I’ve had a couple people come up to me recently with a nagging shoulder pain.  One of them was one of the baseball pitchers that I train during the summer who’s now in College.  He’s had a nagging pain in his throwing shoulder for the past couple of months that’s preventing him from pitching at the same intensity as he used to, and now he’s freaking out because the baseball season is starting in a couple of weeks.  The second is a good friend of mine who’s into the Crossfit thing and he was telling me one of his shoulder has been bothering him for a little bit.  They both had pain in their shoulder with either the shoulder clearing test from the FMS (baseball player) or the empty can test (Crossfit guy).

The Empty Can Test

A quick assessment of their range of motion around the shoulder showed an internal rotation deficit in the painful shoulder for both of them.  Shoulder extension wasn’t too bad in both cases and t-spine ROM was lacking a little bit in the Crossfit guy.

Instead of cranking on their range of motion and possibly forcing something that’s not there (and possibly originates somewhere else), I gave them 2 simple breathing exercises that I learned from the Postural Restoration Institute to re-establish proper diaphragm function, as well as ribs, thorax and scapulae positioning.  I also gave my Crossfit buddy a t-spine mobility and scapular stabilizer drill do to because his posture was not great.

The positioning of the diaphragm can affect all the surrounding structures

After only 5 minutes, both of them had an increased internal rotation range of motion in the painful shoulder; and I did absolutely no stretching or soft-tissue work whatsoever.  And even more importantly, their shoulder pain wasn’t there anymore with neither the FMS shoulder clearing test or the empty can test!

This is how important proper breathing patterns and diaphragm function are.  It can affect the way your shoulder, your pelvis and everything around them is positioned.  Before forcing range of motion and hammering the soft-tissue work, make sure your athletes and clients are breathing right!

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I recently came across the Baby GetUp through my good friend Dr. Perry Nickelston.  When I heard him talk about it, what he used it for and the benefits from this exercise I was thinking to myself: “Hey I’m gonna give it a shot; it sounds like a nice corrective exercise to include in a training program to help develop proper muscle sequencing and reinforce a good fundamental movement pattern”.  The Baby GetUp can indeed help you in that regard, but HOLLY SH*T I wasn’t expecting what I was about to experience!  I wouldn’t even say it was hard; I literally couldn’t even do it!!

As someone who takes care about how my body moves and with the time I spend on corrective exercises I wasn’t expecting to be slapped in the face by the Baby GetUp like I did!  The name of the exercise itself suggest an easier version of the Turkish GetUp.  A ‘regression’ of the Turkish GetUp would be a better term, because it might look simpler, but it doesn’t mean it’s easier.  This is the video from Dr. Perry that demonstrate the Baby GetUp:

You’re probably telling yourself it really doesn’t look that hard.  And you’ll most likely be able to perform it more easily than I did, but I’m sure you’ll be surprised by the level of difficulty of the exercise on AT LEAST one side of your body.

In fact, this is a great way to identify asymmetries from side to side in inner core muscle sequencing.  When trying the Baby GetUp, make sure that you’re not cheating by reaching with your neck, getting your top leg off the floor and holding your breathe in.  This should be a movement pattern that feels (or becomes) ‘nice and smooth’ to perform.  It is a fundamental movement pattern, and if you don’t own it, your setting yourself up for compensation movement patterns, and injury in the long run.

I know what I’m gonna be working on in the next couple of weeks!

For an in depth look at the Baby GetUp, check out Perry’s original article on his website HERE.

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I blogged quite a bit recently about the importance of breathing patterns in posture, muscle tone, optimal movement patterns, injury prevention and cardiovascular functions.  If breathing patterns aren’t optimal, it’s important to train them, or re-train them to make sure your diaphragm functions optimally for all of the reasons above.  Efficient breathing pattern means an adequate use of your diaphragm muscles (yes, you have two), and them functioning optimally is of utmost importance.

But do you know how to identify faulty breathing patterns in the first place?

