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3 Ways to Improve Hip Pain

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Sumo Deadlifts

Do you get hip pain when performing Sumo Deadlifts? We hear more about low back pain when it comes to deadlifting, but hip pain is another common one.

For the brevity of this post, we won’t delve too deep into why pain occurs, but we will provide options for athletes who are experiencing hip pain when they perform sumo deadlifts.

1. Soft Tissue Quality

One factor that can contribute to hip pain when performing sumo deadlifts is soft tissue quality.  Poor soft tissue quality in the areas of:

Rectus Femoris

Adductors

Hip Internal/External Rotators

can be a contributing factor to with hip pain due to the mobility demands of a sumo deadlift.  When performing a sumo deadlift, hip abduction and external rotation mobility is needed more than a conventional or trap bar deadlift.

Before hammering away on self-myofascial release, check to see if you sufficient mobility before thinking you need more.

A couple of quick tests include:

Thomas Test

Normal:

-Thigh reaches table.

-Knee flexed at 90 Degrees.

-Knee in line with hip.

Not Normal:

-Thigh doesn’t reach table.

-Knee doesn’t comfortably flex to 90 degrees.

-Knee not in line with hip.

Hip External Rotation

Normal:

-Heel to Opposite Mid Shin

Ways to improve soft tissue quality in those areas can include:

Another area that can sometimes go unnoticed is Rectus Femoris aka the Quads.  Now, you may ask why the quads could be a contributing factor to hip pain with sumo deadlifts.  Athletes who present with an anterior pelvic tilt or increased tone/tightness in their quads have a propensity to hang out in that anterior tilted position and in turn potentially decreasing mobility at the hip.

By improving soft tissue tone/quality in the quads, this can help to improve hip mobility and decrease the stress and strain on the hip when getting into the sumo deadlift position.

Also, working on hip mobility drills can help.  Drills such as:

½ Kneeling Hip Flexor and Couch Stretches

Quadruped Adductor Rockback

90/90 Hip ER/IR

2.  Starting Position

How you start is how you can finish.  This may not be true for everything in life or lifting, but the starting position in the sumo deadlift can be a key piece of how the lift is performed.

If you are starting in a position such as this:

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where the athlete or client has an increased extension or arch of their lower back, this can potentially be a contributor to hip pain with sumo deadlifts.

This starting position can place the athlete or client into an anterior pelvic tilt.

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Photo credit: https://dailyhealthpost.com/anterior-pelvic-tilt/

By starting off in this position of anterior pelvic tilt, this can decrease the amount of space at the hip joint due to the orientation of the pelvis on the femur.

This does not mean that every single person who presents with an anterior pelvic tilt will have hip pain with sumo deadlifts.  But, if you do, try setting up in a more neutral position to maximize the space at your hip joint as shown below.

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3.  Finish Position

When an athlete is attempting to finish the lift, often times they will “lean back”.

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This idea of leaning back can be something learned over time, can be due to “tightness” in certain areas, etc.  There are various reasons why an athlete may “lean back”, but by leaning back, this piggy backs on the point from before about an anterior pelvic tilt.  

If you lean back, you are going into lumbar extension/hyperextension and creating that anterior pelvic tilt mentioned previously.  By doing this, it can decrease the amount of space at the hip and in some athletes, be a contributor to pain in the hip, but at the end of the movement.

Instead of thinking of “leaning back”, think “stand tall” when coming to the end of the lift.

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By standing tall, you are using your glutes to extend your hips, not your low back, to finish the lift.  Also, by standing tall, you are maintaining a better position from your spine through your hips and maximizing the space at the hip joint.

If you are dealing with hip pain when you perform sumo deadlifts, make sure to:

-Work on Your Soft Tissue Quality

-Check Your Starting and Finishing Positions.


Is Your Grip Strength Holding You Back? 

5 Unique Ways to Improve It!

Grip strength doesn’t get much love.  We hear all the time about strengthening the glutes, hamstrings, core, etc.  But, grip strength is a vital part of many, many lifts and exercises.

If your grip fails, then the rest of the lift can suffer, or even worse, you may not be able to lift heavier weights and in turn, leave a lot on the table.  Also, a strong grip can improve function higher up the kinetic chain at the elbow and shoulder.

Many people train their grip strength by doing wrist flexion and extension curls.  There is nothing inherently wrong with this, but the carryover to grip strength for lifting is minimal.

Think about this.  If you are lifting a heavy barbell off the floor, you need to be able to wrap your hand around the bar and maintain a maximally tensioned hand in order to exert force from your body to that bar to move it.  By doing wrist curls and moving the wrist throughout a range of motion, this may not carryover well to maximal grip strength.

So, if you are looking to take your grip strength to the next level, check out these options.

Option #1: Carry Heavy Stuff

This one often goes unnoticed as an option for improving grip strength.  By training your hand and forearms to hold something and walk with it, helps to not only improve grip strength, but also the endurance of the hand, wrist, and forearm musculature to be able to perform for more than one repetition of a max effort deadlift, etc.

