
http://www.sciencedirect.com/science/article/pii/0277953694900205

11. Garber, C., Blissmer, B., Deschenes, M., Franklin, B., Lamonte, M., Lee, I., Swain, D. (2011). Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults. Medicine & Science in Sports & Exercise, 1334-1359. http://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx

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Random Thoughts on Sports Performance Training: Installment 10

It's time for the May installment of this popular strength and conditioning series.

1. Train OUTSIDE.

One of the things I've noticed over the years - both with sprinting and long tossing - is that athletes seem to "hold back" when they're indoors. They won't run at top speed when there are only 40-50 yards of turf ahead of them because they're already worrying about decelerating before they even really get moving. And, with throwing, there just seems to be more inhibition when an athlete is throwing into a net - as opposed to throwing to a partner who is pretty far away. Maybe it's the quantifiable feedback of actual distance, or maybe it's just less restriction - but the effort is always better.

To that end, it's mid-May and the weather is getting really nice around the country. Now is a perfect chance to get out and sprint in the grass or at the local track. Don't miss this chance, as it'll be snowing again before you know it!

2. When selecting exercises, prioritize upside over avoiding downside.

This will be the "glass is half full/empty" point of the day - and I'll use an example to illustrate it.

Let's take the question of whether or not to prescribe bench presses for baseball players. I, personally, don't prescribe them for this population, but there are still a lot of strength and conditioning coaches out there who do.

Their argument is that they aren't as big a problem as has been proposed. In other words, they're protecting against the downside.

My mindset, by contrast, is to highlight the lack of an upside. In a population where shoulder and elbow issues are astronomically high, does this exercise provide substantial benefit such that it deserves a place in our programs? Does it deliver a better training effect than a push-up variation or landmine press, for instance?

In other words, it's not just a discussion of "good vs. bad;" it's a discussion of "optimal vs. acceptable." Even if some players can "get away with" bench pressing, are we really doing right by these players if our approach to training is to simply try to justify that our exercise selection isn't doing harm?

3. Use fillers to break up power training sets.

Optimal training for power mandates that athletes take ample time between sets to recharge. Unfortunately, a lot of athletes have a tendency to rush through power work because it doesn't create the same kind of acute fatigue that you'd get from a set of higher-rep, loaded work. In other words, you'll want to rest more after a set of five squats than you would after a set of five heidens, even if you were attempting to put maximal force into the ground on each rep with both.

To that end, one thing I commonly do is pair power training exercises with low-key corrective drills. We call these drills "fillers," but that's not to say that they aren't very important. We might pair a rotational medicine ball training drill with a wall slide variation. This helps us get more quality work in with each session, but just as importantly, slows the athletes down to make sure they get the most out of their power training exercises.

4. Coach standing posture.

Static posture assessments are boring; I get it. However, they can still be incredibly telling. Here's an example...

Last weekend, during a two-day seminar I was giving, a trainer approached me and asked about his chronic bilateral knee issues. He described his soft tissue initiatives, mobility work, and strength training modifications in great detail; it was clear he'd put a lot of thought into the issue and was clearly frustrated, especially having been through physical therapy a few times without success. When he was done describing everything, I looked down at his lower body and asked, "Do you stand like that all day?"

He was just "hanging out" in a bunch of knee hyperextension. A follow-up toe touch screen looked pretty similar to this:

photo-68

The toe touch is obviously a movement fault, but he was in a bad starting position before the movement even started. If you stand in knee hyperextension all day - especially if you're a personal trainer on hard, unforgiving surfaces all day - your knees will hurt. It doesn't matter how much you foam roll or modify your strength program. You have to learn to stand correctly before you learn to move correctly.

With that said, apply this to your athletes. How many of them do this during down-time in practice or games? And, next time you watch a Major League Baseball game, watch how many position players just "hang out" like this between pitches - and wonder why we see more hip and back pain on the right side.

IMG_8938

Sometimes, the easiest solutions aren't the most obvious - even when they really are obvious if you know where to start looking!

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Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 10

It's time for the first trio of coaching cue suggestions of 2015!

