Home Posts tagged "Hypermobility"

Baseball Athleticism: It’s Probably Not What You Think It Is

A few weeks ago, I was in Ft. Myers to deliver an in-service for the Minnesota Twins sports medicine staff, and one of the strength and conditioning interns asked me a question:

"I'm new to baseball. If there was one important reminder you'd give to someone in my position with respect to working with baseball players, what would it be?"

My response:

"You have to emotionally separate yourself from your perception of what makes athletes successful. Often, baseball players are successful because of traits and characteristics as much as they are actual athleticism."

Think about it...

We've seen position players who are phenomenal athletes who didn't make it to the big leagues because they couldn't hit breaking balls.

We know of absolutely electric arms who never panned out at higher levels of pro ball because they didn't have effective secondary offerings to complement their fastballs.

We've watched underwhelming physiques hit mammoth homeruns, and we've watched bad bodies on the mound dominate hitters because they've mastered a knuckleball.

Do you think these absurdly long fingers might be able to learn an elite changeup faster than ones that are, say, six inches shorter?

And, do you think this insanely long middle finger might impact how well he can throw a slider?

Don't you think this freaky hypermobility might be advantageous for this pitcher to contort his body in all sorts of directions to create deception and get way down the mound?

Hitters with 20/10 vision are going to stand a better chance of making it to the big leagues than those with 20/40.

I'm not saying you should encourage baseball players to be sloppy fat or weak, or to encourage them to avoid stretching or lifting. I'm just telling you that you need to appreciate that every athlete is successful for different reasons. Some of these traits will impact how you train that player, and others won't matter much at all. Either way, appreciate that baseball players rarely look, run, or jump like chiseled NFL wide receivers. And, more importantly, figure out how to heavily leverage and protect the exact characteristics that make them great.

If you're interested in learning about how your own unique structural and functional characteristics - and how they relate to your on-field performance and training preparations - I'd strongly encourage you to consider a visit to a Cressey Sports Performance facility to get a thorough evaluation to determine where your deficiencies exist. When you put a video evaluation of pitching/hitting alongside a thorough movement screen, it can be a very powerful combination to unlock hidden potential. For both amateur and professional players, we offer both short-term consultations and a more extensive Elite Baseball Development Summer Collegiate Program.

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10 Important Notes on Assessments

I'm a big believer in the importance of the "Assess, Don't Assume" mentality. However, it's crucial that assessments be approached the right way in order to deliver optimal results in strength and conditioning programs. Here are ten thoughts on the subject:

1. Assessments are an easy way to differentiate yourself.

With this era of semi-private training and bootcamps, there are still a lot of coaches and facilities out there that pay no attention whatsoever to pre-participation screenings. On one hand, it's a sad commentary on our industry, as one could argue that omitting assessments sets clients up for injuries. On the other hand, it creates an excellent opportunity for skilled coaches and trainers to differentiate themselves in a low-barrier-to-entry industry. If you're not assessing, you're just guessing! Make it a priority to start learning more about your clients/athletes.

2. Thorough assessments include both specific and general components.

In my eyes, every assessment can be categorized as either specific or general. Specific assessments may be anything from single-joint range-of-motion (ROM) assessments to the provocative tests physicians and rehabilitation specialists may use. They identify specific things like elbow extension ROM or whether a particular test elicits pain.

Conversely, general assessments look at global movements and evaluate multiple joints at the same time. Examples include overhead squats and push-ups.

The problem is that both kinds of assessments can fall short. As examples, you may see unstable young athletes who pass all ROM assessments (specific) with flying colors, but fold up like lawn chairs when they do an overhead lunge walk (general).

You may also see athletes with perfect overhead squats, but significantly limited knee flexion ROM that would make you concerned that they'd pull a quad (rectus femoris) while sprinting. These are just two examples, though; there are countless more we could cite.