There are many different ways to assess breathing patterns, some more advanced than others.  Here are simple ways to identify faulty breathing patterns:

1. Neck muscles’ hypertonicity.  When someone has faulty breathing habits, he will tend to “breathe more through his chest than through his belly”.  Breathing through your chest will make your shoulders go up and down every time you breathe and it will put a lot of stress on your neck muscles.  If you have a client who present with hypertonic neck muscles, it might be because of faulty breathing pattern.  This tension in those neck muscles can also lead to pretty severe headaches, as well.

Hypertonic sternocleidomastoid.  Could be the sign of a chest breather

2. Shoulder protraction.  As I just mentioned in the previous point, a chest breather will put a lot of strain on his neck and shoulder muscles as well.  Assessing the resting posture of the shoulders, as well as how they move when the person breathe (looking for significant up and down motion) can help identify faulty breathing patterns.  A chest breather will have his shoulders sitting higher (sort of shrugged up) and protracted because of the use of the wrong muscles to breathe.

Posture looks better on the right. But both present with protracted shoulders which could be sign of faulty breathing patterns.

3. Rib flare.  This is a really easy thing to identify: simply put the client on his back, ask him to pull his shirt up a little bit, and notice the position of his lower ribs.  If they are flaring out it is most definitely a sign of faulty breathing pattern.

  This is a rib flare.

……not to be confused with a Rick Flair.

4. Hyperextension at the thoraco-lumbar (T-L) junction.  This one goes hand-in-hand with the previous point on the rib flare.  If there is indeed a rib flare, chances are that there will also be a hyperextension at the T-L junction.  This can be caused by a faulty breathing pattern, as well as a lack of appropriate thoracic spine mobility.  People often compensate for a lack of t-spine extension with hyperextension at the T-L segment.

Notice the T-L junction hyperextension

This is some of the stuff that I got from Dr. Jeff Cubos’ presentation in Muscle Imbalances Revealed – Upper Body.  That is a resource with great information, and if you’re interested in learning more about breathing patterns, how to assess for them and how to re-train them properly. You can get it by clicking on the link below:

Muscle Imbalances Revealed – Upper Body

I’ve been blogging quite a bit recently about the FMS and the importance of screening for dysfunctional movement patterns, and fixing them.  As I’ve mentioned before, the FMS is probably the easiest tool in that regard because it gives an easy-to-follow, step-by-step assessment where you can easily score your athletes and fix the faulty movement pattern by applying the appropriate corrective exercises.  After a week or two of corrective strategies, you re-screen and see if they improved.

But what if the corrections don’t fix your athlete or client?  There might be a couple different reasons for that.  The 3 most common would be:

• Inappropriate corrective exercise selection
• Incorrect or faulty performance of the corrective exercises
• Incorrect scoring from the evaluator of the athlete or client

These should be the top 3 reasons to be considered if a movement pattern doesn’t improve.  Sometimes however, the athlete will be screened correctly, given the right corrective exercises and they’ll perform them properly, but the assessment result will still tell you that the movement pattern didn’t improve.  How is that possible?

One thing to consider is the recruitment patterns during high threshold activities.  Let me explain…

A dysfunctional movement pattern may arise from a mobility (or flexibility) problem, a stability problem, or a motor control dysfunction.  In any of these cases your body has engrained some motor patterns when you move, whether it is when you run, jump, walk, lift weights, etc.  The functional movement assessment will allow to get rid of those compensation patterns.

Anyone surprised that I found this image on a Crossfit website?

But if you keep pushing your body to the limit (high threshold activities) while trying to correct a dysfunctional movement pattern, you might be wasting your time.  Your body will always follow the path of least resistance when confronted to a high threshold or max effort activity, which is where the dysfunction will keep being encouraged.  If you’re trying to re-train a movement pattern, it’s not a good idea to train in that max effort zone, especially with conflicting movement patterns.  You’re not giving your body a chance to adjust and get used to the new movement pattern you’re trying to improve.  Your body will always get back to what’s easier when facing a high demand task.