1. Make a straight line from your heels to your head.

I'm a huge fan of inverted rows not only because of the great upper back training they provide, but also because they challenge core control at the same time. Unfortunately, a lot of folks will let the ribs flare up, head to slide into a forward head posture, or knees to hyperextend. All of these are extension-bias compensation strategies that can easily be cleaned up by just focusing on making a straight line from the heels to the head.

Typically, after providing this cue, I'll snap a photo of the posture as a good visual reminder for the athlete, too.

--> Related: 10 Ways to Progress Inverted Rows <--

2. Roll with your forearms, not your hands.

Foam rolling is great, but not if you spend the bulk of your time in bad positions. In my opinion, foremost among these bad positions is doing prone (face-down) rolling while being supported by the hands. The problem is that when you're supported by your hands, you're automatically in a position of heavy lumbar extension (low back arching) - comparable to the upward-facing dog yoga pose. With that said, simply dropping down to support yourself with your forearms is a much better bet for getting your quad and groin rolling in without throwing your back under the bus.

rolling

Keep in mind, of course, that you'll still be in some extension, but it's much closer to the natural lordotic (slight arch) posture we have in normal standing alignment.

3. Keep the head behind the belly button as long as possible.

When we train rotational medicine ball drills, it's important to create a powerful separation of the hip and shoulders. In other words, the pelvis rotates in one direction as the torso rotates in the opposite direction; this stretch helps to create and transfer elastic energy for rotational power. If the torso "leaks" forward early, though, the separation is minimized and force production and transfer is reduced.

One way to prevent this energy leak is to cue an athlete to "stay back" longer. Unfortunately, many athletes don't grasp this vague cue. As such, I like to encourage athletes to keep the head behind the belly button as long as possible. In other words, delay the torso rotation forward a bit longer.

That does it for installment 10. Have a great weekend!

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6 Reasons Anterior Core Stability Exercises Are Essential

This time of year, I'm doing a lot of assessments on college baseball players who are just wrapping up their seasons.  One of the biggest issues that I note in just about every "new" athlete I see is a lack of anterior core control. In other words, these athletes sit in an exaggerated extension pattern that usually looks something like this:

APT-250x300

And, when they take their arms overhead, they usually can't do so without the ribs "flaring" up like crazy.

This is really just one way an athlete will demonstrate an extension posture, though. Some athletes will stand in knee hyperextension. Others will live in a forward head posture. Others may have elbows that sit behind their body at rest because their lats are so "on" all the time.

latsPosture

This isn't just about resting posture, though; most of these athletes will have faulty compensatory movement patterns, too. Once we've educated them on what better posture actually is for them, we need to include drills to make these changes "stick." Anterior core drills - ranging from prone bridges, to positional breathing, to dead bugs, to reverse crunches, to rollouts/fallouts - are a great place to start. Here's why they're so important:

1. Breathing

The muscles of your anterior core are incredibly important for getting air out. The folks at the Postural Restoration Institute often discuss how individuals are stuck in a state of inhalation, with each faulty breath creating problematic accessory tone in muscles like scalenes, lats, sternocleidomastoid, pec minor, etc. These muscles aren't really meant to do the bulk of the breathing work; we should be using our diaphragm. Unfortunately, when the rib cage flies up like we saw earlier, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

Zone-of-Apposition-300x220

(Source: PosturalRestoration.com)

Step 1 is to get the ribs down and pelvis into some posterior tilt to reestablish this good zone. Step 2 is to learn how to breathe in this position, emphasizing full exhalation.

Step 3, as you may have guessed, is to strengthen these "newly rediscovered" patterns with good anterior core training.

2. Resisting extension.

This one is the most obvious benefit, as the muscles of the anterior core directly combat too much arching of the lower back. If you aren't controlling excessive lumbar extension, it's only a matter of time until you wind up with lower back irritation - whether it's just annoying tightness, a stress fracture, a disc issue, or something else.

3. Better force transfer and lower back injury risk reduction.

The research on core function is pretty clear: its job is to transfer force between the lower and upper body. Spine expert Dr. Stuart McGill has spoken at length about how spine range of motion and power are positively correlated with injury risk. In other words, the more your spine moves (to create force, as opposed to simply transferring it), the more likely you are to get hurt. How do you prevent your spine from moving excessively? You stabilize your core.