3. You must always be willing to refer out.

You're better off being a great trainer/coach than you are trying to be an incredibly subpar physical therapist or physician. Even if you had a tremendous knowledge of provocative tests and rehabilitation techniques, as a trainer/coach, you don't have the same resources (e.g., diagnostic imaging equipment) these professionals have. Furthermore, diagnosing is outside your scope of practice, anyway.

I refer out every single week. It creates great opportunities for collaboration that will benefit our clients/athletes, and for our staff to learn from related professionals. If you see something on an assessment that raises a red flag, it's better to be safe than sorry.

4. Don't assess just for the sake of assessing; make it to the point.

My biggest assessment pet peeve is when the process takes too long. You can do an incredibly thorough evaluation in about 30 minutes, and most shouldn't even take that long. The only ones that would require more time would be those with extensive injury histories or other unique circumstances.

[bctt tweet="The sooner you're done assessing, the sooner you can get to training."]

5. Assess in the context of both injury history and functional demands.

As a follow-up to point #4, you never want to go into a movement assessment "blind" with respect to the person in front of you. Rather, it's best to first review a health history and have a discussion about training history, goals, athletic demands, and expectations. I find that it's best to perform an evaluation with a better knowledge of an individual's history than it is to look at movement and then work backward from it.

For example, if your pre-assessment discussion reveals that an individual was a baseball player growing up, you can expect to see more external rotation on his dominant shoulder. That might lead you to look more closely at whether he has adequate anterior shoulder stability, and whether his scapula upwardly rotates enough. It also might help to explain a low right shoulder.

RightER

Basically, you need to see the big picture; the "answers" are usually a combination of a bunch of tests, questions, and observations.

6. You have to emotionally separate yourself your personal biases when it comes to assessments.

Baseball players are the largest chunk of my clientele. As a result, I evaluate shoulders and elbows in a ton of detail.

Recently, we started training an NFL punter, though.

I did a thorough assessment with him, but let's just say that we didn't spend a ton of time worrying about verifying that he had perfect elbow ROM. Instead, we spent a lot more time looking at his core and lower extremity; otherwise, the assessment would have taken all day, and we'd acquire a lot of information that wouldn't have a significant impact on his programming.

7. Don't let hypermobile clients/athletes "cheat" assessments.

Just like you need to have both specific and general assessments, you also need to make sure to include both mobility and stability assessments. Hypermobile (loose-jointed) individuals are notorious for cheating assessments that are biased toward ROM. Comprehensive assessments need to also evaluate stability.

elbow10365821_744096285641478_6191697364410130329_n

In this vein, the Functional Movement Screen does a good job of looking at both sides of the equation. The shoulder mobility, overhead squat, and straight leg raise tests are general assessments largely biased toward mobility, but the trunk stability push-up, hurdle step, rotary stability, and in-line lunge screens are all predominately stability challenges.

To learn more about how hypermobile folks can "cheat" assessments, check out my article, 15 Static Stretching Mistakes.

8. Have some feel; don't make new clients (or any clients) uncomfortable.

If a man is overweight and uncomfortable with his body, it's probably not a great idea to have him take his shirt off for a scapular screen. If a woman is seriously deconditioned, it's probably not a good idea to put her through a lunge assessment that she'll fail miserably. And, it's an even worse idea to do these things in front of a crowded gym.

           Remember that the first day is as much about
           building rapport and starting a friendship as it
            is about evaluating how an individual moves.

As has been said in the past, "They have to know how much you care before they care how much you know."

9. Don't forget to highlight what individuals do well, too.

In How to Win Friends and Influence People, Dale Carnegie wrote, “It is always easier to listen to unpleasant things after we have heard some praise of our good points.” This point applies to fitness and movement assessments, too. Think about it: would you like to be criticized non-stop for 30 minutes? Probably not.

By contrast, if someone highlighted what you did well while also covering some important growth areas for you, wouldn't these suggestions be more well received? Absolutely.

Again, your goal is to establish a great relationship, not just analyze movement.

10. Remember that training is a never-ending assessment.

Every exercise is an assessment. Each time your clients and athletes move, they're providing you with information. The more you pay attention, the better you'll be able to individualize their programs and coaching cues moving forward.

