It all began with a burning sensation in my left shoulder in November 2020 with a simple gesture. I did not give it a second thought, as it subsided in a few minutes. However, I soon began to notice more regular pain with certain movements and difficulty sleeping at night. Honestly. I thought it would subside and chalked it up to some mild rotator cuff inflammation. For years, I had avoided overhead lifts and heavy bench press, while restricting range of motion to reduce stress on my shoulders. With that said, this pain led to me further modifying my workouts.
A few weeks later, the nocturnal pain became more intense and prevalent. I knew it was time to formally rehab my shoulder. So, I did what I would advise my patients to do. I embarked on 6 weeks of rotator cuff and scapular strengthening 3x/week, while using laser, ice, and non-steroidal anti-inflammatory meds to resolve the pain. I stuck religiously to this plan from mid December to the end of February. Unfortunately, nothing helped. Sleeping was interrupted consistently, and my function was limited.
As such, I sought the counsel of a trusted surgeon I work closely with. He ordered an MRI, which revealed a 1 cm near full-thickness tear in the supraspinatus tendon, a type II acromion and a big anterolateral bone spur. As you can see from the list below, I have a borderline medium-size tear.
The idea behind this exercise is applying progressive gradients of resistance that encourage the faulty motion (pulling the leg into adduction and internal rotation) to facilitate increased activation of the gluteus medius/minimus and small lateral rotators to create an anti-adduction/internal rotation force by forcing the brain to work against the unwanted motion (better central nervous system activation). Decreasing such moments at the knee will reduce IT Band issues, patellofemoral pain, ACL injury risk and overuse problems often seen in running.
The video below from my online column for PFP magazine demonstrates how to execute this exercise. It is a great corrective and prehab training activity.
At times, athletes I work with have shoulder or low back pain that is related to restrictions in the thoracic spine. Rotational sports rely upon adequate mobility in the thoracic spine to ensure proper force transmission throughout the body’s kinetic chain. This exercise featured in one of my recent PFP online columns is a nice corrective exercise or mobility drill that can be used to optimize t-spine mobility and resolve any asymmetries.
Keep in mind that forcing through pain or stiffness is not advisable. This exercise can be done daily or as part of the warm-up routine.
As 2020 draws to a close and no holiday travel due to COVID, I found myself spending extra time scanning Twitter, IG and some various blogs related to training and rehab last week. I remember starting my blog many years ago prior to the birth of Twitter and IG (I am feeling old typing that lol). My purpose with this blog has always been to freely share information with clients, the general public and practitioners.
Now, more than ever, there is a plethora of opinions, videos, posts and methods on multiple platforms out there on the web. Many people seek clicks, followers, validation, attention, ad revenue or internet fame. It becomes easy to quickly go down a rabbit hole and become consumed with back and forth convos, online debates about the best exercise techniques/methodology, sales pitches for training programs, and in general what I deem to be excessive or over the top ‘look at me’ promotional posts by certain people. On one hand, the internet is a gift that gives us all a bigger platform and voice, including me. On the other hand, it can also muddy the water, create division among the ranks, and propagate consumer confusion as to what is best for him/her in rehab and training circles.
The spirit and purpose of this year-end blog post is one of a cautionary tale for consumers and young professionals. As someone more seasoned with 24 years of experience rehabbing and training clients, I feel it is important to step back and remember a few important things in this era of instant gratification and access to countless online videos, programs and opinions just a few clicks away.
Long lever abdominal exercises are popular. However, they also pose a risk for the lumbar spine given the relatively poor abdominal strength/control and lever arm created by momentum and the iliopsoas muscle. The stress on the lumbar spine is high as the leg (s) come back down due to reverse muscle action via the attachment of the iliopsoas on the lower lumbar spine. As a result, this can cause a sizable shear force on the spine.
I counsel patients and athletes with prior history of disc pathology to be very careful with any long lever or ballistic abdominal exercises with straight legs as the physics may present higher risk than reward and create excess strain on the spine. While a single workout may not cause harm, there can be a gradual repetitive overload that creates weakness or harm to the disc and/or spine. This exercise from my Functionally Fit column promotes strength and core or pillar stability through resisting excessive spinal extension.
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