Home Posts tagged "shoulder mobility" (Page 2)

Strength and Conditioning Stuff You Should Read: 6/9/18

Happy Saturday! This edition of "stuff to read"is a few days late in light of the Major League Baseball Draft and release of my new resource, Sturdy Shoulders Solutions. As a quick reminder, it's on sale for $50 off through the end of the day tomorrow (Sunday). You can learn more at www.SturdyShoulders.com.

With it being a shoulder product, I figured I'd use this week to "reincarnate" some upper extremity content from my archives:

Are You Packing the Shoulder Correctly? - Most people don't appreciate the relevant anatomy involved in packing the shoulder, so that may actually utilize the wrong muscles to get the job done. This webinar delves into the topic in detail.

3 Tips for Improving Your Back to Wall Shoulder Flexion - This video demonstrates a few quick and easy cues to improve your capacity for overhead reaching.

Exercise of the Week: Standing External Rotation Holds to Wall - This exercise is a great fit for everyday lifters and baseball players alike, as it builds rotator cuff strength without any equipment.

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Have a great weekend!

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5 Reasons to Use “Fillers” in Your Strength and Conditioning Programs

One of the first things some individuals notice when they come to observe at Cressey Sports Performance is that we often pair “big bang” strength and power movements with lower intensity drills. This is also a common programming theme many of those who have completed my High Performance Handbook program have noticed.

As an example, we might pair a prone trap raise with a deadlift…

…or a hip mobility drill with a bench press.

We call these low-intensity inclusions “fillers.” Truthfully, though, I’m not sure that this name does them justice, as “filler” seems to imply a lack of importance. In reality, I think these drills have a profound impact on improving each client/athlete’s session. Here are five reasons why.

1. Fillers slow advanced athletes down on power and strength work.

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

By pairing the strength or power exercise with something a little more mellow, we “force” athletes to take adequate rest and get quality work in on subsequent sets of the “meat and potatoes.”

2. Fillers provide extra opportunities to work on basic movement competencies and corrective exercises.

If something is important, do it every day. For some people, this might be hip mobility work. For others, it might be some rotator cuff work. You might as well do it when you’d otherwise be standing around resting.

3. Fillers improve training economy – and may even allow you to shorten the warm-ups a bit.

This point is best illustrated with an example. Let’s say that I would normally do an 8-10 exercise dynamic flexibility warm-up before my lifting-specific work. Then, I’m warming up to a 600-pound deadlift like this:

135x8
225x5
315x3
405x3
455x1
495x1
545x1
585x1
600x1

On that warm-up progression, I have eight “between-set” breaks to get in a little extra work. Sure, I’m loading on plates, but that doesn’t mean I can’t bang out a few quick reps of ankle mobility or scapular control work. This can be pretty clutch – especially once I’m at the heavier warm-up sets that require a bit more rest – as it can actually allow me to shorten my earlier general warm-up period a bit.

When it comes to training economy, everyone wants to talk about exercise selection (picking multi-joint exercises) and finding ways to increase training density (more volume in a given amount of time). However, don’t forget that movement quality work is still “work.”

4. Fillers help to prevent “backups” in the training facility.

This is a double-edged sword. If you’re doing some hip mobility work between sets in a busy commercial gym, if you aren’t careful, it probably will increase your likelihood of someone stealing your squat rack.

However, in the collegiate, professional, and private sectors, incorporating fillers can be invaluable in preventing log jams where many athletes are trying to use the same piece of equipment at the same time. If you’ve got three athletes sharing the same trap bar, fillers can help things flow a bit smoother – particularly because it keeps less-than-attentive athletes from screwing around between sets.

5. Fillers may give deconditioned clients active recovery between sets to make the most of their time with you.

For some clients, the warm-up is the workout. In other words, they may be so deconditioned that even a set of the Spiderman with hip lift and overhead reach will get their heart rate up. If you paired this mobility drill with an inverted row, it might be a perfect fit for their fitness level. Conversely, if you paired that inverted row with a Bulgarian split squat, it might crush them. In this case, the filler is hardly a filler!

Fillers might have a connotation of “unimportant,” but that couldn’t be further from the truth. Try incorporating them in your programs to get higher quality work, improve training economy, and bring up weak links.

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How to Make the Most of Your Lat Stretches (Video)

I have a love/hate relationship with the lats. On one hand, you need strong lats for all sorts of athletic endeavors, from throwing to sprinting. On the other hand, if they're too overactive, a host of different injuries/conditions can result. With that in mind, preserving full latissimus dorsi length is important, and that's why we incorporate a lot of stretches on this front. It's important that those stretches are done correctly, though, and in today's video, I want to discuss one big mistake we commonly see in this regard.