If you're looking for more information on the assessment side of things, I'd encourage you to check out our Functional Stability Training series. These resources go into great detail on evaluating the lower body, upper body, and core.

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Functional Stability Training of the Upper Body: Why Do You Feel “Tight?”

When Mike Reinold and I released our newest resource, Functional Stability Training of the Upper Body, it quickly became our most popular product of all time. In light of this week's big sale, I thought you might like a little teaser of what to expect.  Here is an excerpt from one of my webinars, "Understanding and Managing Joint Hypermobility:"

Remember, FST-Upper - as well as Lower, Core, and the bundle package - are all on sale for 20% off this week. The discount is automatically applied at checkout; you can learn more and purchase HERE.

fstupper

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Assessments You Might Be Overlooking: Installment 3

It's time for another installment of my series on things you might overlook when assessing a new client or athlete.  Here are three more things to which you should pay attention:
 
1. Shoulder Flexion Range of Motion - This is a valuable test to use in conjunction with a back-to-wall shoulder flexion test. If you can't effectively perform a back to wall shoulder flexion as in the video featured here, then we need to ask "why not?"

 
It might happen because you lack good stiffness in various places - anterior core, lower trapezius, upper trapezius, and serratus anterior, to name a few.  Or, it might be because you're unable to overpower bad stiffness or shortness. Maybe you lack thoracic extension, are too rhomboid dominant, or simply can't get full shoulder flexion range of motion.  To check for this last one, you'll want to put the individual in supine with the back flat and knees and hips flexed.  They should be able to get the arms all the way down to the table - so this would be no good.
 
shouderflexion
 
Shoulder flexion can be limited by a lot of things: short/stiff lats, teres major, long head of the triceps, and inferior capsule.  Regardless of what limits it, though, you can't just take someone with this limited a ROM and plug them into overhead pressing. You're just waiting to chew up a rotator cuff, biceps tendon, labrum, or all of the above.
 
As a little bonus, this is my favorite drill for improving shoulder flexion ROM:
 

 
2. Scapular Upward (or Downward) Rotation - It goes without saying that scapular control - or the ability to position the shoulder blades appropriately - is absolutely essential to safe and effective upper extremity movement.  In order for that to occur, though, the shoulder blades have to start in the right position.  With respect to scapular rotation, "neutral" posture has the shoulder blades sitting at 5 degrees of upward rotation at rest. In the picture below, the black line represents where he should be in terms of upward rotation, but instead, you'll see that he sits in about 20-25 degrees of downward rotation (for the record, there are a number of other things wrong with this posture, so this is only a start!).
 
ScapularDownwardRotation
 
The problem with starting in this much downward rotation (or any downward rotation, at all) is that it's like beginning a race from 20 yards behind the starting line.  When the arm starts to move up, the shoulder blade needs to rotate up to maintain the ball and socket congruency.  If it starts too low, it can't possibly be expected to catch up - so the ball will ride up relative to the socket, regardless of how strong the rotator cuff is to try to prevent that superior migration.  You'll wind up seeing irritation of the rotator cuff, biceps tendon, labrum, or bursa if it's left unchecked.
 
Step 1 is to simply educate people on where the scapula actually should sit, and step 2 is to work on training from that correct new starting position.

3. Constant stretching - I always take note of when I see a client who seems to be stretching "nervously" when they're just standing or sitting around.  You'll often see people cranking on their shoulders, cracking their necks, touching their toes, or any of a number of things that make them "feel better.
 
The problem is that these people are often stretching out protective tension - or stiffness that's there because they lack stability elsewhere.  This is often the case with those with significant joint hypermobility.  They're already unstable, but the stretching is like picking a scab; it gives them temporary relief from the tightness, but only makes things worse in the long run.  It might be hamstrings tightness in someone with crazy anterior pelvic tilt, biceps tightness in those with anterior shoulder instability, or any of a number of other presentations throughout the body.  Unquestionably, though, the most common one is neck stretching in those with poor scapular control.
 