Carrying options can include:

Suitcase Carries

Suitcase Carries with Perturbations

*this can be a good option to train the entire arm to have to stabilize against a destabilizing force

Farmer’s Carries

Bottoms Up Waiter Carries


Bottoms Up Carries Kettlebell Carries

Bottoms Up Water Carries with Perturbations

Option #2 Lift Heavy Weights

This sounds simple and lifting heavy weights might be challenging with subpar grip strength, but by training submaximally and increasing your strength base by training submaximally, this can help to improve your grip strength training at lower loads.

Lifts such as:

Trap Bar Deadlifts

Sumo Deadlifts

Conventional Deadlift

Option #3 Dial In Your Starting Position

An often overlooked area is dialing in your starting technique position.  If your upper body is in a poor position for the start of the deadlift, it is going to place a greater demand on your grip strength vs delegating the stress throughout the body.

For example, if you are lacking proper lat engagement when starting a deadlift, this can increase the demand on the low back as well as on the hands and forearms.

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By engaging the lats as shown below, this helps to engage the core, decreases strain on the low back, and helps to delegate the stress throughout the body versus to just 1-2 areas.

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Option #4 Fix Your Hand Position

Another area that I find holds people back as they are trying to lift heavier weight is the position of their hand, specifically their thumb.

Now, this may sound crazy, but I’ve found anecdotally that thumb position can maximize or minimize someone’s capability to lift heavier weights.

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By using either of the thumb positions shown above, this can make it very challenging to hold onto the bar effectively as the grip demands increase.  The thumb plays a major role in intensifying one’s ability to maximally grip the bar and hold onto it during lifting movements.

Also, utilizing only 4 fingers and the muscles specific to those fingers isn’t as strong as utilizing 5 fingers and the muscles associated with those as well.

Instead, try wrapping your thumb around the bar and to your hand.

Optiion #5 Utilize Different Implements in Your Training

Another option is to utilize thicker handles or different training implements into your training for upper and lower body that will tax the grip on another level.

Options include:

Fat Gripz

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Thicker Bars

You can also implement ropes, towels, or other implements for upper body pulling or lower body training to either have to hold a grip on a wider object OR utilize a grip that is not as easy as holding a bar ie. performing pull-ups holding onto towels vs the bar.

So, if you are looking to improve your grip strength and either are not looking to do wrist curls or your grip training hasn’t been working, try:

-Carrying Heavy Stuff

-Lifting Heavy Stuff

-Dialing in Your Starting Position

-Fixing Your Hand Position

-Utilizing Different Implements in Your Training.

 


5 Shoulder Sparing Strategies

The shoulder is a very common area where people experience pain and difficulty with certain movements.  Whether it be lifting overhead or getting the arms in a certain position for lower body lifts, the shoulder can sometimes get beat up with prolonged training, poor training habits, etc.

In this week’s blog post, we will discuss 5 strategies to help spare your shoulders and keep you healthy and training pain-free.

1. Optimize Your Soft Tissue Quality

The shoulder is a joint that functions well when the muscles that cross the joint possess good soft tissue quality.

Specific areas such as:

  • Latissimus Dorsi

  • Teres Major

  • Pectoralis Minor

  • Triceps

As well as many others need to have good soft tissue quality structure in order to decrease strain on the shoulder joint and surrounding structures.

Performing Self-Myofascial Release using a foam roller, lacrosse ball, etc. can be a big help.

2. Improve Scapulohumeral Rhythm

Even if you have optimal soft tissue quality, making sure that the scapula and humerus move well is key.

If the scapula doesn’t move appropriately when the humerus is moving, it can create stress at the shoulder that can affect the rotator cuff, labrum, etc.

We like to see approximately 50-55 degrees of upward scapular rotation.

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Drills that can be used to improve or maintain adequate upward scapular rotation include:

Back to Wall Shoulder Flexion

-When shoulders reach shoulder height, gently reach forward and continue reaching until your arms are overhead

Yoga Push-ups Sans Pushups

-Think of pushing the ground away from you when bringing your arms overhead.

Feet Elevated Yoga Push-Ups

-Think of pushing the ground away from you when bringing your arms overhead.

3. Don’t Forget the Thoracic Spine

Improving and/or maintaining good thoracic spine mobility is key to shoulder function.  If the thoracic spine doesn’t move and function well, then the shoulder can suffer.

Here are some good thoracic spine mobility drills:

Sidelying Rib Roll

Sidelying Thoracic Rotation

Bench T-Spine Mobs

A-Frame Thoracic Spine Mobilization

4.  Balance Your Pushing and Pulling

When athletes or clients present with shoulder pain, we like to check their training program to make sure there is a balance between their vertical/horizontal pulling and pushing movements.

When someone is dealing with active shoulder pain, I like to recommend that they balance their strength program with 1 pushing movement for every 3 pulling exercises.