Speaking of upper body work, if you're interested in learning more, be sure to check out my new resource, Sturdy Shoulder Solutions.

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A Tip for Turning Off the Lats (Video)

The Back to Wall Shoulder Flexion is one of my favorite shoulder mobility exercises, as it forces individuals to learn how to integrate good core positioning with adequate overhead range of motion and stability. Unfortunately, some people struggle with really learning to shut the lats off to allow for proper overhead movement. Here's one strategy we like to employ:

*note: during the video, I said "reflex neuromuscular training" and meant to say "reactive neuromuscular training." Sorry, I get excited when I'm talking about shoulders. 

For more strategies like this, be sure to check out my new resource, Sturdy Shoulder Solutions.

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Shoulder Strategies and Hip Helpers: Part 1

I've spent the past week going through Tony Gentilcore and Dean Somerset's awesome new resource, The Complete Shoulder and Hip Blueprint. With that in mind, Cressey Sports Performance staff member Tim Geromini and I pulled together ten solid takeaway points from the resource that we thought you'd like. Here are the first five, in no particular order...

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1. Full scapular range of motion during push-ups often gets overlooked as a great "corrective."

Tony did an excellent job of making this point during the shoulder portion of the seminar. Push-ups (when done properly) take take the scapula from retraction during the eccentric phase of the push-up to protraction and "wrapping around" the rib cage during the concentric phase. It is usually scapula protraction that is omitted, as many people only focus on straightening their arms to finish the push-up. This creates excessive glenohumeral (ball-on-socket) motion and insufficient scapulothoracic (shoulder blade on rib cage) movement.

Learning to "fill up" the upper back and get the shoulder blades to the arm pits can be a game changer for optimizing scapular control.

2. Your hip structure impacts your likelihood of surgical success.

Citing 2015 research from Fabricant et al, Dean noted that patients with retroverted hips had saw less improvement following surgery for femoroacetabular impingement (FAI) than those with anteverted hips.

This shouldn't be surprising if you understand the implications of these hip presentations. Anteverted hips gives rise to more hip flexion and less hip extension, whereas retroverted hips will yield hips that do well with extension, but struggle getting into flexion.

FAI is a flexion-based pathology; bony overgrowth occurs because the femoral head (ball) bangs repeatedly into the acetabular rim (socket). It makes sense that a hip structure more conducive to allowing flexion would be less likely to re-develop these negative structural changes after a surgical intervention.

fai
Source: Lavigne et al, 2004

That said, the big takeaway from this is that the more retroverted a hip is, the more conservative the rehabilitation ought to be - and the less aggressive that "patient" ought to be with squatting, etc. in the years that follow.

3. Don't let a lack of a partner prevent you from doing rhythmic stabilization work.

The main function of the rotator cuff is to center the humeral head (ball) on the glenoid fossa (socket). Partner assisted rhythmic stabilization drills are fantastic in training this quality. Here's an example:

However, if you don’t have a partner available to help, a nice substitute would be this simple exercise you can do with a band.

The pushing and pulling on the band with your free hand serves as form of distraction that will force the rotator cuff to resist. Of course, things like the Body Blade and Shoulder Tube can be options as well. Rhythmic stabilizations will always be the best option because they are less predictable, though.

4. Full exhalations can quickly enhance mobility - but only if you FORCEFULLY exhale.

A commonly overlooked limitation to mobility is alignment issues. As an example, if the pelvis is stuck in anterior tilt, the hip will be limited in internal rotation and flexion. As such, adding core stability (in this case, the ability to hold the pelvis in posterior tilt) can often quickly make changes to hip range of motion.

A great way to do this, as Dean notes, is to perform course stability exercises with full exhalations. When you exhale fully, the anterior core is engaged, as the rectus abdominis and external obliques, in particular, help to get air out. You can do this in various positions, but the most well-known are definitely prone and side plank positions with full exhale. It can't just be a light exhale, though. You have to work very hard and blow out every last bit of air to get that cord engagement in order to really assess that positioning will change the range of motion.

deanside

We've used these strategies a lot in the past, but this video was a good reminder that we have to really push folks to get all that air out, especially if it's the first time we're cueing them to do so.

5. Make sure you're getting motion in the right places during your thoracic spine extension work.

Improving thoracic spine extension in some people is an important part of improving overhead mobility. It’s not uncommon for many to grab a foam roller and haphazardly start leaning back in an attempt to do so. Unfortunately, many individuals perform their reps with incorrect technique; check out this video to learn more.

Speaking of learning more, I strongly encourage you to check out Tony and Dean's excellent new resource, The Complete Shoulder and Hip Blueprint. It's on sale for $60 off this week at an introductory discount; click here to learn more.