That’s why it’s smart, even necessary, to back off the training intensity for a little bit while you re-train a correct movement pattern.  After a week or two you can start reinforcing that new, more efficient movement pattern with lifting exercises and progressive loads, and higher demand activities, because let’s face it: your body will keep facing high threshold demands in training, sports and in everyday life.  But it is important to gradually return to that point if you want to maintain the effect of the corrective work you’ve been doing.  It doesn’t mean discontinuing all activities and training to focus solely on corrective exercises.  It just means to avoid conflicting movement patterns (someone should avoid heavy squatting for a while if he’s trying to correct his deep squat pattern, or avoid max effort bench pressing if trying to improve shoulder mobility).  It’s just about being smart about it, and knowing what exercises or activities could impair your corrective strategy efforts, and lowering the intensity or removing them from your routine for a couple of weeks while you fix your dysfunctional movement patterns.

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I’m referring to movement assessment as one that assesses the way to body moves and how you can use such an assessment to identify possible injury risk factors.  The Functional Movement Screen is probably one of the most popular ones out there, and for a reason.  It is a system that has been proven very effective.  You test a movement pattern; if it’s dysfunctional or asymmetrical, you give the corrective drills.  And then you retest.  Simple enough, right?  And if implemented the right way it is an invaluable tool that works to reduce the incidence of injuries, plain and simple.

But other than just screening movement patterns to help prevent injuries, the FMS might be seen in a bigger picture of the health and performance continuum…or should I say ‘should be seen’.  I don’t think that many people in the strength and conditioning and athletic training community even know about the FMS.  A couple of pro teams and colleges have actually started using it in different teams, but that’s about it.

Let me explain what I’m talking about when I say the FMS should be included in the bigger picture.  The basic evaluation in pretty much any setting whether you’re dealing with pro athletes or just recreational athletes, is the physical.  Everyone needs to pass a physical before engaging in an activity, and athletes usually need to get at least one every year to make sure they don’t have physical or physiological restrictions that could limit their performance or be dangerous to their health (e.g. cardiovascular problems, respiratory problems, joint problems, etc).

There is also another type of evaluation that usually goes on with athletes of different levels, and it’s the performance testing.  Teams want to collect measurements of strength, speed, power and conditioning levels of their athletes (e.g. lifting tests, jumping tests, sprint tests, etc).  And this is understandable because it is a good way to determine the level of fitness of each player on the team, and it can also serve as a basis of comparison between players.

But when you think of each step of the evaluation process, you can clearly find holes in that continuum.  Athletes first get a physical to clear any disease or incapacitating condition, and then….right on to the performance testing.  Is it me or there is something between the two that’s clearly missing?  If you think about it for a second, wouldn’t it make sense to assess the way an athlete move before throwing him under the bus with max intensity performance tests?  What if an athlete has major knee valgus during knee flexion?  It is a position that puts your knees at risk for a serious injury…and we’re going to throw him under a 405 pounds bar to attempt a max squat, without any consideration for the very high risk of injury related to the way this athlete moves?

Perfect.

Including movement based assessments in the health/performance evaluation protocol only makes sense to me.  But it shouldn’t be limited to a couple individuals who know the FMS and are willing to implement it on their own; it should become a staple, a part of the process, just like the physical and just like the performance tests.

The problem then becomes: how do we go about this?

Food for thought.

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When we think about assessment, we often think about assessing range of motion at different joints and in different angles.  The Thomas test to test hip extension, the Ober test (or adduction drop test as the PRI folks would call it) to test adduction, internal and external rotation both at the hip and at the shoulder are all examples of range of motion measurements.  Although I can’t say these tests aren’t useful because they do have a purpose and they do give you valuable information about a client, do those tests should be the focus of our assessments?

I ask the question because I really don’t hold the absolute truth on the subject, but here’s something to think about with the way we approach our assessment protocols: are we more interested in isolated range of motion at different joints or how the body move as a whole?  We’ve been big proponents of multi-joint exercises and training the body as a whole for quite a bit by now.  We know that the body doesn’t work with in isolation, and with what we know about the fascial system now and with the work of brilliant people such as Thomas Myers we know that isolation pretty much doesn’t exist at all in the body.  So if anatomy and movements don’t work in isolation and we don’t train the body that way, it would only make sense to assess the body the same way, wouldn’t it?

