By far the most common problem I see in the clinic is shoulder pain. Most of the time it is related to overuse, rotator cuff tendonitis/impingement and labral tears. Because we are geared more toward sports rehab, I also treat a lot of overhead athletes (baseball players, volleyball players and swimmers).
A common thing I will see in those suffering from impingement or rotator cuff pain is scapular winging. Most of the time the muscle is simply deficient in strength/endurance and it along with the lower trap become overpowered by the upper trap, levator or even the rhomboids. Shortened scapulohumeral muscles, poor posture and pec tightness can also impact winging.
There are many traditional exercises such as serratus punches, push-ups with a plus, and serratus plank push-ups to name a few, but I wanted to include a closed chain exercise that can be very effective for facilitating proper activation of the serratus – quadruped rocking.
In the video, I show it with both hands fixed on the floor progressing to one hand (on the involved side). The key is quality of movement throughout. After you check out the video, be sure to scroll down and click the link to a full column I wrote for PFP magazine on this exercise as it further explains the technique and application.
Click here to read the online column for PFP Magazine.
Well, Thanksgiving is upon us in 2011. I want to wish you and your family a wonderful holiday. In today’s post I will review a November 2011 article in the American Journal of Sports Medicine that looked at the effect of the Nordic hamstring exercise on hamstring injuries in male soccer players.
For those not familiar with Nordic hamstring exercises, see the photo below:
In this randomized trial, the researchers had 54 teams from the top 5 Danish soccer divisions participate. They ended up with 461 players in the intervention group (Nordic ex) and 481 players in the control group. The 10 week intervention program was implemented in the mid-season break between December and and March because this was “the only time of the year in which unaccustomed exercise does not conflict with the competitive season.
The trial was conducted between January 7, 2008 and December 12, 2008 with follow-up of the last injury until January 14, 2009. In the intervention group, all teams followed their normal training routine but also performed 27 sessions of the Nordic hamstring exercises in a 10 week program (as follows)
Week 1 – 2 x 5
Week 2 – 2 x 6
Week 3 – 3 x 6-8
Week 4 – 3 x 8-10
Weeks 5-10 – 3 sets, 12-10-8 reps
Weeks 10 plus – 3 sets 12-10-8 reps
The athletes were asked to use their arms to buffer the fall, let the chest touch the ground and immediately get back to the starting position by pushing with their hands to minimize the concentric phase. The exercise was conducted during training sessions and supervised by the coach. The teams were allowed to choose when in training it was done, but they were advised not to do it prior to a proper warm-up program.
Shoulder impingement and scapular dysfunction are common issues that plague many clients. Research indicates that certain muscles tend to dominate others while other muscles fatigue easily leading to faulty movement patterns and increasing the risk for impingement. Muscle length and posture are also key factors to consider.
I like to use a mini-band retraction with clients exhibiting excessive scapular abduction. In the video below, you will see a simple, yet effective exercise to address this faulty alignment of the scapula. Keep in mind, you must observe the client or patient from behind with the scapula exposed to properly assess alignment and movement.
This exercise is designed to strengthen the middle trapezius and rhomboids. In addition, it will improve scapular stability. Scapular abduction is usually more evident with elevation from 90-180 degrees as the ratio of scapular movement to glenohumeral movement is 1:1 instead of the normal 1:2 ratio throughout since the scapula is already in an excessively abducted posture at rest.
To read more on the application and exact execution of this exercise, click hereto read my column for PFP Magazine.
I work with many runners in our clinic. I often see restrictions in the soleus. While the running community is warming up to soft tissue mobilization, many runners are still resistant to embrace it routinely and engage in it more so only when they are hurt or lacking flexibility.
STM (soft tissue mobilization) should be part of every runner’s maintenance program. Why? Simply put, repetitive stress takes its toll on the body. Rolling or releasing the tissue increases blood flow, eliminates trigger points, and facilitates optimal soft tissue mobility and range of motion.
In the diagram below, you can see common trigger points in the soleus. The X represents the trigger point & the red shaded area is the referred pain caused by the trigger point.
In the case of the soleus, restricted dorsiflexion could lead to other biomechanical compensations with running. Initially, this often creates a dysfunctional and non-painful (DN) pattern. Over time, this may eventually become a dysfunctional and painful (DP) pattern forcing runners to seek medical care. The terms DN and DP come from Gray Cook’s Selective Functional Movement Assessment (SFMA).
The gait cycle is certainly altered from dysfunction in this muscle. If ankle joint dorsiflexion is compromised (a common effect of soleus restrictions), there can be increased strain on the quads and altered movement in the hip. Overpronation and excessive hip adduction and internal rotation are common compensations seen with running. Other signs and pathology that may be associated with a soleus trigger point may include:
Plantar fasciitis
Heel pain
Shin pain
Knee or hip pain
Back pain
As such, restoring mobility is important. A recent study revealed that immediate improvement in ankle motion can be attained with just a single treatment (click here for the abstract).
So how do you effectively resolve soft tissue issues in this area? I suggest using a foam roller or better yet the footballer and baller block in the Ultimate 6 Kit for Runners by Trigger Point (see pic below)
Eliminating the “false step” has been a personal mission of many strength coaches I have heard or worked alongside of in my 15 year career. I used to wonder quietly why it was such a bad thing early on in my coaching. Based on angles and observation it seemed almost reflexive for most athletes.
Then a few years ago I had the privilege of seeing Lee Taft present his theory on speed development and multi-directional speed training and it all came together for me. Lee eloquently explained that the “false step” is really just a plyo step – a chance to load the body up for what it was meant to do. It essentially allows the athlete to reposition the body (or center of mass) more efficiently to load and explode. Ever wonder why sprinters use a starting block?
Look at all like an athlete’s body position once they step back and begin to move forward?
This topic has been covered in previous point/counterpoint articles in the NSCA journals and debated on forums, blogs and seminars alike. For me, I have been encouraging the “false step” or “plyo step” the past few years because it is ‘normal’ for athletes to move that way. As a matter of fact, one of the first things I do is put them in an athletic parallel stance position and ask them to accelerate for 10 yards. Not once have I seen them not step back provided I do not cue them to do so.
Keep in mind that previous research done (Kraan, GA, van Veen, J, Snijders, CJ, and Storm, J. Starting from standing: Why step backwards? J Biomech 34: 211–215, 2001.) indicates that stepping back is instinctive in up to 95% of subjects. Pretty telling, right? Even so, many coaches will still argue this technique slows the athletes down.
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