4. Indirect effects on rotary stability.

For a long time, I looked at control of extension as "separate" from control of rotation at the spine. In other words, we did our anterior core drills to manage the front of the body, and our chops, lifts, side bridges, etc. to resist unwanted rotation. However, the truth is that these two approaches need to be treated as synergistic.

As an example, every time I've seen an athlete come our way with an oblique strain, he's sat in an extension posture and had poor anterior core control - even though an oblique strain is an injury that occurs during excessive rotation. All you need to do is take a quick glance at the anatomy, and you'll see that external obliques (like many, many other muscles) don't function only in one plane of motion; they have implications in all threes - including resisting excessive anterior pelvic tilt and extension of the lower back.

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What this means is that you can't simply ignore coaching in one plane when you think you're training in another one. When you do your chops and lifts, you need to prevent lumbar hyperextension (arching) . And, when you do your rollouts, you can't allow twisting as the athlete descends. Finally, you can add full exhales (a predominantly anterior core challenge) to increase the difficulty on rotary stability exercises.

5. Improved lower extremity function and injury risk reduction.

Lack of anterior core control directly interferes with lower extremity function, too. If the pelvis "dumps" too far forward into anterior tilt, the front of the hip can get closed down. As I described at length here, this can lead to hip impingement.

With a squat variation, while some athletes will stop dead in their tracks with this hip "block," others will slam into posterior tilt to continue descending. This is the "butt wink" we've come to see over and over again in lifting populations. When neutral core positioning is introduced and athletes also learn to manage other extension-based compensations, the squat pattern often improves dramatically. This can "artificially" be created transiently elevating the heels, turning the toes out, or by having an athlete hold a weight in front as a counterbalance.

Additionally, athletes in heavy extension patterns often carry their weight too far forward, throwing more shear stress on the knees during lunging and squatting. The more we can keep their weight back to effectively recruit the posterior chain, the better.

6. Improved shoulder function and injury risk reduction.

The lats can be your best friend and worst enemy. On one hand, they have tremendous implications for athletic performance and aesthetics. On the other hand, if they're "on" all the time (as we often see in extension-based postures), you can't get to important positions with the right movement quality. Overactive lats will limit not only shoulder flexion (overhead reaching), but also upward rotation of the shoulder blades. I covered this in quite a bit of detail in Are Pull-ups THAT Essential?. Moreover, with respect to elbow function, overactive lats can be a big issue with allowing throwers to get true external rotation, as I discussed here:

If you're using your lats as an "all the time" core stabilizer, you aren't just at risk of extension-based low back pain, but also problems at the shoulder and elbow. If you can get your anterior core control under control and normalize the length and tone of the lats, your "healthy exercise pool" for the upper body expands dramatically. Getting overhead is easier, and you'll feel stronger in that position. The same goes for external rotation; not surprisingly, pitchers always say that their lay-back feels smoother after soft tissue work on the lats, as an example.

Wrap-up

These are just six benefits of training the anterior core, but the truth is that they could have been broken down in much more detail as they relate to specific injuries and functional deficits. If you're looking to learn more on this front - and get a feel for how I like to train the anterior core - I'd encourage you to check out my presentation, Understanding and Coaching the Anterior Core. It's on sale for 40% off this week; just enter the coupon code SPRING at checkout to get the discount.

AnteriorCore

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The Overhead Lunge Walk: My Favorite “Catch-All” Assessment

We spend a good chunk of our lives standing on one-leg. Obviously, that means we need to train on one leg, but it's also important that fitness professionals and rehabilitation specialists assess folks when they're in single-leg stance, too. Enter the overhead lunge walk, which is likely my favorite assessment because of just how comprehensive it is.

Why is it so great? Let's examine it, working from the upper extremity to the lower extremity.

First, you can evaluate whether someone has full extension of the elbows. Just tell folks to "reach the fingers to the sky." In a baseball population, as an example, you can quickly pick up on an elbow flexion contracture, as it's quick and easy to make a comparison to the non-throwing side.

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Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.

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At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:

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You can also tell whether the aforementioned hypermobile folks actually move excessively at the ball-and-socket joint of the shoulder, as they'll actually go too far into flexion instead of moving through the shoulder blades.