There is no one solution for everyone's problem, but I would encourage you to always ask, "Why is this tight?"  And, don't even think about stretching until you know the answer.
 
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 and Functional Stability Training of the Upper Body
 
 fstupper

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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.

clinical20.d35f2625985e82b04b487d9433e44543

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!

painfularc-for-acj

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.

Layout 1

 

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Assessments You Might Be Overlooking: Installment 1

I generally perform 8-10 new evaluations per week.  They may be individuals who plan to train with us at Cressey Performance for the long haul, or they may just be popping in for a one-time consultation regarding a particular issue or training technique concern.  Sometimes, they'll be rehabbing with one of the physical therapists with whom we work closely, and seeking us out to maintain a training effect in spite of their injury. 

Regardless of the scenario, I'm fortunate to see a lot of variety in a typical week of evaluations, and it has led to me thinking outside the box and appreciating a few things that are commonly overlooked by trainers and rehabilitation specialists.  With that in mind, today, I wanted to kick off a new series about these under-appreciated observations that can really make a difference in your takeaways from an evaluation.

1. Standing/Sitting Posture

There are a lot of trainers who'll observe this in passing, but in many cases, they'll only note something if it's something really dramatic.  My suggestion along these lines would be to note not just what's going on in the sagittal plane (kyphosis, lordosis, forward head posture), but also what's happening in the frontal and transverse plan.  Do they always cross one leg over the other?  Does one shoulder sit markedly lower than the other? Do they sink into one hip and carry more weight on that side?

IMG_8938

As an aside, Greg Robins recently wrote up a great posture blog about some of the most common aberrant patterns we see.

2. Handshake

Believe it or not, a handshake can tell you a ton.  If it goes like this, it's safe to say that you probably won't need to do any direct arm work with this individual, who'll quickly become either the coolest (or most awkward) client of all time. 

Joking aside, handshakes can tell you a lot, particularly with respect to joint hypermobility.  First off, what's the feeling of the fingers?  Are they more rigid or "pliable?" If they're more pliable, chances are that you're going to be dealing with someone who has considerable congenital laxity (loose joints).  Second, are the hands cold, even in the middle of the summer?  Chances are their circulation is poor - another common symptoms of those with considerable joint hypermobility.

To test these theories, here's a challenge for you.  Go shake the hands of ten of your friends/colleagues today. Note the feel of the hands, and then follow up the handshake with a Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

I'm sure you'll find that the coldest hands with the most pliable fingers are the ones who have high scores on the Beighton test.  When you have folks like this, they need more stability work than mobility training.  And, if an individual has a noteworthy injury history, you need to ask if he/she has been stretched aggressively in previous training or rehabilitation scenarios - particularly if he/she had negative outcomes with those experiences.

Also, if a young athlete gives you a lame, limp-wristed handshake, it's a sign that he's going to need to step up his game if he doesn't want to live in his parents' basement for the rest of this life.  I recommend introducing him to the foundation of the Ron Swanson Pyramid of Greatness to get the ball rolling (definitely worth a zoom-in):

rspyramid_1500

3. Medications

It is absolutely shocking to me how many people in the fitness industry overlook medications on an initial evaluation.  Perhaps it is the new era of bootcamps and semi-private training leading to a less individualized approach (particularly with respect to assessment), but you can learn so much about what a client needs by reviewing medications.  And, it's one reason why we have an initial one-on-one assessment with every new client at Cressey Performance.

Of course, you're looking for the obvious stuff - beta-blockers, prescription inhalers, etc. - that have definite impacts on how someone will respond to exercise.  Taking it a step further, though, there are hundreds of other medications that can impact how you program for and coach a client.  The problem is that not everyone views the term "medication" the same - so people will generally underreport on their health histories. In other words, you need to "pry" and ask if there really aren't any pills they take.  Recently, there was even an instance when I was able to guess a medication a kid was on just by asking his mom after observing his habits during the evaluation.