With all this fascia do you really think you can isolate one muscle at one joint?

A lot of you are already familiar with the FMS as an assessment tool.  A couple of you might be familiar with the SFMA, which is another more advanced assessment tool geared more towards physical therapists and the medical crowd.  As simple as those assessment protocols seem, there might be more to it than just ranking a client from 0 to 3 on different tests.  I’ve been reading Gray Cook’s Movement book for the last week or so, and I just realized that an assessment like the FMS is much more than what it seems.

It assesses movements patterns and it can tell you a lot about how your clients and athletes move.  It also assesses how the body moves as a whole, not in isolation and not by measuring isolated range of motions.  Dysfunctional movement patterns are really easy to spot using that assessment and using correction strategies to fix those test might be all someone needs to move properly and stay out of the “injury risk” zone that we know can lead to bigger problems and injuries in the long run.

Again, I’m not suggesting that isolated range of motion measurements don’t have their place.  But assessing movement patterns might be even more important because it’s the way your body moves as a whole that’s going to matter in the end.

Food for thought.

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I don’t think I’ll surprise anyone by saying that I’m a big injury prevention guy.  I do think that addressing muscle imbalances, posture and reinforcing good movement patterns are a crucial part of any training program.  Think about it: does it really matter that you get your athletes stronger and faster if they don’t play half of the season because of a hamstring pull, or whatever other injury?  No.  That’s why it should be the priority of a strength coach to address these things.

But it’s also very easy to get caught in the injury prevention mindset and focus on nothing else.  It’s important to help our athletes prevent injuries, but we’re not physical therapist.  We shouldn’t treat our athletes like patients, and they should never feel like they’re coming in for a treatment when they walk through your door, no matter what.  We have our own skill set as strength coaches, and physical therapists have theirs.  What we really need to do is bridge the gap between strength training and rehab, and not do both.  We can’t send everyone who have a slight pain in their shoulder to physical therapy.  We can however, and should be able to assess them and identify dysfunctions and/or muscle imbalances, but we shouldn’t try to “treat” someone who has all the symptoms of rotator cuff tendinosis.  That’s not our job, we need to refer out!  That’s why it is so important to have a good network of professionals around us.  But I digress.

Unless you can do it all like this guy, you probably need a good network

Despite the little aches and pains of our clients and athletes, we should always keep their goals in mind.  Foam rolling, mobility exercises, activation drills should be important tools in our toolbox, but never the bulk of our training programs.  When foam rolling turns into a 25 minute deep massage session before training and when your fat loss clients are doing more scap wall slides and ankle drills than exercises that will actually make them burn some calories, that’s when we start overdoing the injury prevention side of things.

Dude, seriously just take the roller out on a date!

This obviously applies to relatively healthy clients and athletes.  It’s a different situation when one of your athletes comes back from a sports hernia surgery.  But I think you get the point.

Make your athletes better, stronger, faster and injury resistant.  Don’t be a physical therapist.  Be a strength coach who knows something about functional anatomy.

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Can you improve range of motion at the gleno-humeral joint without working on range of motion at the gleno-humeral joint? As counter-intuitive as it sounds, the answer is: YES.

Having good range of motion at the gleno-humeral joint is very important for shoulder health.  For baseball pitchers it’s even more important.  Having an appropriate amount of external rotation, internal rotation and comparable total motion between both sides is an important predictor of injury in many cases.  I mentioned recently in a blog post that sometimes simply doing static stretching might make you try to chase improvements in range of motion without ever getting where you want.

The shoulder joint is a good example of how you can improve range of motion at one joint by addressing other areas that are not direct work to the specific muscles.  Think about how the shoulder joint is built and what bony structures are part of the shoulders.