You can determine whether an individual has an excessively kyphotic, neutral, or extended thoracic spine. If they're kyphotic, they'll struggle to get overhead without compensation (arching the lower back or going into forward head posture). If they've got an excessively extended thoracic spine, they'll actually go too far with the overhead reach (hands will actually wind up behind the head if it's combined with a very "loose" shoulder).

You can tell whether an individual is able to fully upwardly rotate the shoulder blades in the overhead position.

You can tell whether someone preferentially goes into forward head posture as a compensation for limited shoulder flexion, poor anterior core control, or a lack of thoracic spine extension or scapular posterior tilt.

You can evaluate whether an individual has enough anterior core control to resist extension of the lumbar spine (lower back) during overhead reaching. This is a great test of relative stiffness of the rectus abdominus and external obliques relative to the latissimus dorsi.

You can evaluate whether an individual is in excessive anterior or posterior pelvic tilt from the side view.

Also from the side view, you can determine whether the athlete hyperextends the knees in the standing position.

With the lunge, you can see if an athlete is quad dominant - which is clearly evidenced if the stride is short and the knee drifts out past the toes of the front leg. You can also venture a guess as to whether he or she has full hip extension range of motion.

Also with the lunge, you can determine how much control the athlete has over the frontal and tranverse planes; does the knee cave in significantly?

You can make a reasonably good evaluation of foot and ankle function. Does the ankle collapse excessively into pronation? Or, does he stay in supination and "thud" down?

Does the athlete handle the deceleration component effectively, indicating solid eccentric strength in the lower extremity?

As you can see, this assessment can tell you a ton about someone's movement capabilities and provide you with useful information for improving your program design. Taking it a step further, though, it goes to show you that if you select the right "general" assessments, you can make your assessment process much more efficient.

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7 Random Thoughts on Corrective Exercise and Post-Rehab Training

If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."

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1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.

Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.

Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.

2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.

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3. Soft tissue work is effective.

Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!

For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.

The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.

With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.

4. Strength can be corrective.

Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?

Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.

Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.

This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.

And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.

Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!

5. Minimalist sneakers might be your worst nightmare if you have high arches.

I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.

The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.

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All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.

6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.

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This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:

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By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.

If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.

7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.

This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.

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How Chronic, Prolonged Sitting Impacts Your Body – and What to Do About It

Last week, over the course of two days, I made the long drive from Hudson, MA to Jupiter, FL. Suffice it to say that all those hours in the car gave me a newfound appreciation (or distaste?) for just how hard sitting is on the body. As such, it was really timely when my friend Michael Mullin emailed along this guest post on the subject. Enjoy! -EC

Disclaimer:

In this article, the author describes a fictional scenario in order to demonstrate a point related to the degree of information and misinformation there is in the layman and professional literature. It is in no way an attempt to create alarm that these facts apply to every person and every situation. While this article is not scientifically based, the published references are meant as an example of what some studies have found of the impact prolonged sitting and being in a stressful environment has on the body. Please read this article with the intent with which it was written—to provide concrete tools to use if you have to sit for extended periods of time.

I would like to have you read the scenario below and let me know if you would want this job.

“Congratulations on being selected for the position of top minion here at Do Everything Against Design, Inc. (DEAD).  Our company is a prestigious purveyors of thneeds—and a thneed is a thing that everyone needs (5). We pride ourselves on our commitment to being on the cutting edge of business and we use only the best, most up-to-date information possible to dictate how we run our business.”

“Let me start off by saying that this job will provide all kinds of potential benefits. It is up to you to decide how committed you are. The potentials are endless—overuse injury, chronic pain, depression, increased alcohol use, drug or medication use, cancer, increased general mortality, even bullying—that’s right, just like when you were a kid—are all very real possibilities here at DEAD, Inc.”

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“So first thing we will do is get you set up with your work area and station. Here is your cubicle which studies have shown are detrimental to not only work life but also your personal life (1). And here is your ergonomically correct chair so that your body doesn’t have to move, because research has shown that sitting 90% of your day, will almost double your risk of developing neck pain (2). We are also well aware of the fact that this increased time sitting will ultimately yield to a higher mortality rate for you (3), and make you feel generally crummy, but we are willing to take your chances. In fact, don’t even bother trying to counter all this sitting with exercise, because it will increase your risk for certain cancers by up to 66% regardless of how active you are when not sitting! (4)”

“However, placing this degree of stress and strain on your body is mainly so that we can reduce the organization’s costs and increase productivity (5), which is what is most important to us. Because ‘business is business and business must grow, regardless of crummies in tummies you know’ (6). And you do want to be a team player, don’t you?”