200534351-001

As an obvious example, there are loads of people out there who pop non-steroidal anti-inflammatory (NSAID) pills like candy because they've got chronic low back, shoulder problems, or any of a number of other issues.  In their eyes, though, these "get-me-by" pills don't count as drugs because they can be bought over the counter.  They can mask pain during exercises, and obviously have significant side effects. It's a trainer's responsibility to be "in the loop" with a client, his doctor, and a rehabilitation specialist to determine what the right course of action is to get this individual off those NSAIDs over time.

In a youth athlete population, we've had three kids who have had extensive and prolonged negative reactions to the Isotretinoin (Accutane) that was prescribed to treat acne. In two of these cases, the kids were excellent D1-caliber athletes who gradually felt worse and worse over the course of months in spite of no change to training volume or lifestyle factors.  We were all stumped because they had never reported that they'd started taking the medication.

Once we found out the cause, their parents got them off the Accutate right away, and symptoms resolved over the course of a month. However, these experiences led me to look further into the side effects of this prescription medication. I was astounded.  There are reports of depression, muscle weakness, joint pain, vision problems, dry skin skin dryness, and several other side effects. The FDA even warns, "Accutane may stop long bone growth in teenagers who are still growing." I'm not a dermatologist, so it's not my place to say that it's right or wrong.  However, it absolutely, positively is something you need to inquire about on a health history if you see it listed - or even if you suspect that a kid might be a candidate for it.  That said, I've known a lot of kids whose acne has improved considerably once they've gotten all the crap out of their diet, but that's a conversation for another day!

If you see a sleep aid listed on a health history, you may need to think twice about programming high-volume training for an client, and spend some extra time discussing recovery methods.  If you see anti-depressants, anti-anxiety, or ADHD medications on a health history, it may change the way you approach coaching this individual.  These are really just the tip of the iceberg; you have to keep your eyes open and consider/discuss the implications when appropriate.

I'll be back soon with more assessments you might be overlooking.  In the meantime, if you'd like to learn more about some of our approaches to assessment, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.

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15 Static Stretching Mistakes

One of the most debated topics in the strength and conditioning world in recent years has been whether or not static stretching is necessary and, if so, when it should be implemented.  While I don't think everyone needs it, and that there are certainly are times when it is a bad idea to utilize, I'm still of the mindset that it can have some solid benefits when implemented properly. 

Unfortunately, like all training initiatives, some people do it all wrong. To that end, I wanted to devote today's article to covering the top 15 static stretching mistakes I encounter.

Mistake #1: Stretching through extreme laxity.

This is the most important and prevalent one of all, so it comes first.  When I see someone doing this, this is pretty much how I feel:

We're all have a different amount of congenital laxity.  Basically, this refers to how much "give" our ligaments have.  Some folks have naturally stiff joints, and others have very loose joints.  This excessively joint laxity is obviously much higher in females and younger populations, but, as Leon Chaitow and Judith DeLany discuss in Clinical Applications of Neuromuscular Techniques: Volume 1, it is also much higher in folks of African, Asian, and Arab origin.

When you take someone who is really lax and implement aggressive static stretching, it's on par with having someone with a headache bang his/her head against a wall.  It makes things worse.

This is a tricky thing to understand, though, because many of these "loose" individuals will comment on how they feel "tight."  Usually that tightness is just them laying down trigger points as a way for the body to create stability in areas where they are chronically unstable.  They'd be better off working on stability training to get back to efficient movement.

I think yoga has a tremendous amount of applications and we borrow from the discipline all the time, but I think this is where many modern yoga classes fall short; they have everyone in the class go to the same end-range on certain exercises. Folks with serious joint laxity should not only contraindicate certain yoga poses, but also modify others so that they're training stability short of the true end-range of their joints. Unfortunately, most of the people you'll see in yoga classes are hypermobile women; you see, they like to do the things they're good at doing, not necessarily what they need to do.