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Exercise of the Week: Resisted Scapular Wall Slides

Today's "Exercise of the Week" guest post comes from Lee Boyce. Enjoy! -EC

One of the basic exercises that people are taught to practice for improved shoulder rotation, upper back activation, scapular mobility and anterior muscle release as a by-product is the standard scapular wall slide. To do them, a lifter would simply stand with the heels, butt, upper back, shoulders and full arms and hands against the wall, reduce the lower back arch, and slide the hands up and down, mimicking a full shoulder press movement pattern.

Regressing this movement is as simple as taking the feet a few inches away from the wall and assuming position otherwise. Progressing this movement, however, is another story.

The problem is that people adapt quickly to an unloaded mobility drill, and because of this, the wall slide can become another non-transferrable “skill” that doesn’t carry over to generally improved posture or performance. Moreover, depending on whether the humerus is properly nested in the glenoid fossa to begin with, the wall slides themselves may always pose a problem from a biomechanical perspective. To help this cause, adding some mild resistance can “remind” the muscles of the rotator cuff to center the humeral head in the socket and create a much more effective external rotation position. Plus, using a neutral grip via ropes (as compared to a palms-forward grip) creates a much more ideal (and shoulder friendly) environment for external rotation that can act to counter anterior shoulder glide.

For resisted scapular slides, I like using a cable pulley, and performing the lift from a seated position. It’s a bit easier for a lifter to focus on avoiding back hyperextension, which is a common compensation pattern when lifters have insufficient shoulder mobility.

This movement creates a force angle that works against the standard slide pattern, so keeping the hands and arms moving along the same plane becomes a much more challenging task for the scapular muscles. It’s easy to “let up” and allow the hands and arms to drift forward. To view the movement in action, watch the video below.

Coaching Cues

1. Have the athlete sit squarely on a box or bench. The closer parallel the box puts him in, the better.

2. Set up the cable pulley and ropes in a position just above head level. This way, at the top position, the force angle won’t be strictly downward, and there will be ample tension throughout.

3. If the lifter is still novice or intermediate level as far as shoulder mobility and control goes, a neutral grip is recommended for reasons mentioned above. If the lifter is more advanced, he can feel free to pinch-grip between the thumb and first finger, and face the palms forward.

4. During the movement, avoid slipping into lower back hyperextension; maintain thoracic region extension; and be sure to maintain neutral head posture. Also, avoid letting the elbows fall out of line with the hands in the vertical plane.

5. Your target areas are the rotator cuff muscles, rear deltoids, and lower traps (as you raise the weight further overhead). When you start feeling this in other areas like the biceps and upper traps, readjust positioning and continue.

6. The exercise is very specific, so it shouldn’t take much weight for it to be effective. 15-20lbs of resistance on most machines is usually plenty.

7. The movement won’t work if it’s done in a rush. Think of a 2121 tempo as a solid guideline.

8. Use higher reps to build up the muscular endurance of these muscle groups.

9. Your range of motion should replicate your typical dumbbell shoulder press – meaning the rep begins very close to the shoulder level, and ends at a full arm extension overhead.

10. Through the movement, remember to keep the hand separated (pull the rope handles apart) as much as possible. Doing so keeps the upper back engaged, avoids internal rotation, and keeps the hands stacked over the shoulder, where they belong.

About the Author

Lee Boyce (@CoachLeeBoyce) is a strength coach, writer, and former collegiate level sprinter and long jumper, based in Toronto, Canada. In 2013, he was named to the training and treatment staff for team Jamaica at the Penn Relays . He’s regularly featured in the largest fitness publications as a writer. Visit his website at www.LeeBoyceTraining.com or check him out on Facebook.

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Breaking Bad Bench T-Spine Mobilization Habits

I've spoken at length about how much I love the bench t-spine mobilization. Candidly, it's far more than an upper back mobility exercise - but you only can get the myriad of benefits it offers if you coach this drill correctly and prevent all the common compensations that can occur. Check out today's video for more details:

If you're looking for more information on these classic "extension posture" exercise technique compensations, I would encourage you to check out my presentation, Understanding and Coaching the Anterior Core.

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3 Tips for Improving Your Back to Wall Shoulder Flexion

I've often alluded to how important I think the back to wall shoulder flexion drill is as both an assessment and actual training exercise. Today, I've got three strategies for improving your performance of this exercise:

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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.

IMG_7810

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

elbow10365821_744096285641478_6191697364410130329_n

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

IMG_7895

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."

cropped-postrehabessentialsheader

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.

manual_therapy_page

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.

mx00gy_nb_14_i

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.

yoga

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:

yoga1

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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