“In fact if you do end up having any physical problems, there is a greater than 63% chance that it is actually due to work (7). And if it isn’t from sitting too much (8), then it is due to the psychological stress that this position places on you. Heck, it might even be due to me and the stress I place on you! I will give you an 80% chance that our workplace stress will be the most important factor you will have to deal with here (9).”

forward head posture man

“We have also found that this job can also really give you a great chance on becoming an alcoholic or binge drinker (10), so you have that going for you as well.”

“If stress does become greater than you can learn how to cope with, which is apparently one important part of your employment here (11), then rest assured that we don’t really have a plan in place, because 80% of facilities do not have formal programs in place to deal with workplace stress, and of those that do, only about 14% say it is effective (12). Since that’s what the research suggests, then I mean, how important can establishing a plan be?”

“The single greatest thing about this whole situation is that I will actually pay you to let me break you down, little by little, bit by bit, until you feel beaten and broken. Don’t you see? It’s a win-win situation for both of us here at DEAD, Inc!”

I decided to title this article differently from my original title, “Your Employer Is Trying to Kill You” because I thought it might be a little less inflammatory. But, if you think about it, if data were used to truly guide what we should be doing, than many jobs where employees have to sit the better part of the day are truly a form of abuse. OSHA should be having a field day with these kinds of stats!

This is not about trying to bash many of the companies that have these incredibly sedentary work environments, though. Moreover, it's also not about the fact that I disagree with how our ergonomic evaluations and standards currently are. This is more about trying to create a "Movement/Movement."

Michael Mullin

Our bodies are designed for movement. Period. Our brains are designed for processing and trying to create efficiency so that we can process more. Now that’s pretty smart, however, highly detrimental when it comes to the importance of movement. Because if we continue to listen to what our brain is telling many of us, then it will constantly suggest that we just continue to sit to conserve energy.

So what to do for those of us who have to sit regularly during the day?

  • Get up regularly, even if it means setting a timer at your desk to walk down the hall a couple of times. Not only good for the body, but also good for the brain.
  • Stand every time the phone rings in your office, even if it means you have to sit back down to do something at your computer for the call.
  • Every hour, independent of getting up for regular walks:
    • Sit at the front edge of the chair, hands resting on thighs and body in a relaxed position—not too slouched or sitting up too straight. Take a slow breath in through your nose, feeling your ribs expand circumferentially. Then slowly, fully exhale as if you are sighing out and exhale more than you typically would, without forcing or straining. Inhale on a 3-4 count, exhale on a 6-8 count, then pause for a couple of seconds. Re-inhale and repeat for 4-5 breaths.
    • Staying in this position at the front edge of the chair, reach one arm forward, alternating between sides, allowing your trunk and torso to rotate as well. Your hips and pelvis should also shift such that your thighs are alternately sliding forward and back. Perform 10 times on each side, slowly and deliberately and while taking slow, full breaths.
  • Consider using your chair differently, depending on the task:
    • When doing work on the computer, sit with the lowest part of your low back (i.e. sacrum) against the seat back, but don’t lean your upper body back. This will give the base of your spine some support, but also allow for good trunk muscle activity as well as proper thoracic circumferential breathing.
    • When doing general work such as going through papers, moving things around your desk, filing, etc., sit forward on your chair so that you are more at the edge of the chair. This will allow your legs to take more load and your trunk muscles better able to aid in support, reaching and rotating tasks.
    • When reading items or reviewing paperwork, recline back with full back contact to give your muscles, joints and discs a rest. Make sure to hold the items up at roughly shoulder height—even if you support your arms on armrests or desk.

Remember, chairs and sitting is something that WE as humans created and the current norm is in no way optimal. We were not put on this planet to sit on chairs, and in particular not ones which shut our system off and limit our movement and ability to breathe normally. Until organizations and the general mindset changes to balance work requirements, work efficiency and human health, then we will be constantly be dealing with companies such as DEAD, Inc.