How do you know if you're lax, though? I like to use the Beighton hypermobility scale to assess for both generalized congenital laxity and specific laxity at a joint. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

Beighton_Score

One of the biggest problems I see in today's strength and conditioning world is that we assume all "big, strong" athletes are tight and need aggressive stretching.  As an example, take a look at this high Beighton score in a 6-3, 240-pound athlete.  We do very little static stretching with him - and absolutely none in the upper body.

If someone is really lax, nix the static stretching and instead spend more time on stabilization work.  If they still feel like they need to "loosen up," tell them to do some extra foam rolling.  They'll transiently reduce some of the stiffness they're feeling, but they won't be working through harmful end-range joint range-of-motion in the process.

Mistake #2. Substituting knee hyperextension for hip flexion in hamstrings stretches.

This comment piggybacks a little bit on mistake #1, as lax individuals (who probably shouldn't be stretching their hamstrings, anyway) are the most likely to have problems with this.  Because the hamstrings are two-joint muscles (knee and hip), folks will often allow the knee to "give" extra because they are subconsciously trying to avoid an uncomfortable stretch at the hip - or they simply aren't paying attention.  These are the same folks who have terrible hip hinges on toe touch tests, yet can touch their toes without a problem; they just go to knee hyperextension to make it happen.  As an example, this particular athlete scores really high on the Beighton hypermobility score, and he can actually put his palms flat on the floor with little to no posterior weight shift (the wall blocks him). 

How does he do it? Knee hyperextension. 

We'd much rather get a good hip hinge without resorting to excessive joint range of motion at the knee. You get good at what you train, so if you're always doing your static stretching in a bad position, you're going to be more likely to wind up in knee hyperextension on the field - and that's where ACL injuries occur.

Mistake #3: Not creating stiffness at adjacent joints.

In a previous post, I talked about why stiffness can be a good thing, in spite of the negative connotation of the word.  Stiffness is a crucial part of keeping us healthy and enhancing athleticism.  "Good" stiffness allows us to overpower "bad" stiffness that's occurring in the wrong places, and it helps to transfer force as part of the kinetic chain.  Static stretching can either be an opportunity to foster good stiffness or develop bad habits.

You see, we static stretch to transiently reduce stiffness (or true tissue shortness).  However, if we don't stabilize (stiffen up) adjacent joints, it defeats the purpose. Let me give you an example.

Let's say that I want to stretch my hamstrings in the supine position with not just a neutral position (center), but also a bias toward internal rotation/adduction (left) and external rotation/abduction (right).


 



 

 

Now, let's see what happens to these stretches if one doesn't engage the lateral core to prevent the pelvis from rolling toward the direction of the stretch on the ones that go out to the sides.

Mistake #4: Irritating the medial aspect of the knee with 90/90 hip stretches.

Most folks are familiar with doing 90/90 hip stretches or cradle walks as a way to improve hip external rotation in a position of hip flexion.  This is the position I commonly see people using at the point of maximal stretch:

The problem is that many folks crank excessively on the medial aspect of the knee by rotating the tibia (lower leg) instead of the femur (upper leg).  This actually parallels what happens during a McMurray's Test for medial meniscus pathology:

It's a pretty safe bet that static stretching into a position that replicates a provocative test is never a good idea - and it's one reason we use 90/90 stretches very sparingly.  If you are going to use this stretch, however, I recommend that individuals grab the quadriceps on the stretching side to ensure that the majority of the pull into external rotation and flexion comes from the femur and not the tibia.  The opposite hand is simply there to support the weight of the lower leg.

Mistake #5: Substituting valgus stress at the knee for hip adduction/internal rotation stretching.

It's really important than folks have adequate hip internal rotation, as a loss of hip internal rotation has been correlated with low back pain, and it can certainly predispose individuals to hip and knee issues as well. The knee-to-knee stretch is a popular approach for maintaining and improving hip internal rotation, and it's also my chosen method for demonstrating how incomplete my goatee was at the time of this picture.  

lyingkneetoknee

As you can see from the picture, this position can also impose some valgus stress at the knees if it isn't coached/cued properly.  So, instead of thinking of letting the knees fall in, I tell athletes to actively internally rotate the femurs (upper leg).  The stretch should occur at the hips, not the knees.