Now think about how the position of the scapula, for example, can affect movements occurring at the gleno-humeral joint and its resting posture.  If you have an anteriorly tilted scapula, your whole gleno-humeral joint will be affected and your range of motion might be different than what it should be with a neutral scapular position.  Same thing with someone who has a significant kyphosis and doesn’t have a lot of range of motion at the thoracic spine; it’s going to affect the way the whole shoulder will be positioned.  Range of motion will also be affected.

Working to improve thoracic spine range of motion and scapular stability without doing any specific stretching for the gleno-humeral joint will improve your range of motion.  They both will help reposition the humeral head in the glenoid fossa to allow for optimal range of motion.  And by doing this you also avoid trying to crank on the end range of motion of the gleno-humeral joint, which might not always be a good idea if there’s some sort of bony limitation.  I have recently seen 20-25 degrees of improvement in total motion (external + internal rotation ROM) in 4 weeks on one of my pitcher’s throwing arm only by hammering on the thoracic spine mobility drills and the scapular stability and strength exercises!  That just goes to show you how important it is to take a look at the bigger picture.

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One thing that most people in the fitness industry with a minimum of education would agree on is that exercises should be trained in a full range of motion.  Yet we see this in most gyms and training facilities: the guy who sacrifices range of motion to add weight to the bar (aka doing quarter squats or not touching his chest with the bar when he bench presses).  It, of course, does serve a big purpose: boosting your ego.  But from a functional training and injury prevention stand point, let’s face it: it’s retarded!

But sometimes getting full range of motion isn’t optimal. Wait….really?!  I’m not talking about the “but it’s too hard if I go all the way down!” reason of not doing it.  There are individual structural differences in the way we are built and optimal range of motion might not be the same for everyone.  Before we go any further, please don’t use this as an excuse for  before you or your athlete have actually been diagnosed with a specific condition.  The truth is that most of the time if it doesn’t come from an ego condition, most of the time it can be fixed with appropriate modalities (soft-tissue work, mobility, activation drills, etc).  But some other times, it can’t.

Femoroacetabular impingement (FAI) is an abnormality that presents itself at the hip.  It comes in the form of a bony prominence on the femoral head, classified ‘cam’ impingement (mostly seen in males) or a deformity in the acetabulum, classified ‘pincer’ impingement (mostly seen in females).  A mixed type can also be seen.  FAI basically restricts motion in hip flexion and internal rotation.  Because of that, going into full range of motion on exercises like squats, lunges, rear foot elevated split squat and the like might cause some damage to the cartilage or the labrum of the hip.

FAI is not a wide spread diagnosis.  This is something you might see in a small percentage with young and middle-aged athletes, and definitely not in a very high percentage with the rest of the population.  So don’t jump to the conclusion when you see one of your athlete or client not being able to achieve full range of motion on a lower body lift.  I wrote not too long ago how you can use a simple test to help you point in the direction of FAI, but don’t use only that test by any means to diagnose yourself or your athletes with such a condition (the test is meant to help you identify abnormalities, but not make a diagnosis).  Other signs to look for, such as the hips shifting (side to side or any kind of rotation) when performing exercises like deep squat and lunges may be indicative of possible FAI.   If you suspect something and the quadruped rock test seems to indicate a positive result, make sure you refer out to someone who will be able to confirm the diagnosis.

But the point is that some people, as counterintuitive as it sounds, shouldn’t achieve full range of motion on certain exercises because of a structural limitation that might cause damage to the joint when loading certain exercises in a range of motion that the joint doesn’t have.

In cases that present with femoroacetabular impingement or other type of structural limitations, sometimes we’re better off avoiding full range of motion.  But when your ego is the “special condition”, just check it at the door…otherwise something bad might happen.

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I’m on vacation this week (don’t worry I didn’t bring my lap top to the beach, I just wrote these posts last week!), so I will keep the posts short, but hopefully you can still something out of them!

About two weeks ago my colleague Kevin Neeld posted a video on how to assess for femoral anteversion and retroversion.  The video why this type of assessment might be very important, especially for hockey players.  Kevin also explains in detail how to assess range of motion at the hips.  If you haven’t seen it on his website already, make sure you watch the video below!

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