Note: the references to this article are posted as the first comment below.

About the Author

Michael J. Mullin, ATC, PTA, PRC: Michael is a rehabilitation specialist with almost 25 years of experience in the assessment and treatment of orthopaedic injuries. He has published and lectured extensively on topics related to prevention and rehabilitation of athletic injuries, biomechanics and integrating Postural Restoration Institute® (PRI) principles into rehabilitation and training. He has a strong interest in system asymmetry, movement, rehabilitation and respiratory influences on training and their effect on athletics. He has extensive experience with dancers, skiers, and professional and recreational athletes of all interests. You can find him on Twitter: @MJMATC

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Breathe Better, Move Better!

Earlier this week, I posted a video on different ways to look at upper body pressing.  In light of the great feedback I received, I have another one for you.  Today, I’m going to talk about breathing, a topic that has taken the fitness industry by storm in recent years. 

We can use breathing to help with relaxation (yoga, meditation), but also with bracing the core to lift heavy weights.  If you have something that can help with two extremes like this, you know it can be “clutch” when it comes to making or breaking your fitness progress.   And, that’s why today’s video will be so beneficial to you:

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This video today focuses on some of the breathing strategies I uses in terms of exercise selection and coaching cues with our athletes at Cressey Performance.  These drills are awesome for enhancing core stability and correcting bad posture. Fortunately, you can have the same great results if you just pay close attention to the cues I outline and put them into action.  And, be sure to keep an eye out for the release of The High Performance Handbook next week!

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Assessments You Might Be Overlooking: Installment 2

It's time for round 2 of my series on things you might overlook when assessing a new client or athlete.  Here are three news things to which you should pay attention:

1. Nervous Tick/Anxiety

When I see someone who is constantly "on" - foot tapping, cracking knuckles, fidgeting while standing/sitting, or any of a number of other displays of nervous energy - I'm obviously wondering if this is someone who is so wired that stress outside of training could be a serious problem.  These folks often have poor sleep quality and don't recover well. 

However, it may extend beyond that.  If you check out Clinical Applications of Neuromuscular Techniques, Lean Chaitow and Judith DeLany reflect on how congenital laxity (loose joints) is correlated with anxiety disorders and panic attacks.  So, even in my first dealings with people, if they're really on edge, I'm wondering we're going to need to do a lot more stabilization work, as opposed to actually created new range of motion.

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2. How They Carry Their Bags

A lot of people really don't understand how their daily habits impact their long-term movement quality or the presence or absence of pain.  Along these lines, it always surprises me to see people with low right shoulders who always carry their backpacks or purses over the right shoulder, just feeding into this excessive asymmetry with constant scapular depression.  An initial evaluation is the perfect time to pick up on these things and counsel clients and athletes on how to prevent activities of daily living from interfering with fitness progress.

3. Clavicular Angle

The clavicle is like the bastard child of the upper body; it never gets any love.  In fact, there are a lot of people who don't even know what a clavicle is unless you call it by its common name, the collarbone.  It's actually a tremendously important bone, as it is the link between two very important joints of the shoulder girdle: the acromioclavicular (scapula with clavicle) and sternoclavicular (sterum with clavicle) joints.

A normal resting posture of the clavicle is about a 6-20° upslope (medial to lateral).  What you'll often see with folks with faulty upper extremity posture is a horizontal or even downsloped collarbone.  Check out this right-handed pitcher (left side is more normal, right is really "stuck down"):

claivicle

Just like a scapula needs to upwardly rotate for optimal function in overhead activies, a clavicle needs to upwardly rotate, too. From 0-90° abduction, you only need 5-10° of clavicular upward rotation.  From 90-180° of abduction, you need 20-25° of clavicular upward rotation.  This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus), as well as the positioning of the thoracic spine.

Keep in mind that where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° of overhead reaching.  Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed?  Nope!

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If that clavicle starts as too horizontal (downwardly rotated), it's like starting a race from a few yards behind the starting line.  Getting resting posture where it needs to be helps to ensure that the subsequent movements that take place will be free, easy, and pain-free.

I'll be back soon with more commonly overlooked assessments.  In the meantime, if you're looking for an additional resource on this front, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.

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