In folks with a history of medial knee issues, we won't use this static stretch.  Rather, we'll use a kneeling glute stretch, which still gets a bit of stretch into adduction, which will still stretch several of the hip external rotators indirectly.

Lastly, keep in mind that the knee-to-knee isn't a stretch most females will ever have to utilize because of their tendency toward a knock-knee posture (wider hips = greater Q-angle) at rest.

Mistake #6: Not monitoring neutral spine during hip stretching.

This point really works hand-in-hand with #3 from above, which talked about establishing stiffness at adjacent joints.  Certainly, maintaining neutral spine falls under the category of "good stiffness," but because it's such a common mistake, it deserves attention of its own.  When the hip flexes, you shouldn't go through lumbar flexion. For this split-stance kneeling adductor stretch, notice the correct on the left and the incorrect on the right:

And, when it extends, you shouldn't go through lumbar extension.  Again, the correct is on the left, and incorrect (hyperextended) is on the right:

Mistake #7: Not monitoring neutral spine during standing stretches.

Again, this is another point that piggybacks off of establishing good stiffness, but I see a lot of people doing upper extremity stretches - overhead triceps, lats, pecs - in terrible spine posture.  Perhaps the best example is the overhead triceps stretch with the lumbar spine in hyperextension, plus forward head posture further up.

Mistake #8: Stretching your lower back.

There may be times when a qualified manual therapist might want to do some mobilizations on your lower back. The rest of you really shouldn't be stretching your spine out. Stretch your hips, and mobilize your thoracic spine (upper back), where it's much safer for you to move. Focus on building up some core stability.

Mistake #9: Stretching your calves – and then wearing high heels the rest of the day.

There's nothing wrong with the "stretching your calves" part; it's the high heels part that makes me want to bang my head against the wall. Talk about a dog chasing its tail!

Mistake #10: Stretching a throwing shoulder into extension and/or external rotation (and creating valgus stress at the elbow in the process).

I devoted an entire video to this topic last week in my baseball-specific newsletter:

Mistake #11: Stretching through pain or neurological symptoms.

I honestly can't think of a single reason why anyone should ever stretch oneself through pain. Sure, there may be times when physical therapists may push a post-operative joint through some uncomfortable ranges of motion, but that's a trained professional making a educated decision.  You stretching yourself through pain is just throwing a bunch of s**t on the wall to see what sticks.  Don't do it.

Sometimes, an indirect approach is better.  As an example, there is research demonstrating that core stability exercises can transiently and chronically improve hip internal rotation - even without stretching the joint.  If you're hurting while stretching, see a qualified medical professional to help you devise a plan to work around the issue while reducing your symptoms.

On the topic of neurological symptoms, as an example, intervertebral disc issues with radicular symptoms into the legs may be exacerbated by stretching the hamstrings.  Similar issues can come about if folks with thoracic outlet syndrome perform aggressive upper body stretching. If nerves aren't gliding the way that they need to be, the last thing you want to do is yank on them.

Mistake #12: Not tightening the glutes during hip flexor stretches.

I've written previously at length about how anterior (front) hip irritation is often caused the head of the femur (ball) gliding forward in the acetabulum (socket) during hip extension.  This femoral anterior glide syndrome (described in detail here), was originally introduced by physical therapist Shirley Sahrmann.  Effectively, the hamstrings have a "gross" hip extension pull - meaning that they don't have a whole lot of control over the head of the femur.  Therefore, we need to have great gluteus maximus contribution to hip extension, as the glute max posteriorly pulls the femoral head back during hip extension so that the anterior hip capsule doesn't get irritated.

What we don't consider, however, is that if we stretch a hip into hip extension (osteokinematics), we also need that glute contribution to control the glide (arthrokinematics) of the femoral head.  This is a definite parallel to what I described earlier with respect to stretching a throwing shoulder into extension or external rotation; you don't just want to do it carelessly. As such, whenever you stretch the hip into extension, make sure that you tighten up the glute:

Mistake #13: Stretching into a bony block.

There are a lot of things that may limit range of motion at a joint.  It could be muscular shortness/stiffness, capsular tightness, muscular bulk, swelling, or guarding due to injury.  In many cases, though, it simply has to do with the congruency of the bones (or lack thereof) at a joint.

In the case of a "fresh" bone spur or loose body at the posterior aspect of the elbow, aggressively stretching into extension could easily provoke symptoms.  Conversely, I've seen some elbows with flexion contractures that are a combination of bony blocks and subsequent tissue shortening and capsular tightening that can be stretched until the cows come home with no problem. 

Each case is unique - but at the end of the day, remember that you're better off being too tight than too loose.  In other words, if you're unsure about something, don't stretch it.

Beyond just reactive changes like bone spurs and loose bodies, we also have folks who simply have different congenital or acquired bone structures.  Many individuals have retroverted (externally rotated) or anteverted (internally rotated) femoral carrying angles.  Those in retroversion will lack hip internal rotation no matter how much you stretch them, and those in anteversion aren't going to be gaining external rotation no matter what you do.  Trying to power through these bony blocks will likely create hip discomfort as well.

We also see retroversion as an adaptation in throwing shoulders, where bones "warp" to allow for more lay-back during the extreme cocking phase of throwing.  This is why most throwers will have significantly less internal rotation on the throwing shoulder than on the non-throwing shoulder in-spite of the fact that they have symmetrical total motion (IR + ER) from side to side; they simply shift their arc.

Before you stretch, you better find out if it's bone or soft tissue that is limiting you at end-range.  If it's bone, you're better off leaving things alone.

Mistake #14: Putting the band behind your head during hamstrings stretching.

This one drives me bonkers.  It screams "I know stretching isn't hard to do, but I'm still too lazy to put any semblance of effort into doing it correctly."  Why create forward head posture and neck stress when stretching the hamstrings?

Mistake #15: Not monitoring your breathing.

Nowadays, I'd say that we do just as much "positional breathing drills" as we do actual stretches. The more I learn (particularly from the Postural Restoration Institute school of thought), the more I realize that breathing in specific positions can have a dramatic effect on reducing tissue stiffness. For instance, here is one that many of our right-handed pitchers do. 

The left femur is internally rotated and adducted, the left rib flare is "tucked," right thoracic rotation is encouraged, the lumbar spine is flat, and the right shoulder blade is fully upwardly rotated with a bit of upper trap activation. We cue the athlete to inhale through the nose without allowing the rib cage to "fly up," and then encourage him to exhale fully, allowing the ribs to "come down."

We stretch to reduce tone, not increase it - and most athletes are in a constant state of inhalation, which corresponds to a big anterior pelvic tilt and lordotic curve. 

APT-250x300

When the rib cage flies up like this, 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

In this extended posture, rather than effectively use their diaphragm, athletes will overuse supplemental respiratory muscles like lats, sternocleidomastoid, scalenes, and pec minor - and these are all areas where we're always trying to reduce tone.

Teaching athletes how to control their breathing during stretching - and paying particular attention to fully exhaling on each breath - goes a long way to help reduce sympathetic nervous system stimulation, get rid of unwanted tone in the wrong places, effective favorable changes to posture, and make the most of the stretches you're prescribing.  I think the folks in the yoga and Pilates worlds have done a good job of drawing attention to the importance of breathing, and we should appreciate that with respect to how static stretching and dynamic flexibility drills are implemented.

Conclusion

There are really only 15 mistakes that were right on the tip of my tongue - to the tune of 2,800 words!  To reiterate, I have a lot of clients/athletes who do absolutely no static stretching, but that's not to say that it can't be of benefit to a good chunk of the population.  Just remember that each body is unique, so no two static stretching programs should be alike in terms of exercise selection and coaching cues. 

If you benefited from this article, please share it via Facebook or Twitter, as this is a very misunderstood topic in the world of health and human performance.  Thanks for your support!

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