For example, if someone has pushups in their routine,

I recommend that they perform 3 pulling movements.  Pulling movements can consist of vertical or horizontal pulling such as:

Tall Kneeling Batwings

1-Arm Cable Row

Pronated Inverted Rows

Once someone symptoms start to improve, I usually recommend that they continue having a more dominant pulling versus pushing program.  I advise athletes and clients to decrease to a 2:1 pulling:pushing ratio.

5.  Ditch the Barbell

Another tip I advise athletes is to switch up barbell upper body movements for dumbbell upper body movements. Whether it be barbell bench press or barbell overhead press, switching to dumbbell movements can help shoulders move and feel better.

Movements such as:

Dumbbell Overhead Press

Dumbbell Floor Press

There are more degrees of freedom when it comes to using a dumbbell vs a barbell.  Even if someone is not dealing with active shoulder pain, swapping out the barbell for a dumbbell can be a great way to stay moving and feeling great.

If you are dealing with active shoulder pain or are trying to keep it from occurring, try:

  • Optimizing Your Soft Tissue Quality

  • Improve Scapulohumeral Rhythm

  • Improve Thoracic Spine Mobility

  • Balance Your Pushing and Pulling Movements

  • Try Ditching the Barbell


Ways to Train with Low Back Pain

Low back pain is the most common ailment people present with to physical therapy clinics.  80% of people will experience low back pain at last once in their lifetime. Some people will have some discomfort and can go about their daily routine while others are laid up on the couch, taking pain medication, using ice or heat, and can barely move.

If you are one of those people who are laid up on the couch, go see a licensed healthcare practitioner ie. physical therapist, sports chiropractor, etc.  Also, if you are having low back pain that isn’t improving, go see someone!

For everyone else, who has either dealt with low back pain before or is currently trying to get to the gym to train, check out this article for ways to continue to train at the gym without making things worse.

1. Change Your Lifts

When someone has low back pain, they typically won’t like to back squat.  The back squat requires a great demand for mobility throughout the body. Anecdotally, most athletes and clients who’s back is bothering them will typically not tolerate the axial loading that occurs with the bar on the back.

With that being said, try other squat variations such as:

Front Squat

Goblet Squat

By changing the position of the load from the back of the body to the front or into the hands, it can improve core musculature activation as well as just simply feel better for some athletes.

2. Place an Emphasis on Technique

There is a spectrum of opinions on this topic.  Some people say that you need to have perfect form 24/7 while others say technique doesn’t matter.  Like most things, it depends.

If someone is dealing with active pain with certain movements or positions while lifting, we don’t want to keep irritating what is already irritated.  We need to let things calm down. If you are continuing to load something and it is making it worse, not better, then something has to give.

If you are rounding your low back in the bottom of the squat,

and this bothers the back and continues to make things worse, stop!  I’m not saying that you need to stop squatting all together, but adjusting your technique may be key to helping you be able to continue training and feel good.

If you are squatting and continuing to round at the bottom of a squat, try limiting your depth by using a box squat so you can maintain good technique and can still maintain a training effect.

or don’t squat as deep and maintain good technique and continue to work on improving your technique as things feel better.

Another good variation is using a goblet squat with a pulse or with a breath.

Both of these drills can be great options to train the body to control the bottom position of the squat, maintain tension throughout the body, and improve the body’s ability to attain deeper squat depths safely and pain-free.

3. Change Your Pulling Options

If pulling from the floor bothers your back, try elevating where you are pulling from using these variations:

Rack Pulls

Trap Bar Deadlifts

Cable Pull Thrus

*even though trap bar deadlifts are from the floor, it decreases the amount of mobility needed since the handles are higher as compared to a sumo or conventional deadlift.

4. Place an Emphasis on Single Leg Strength

Even though the mentioned lifts prior to this utilize both lower extremities, placing an emphasis on single leg training is key for lower back health.  Improving single leg strength can help carryover to bilateral lower extremity performance as well improve lumbopelvic stability and strength.

Here are a bunch of options for you to utilize to help give your back a break as well as maintain a lower body training effect.

Step-Ups

Lunges

Bridging Variations

Single Leg Deadlift Variations

If you are currently dealing with low back pain or have in the past and want to be able to continue to train at the gym, try adjusting your lifts, placing a great emphasis on technique, changing your pulling position, and adding in single leg training.  

This isn’t an exhaustive list of what to do/not to do with low back pain, but these are options if you want to continue to be able to train.


 

Ways to Train

Lower Body

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Knee Pain

Knee pain is one of the most common complaints among people who exercise.  Whether it be running or Crossfit or any other exercise endeavor, knee pain can be frustrating and cause people to either try to push through the pain or stop doing anything all together.

The key with knee pain is to train intelligently and still gain a training effect without making things worse.

DISCLAIMER: If any of the suggestions in this article make symptoms worse/not improve, stop!  Speak with a licensed medical practitioner to get to the root cause of the problem.

With that being said, retraining and improving movement quality is important.  There will eventually come a point where training with some discomfort is needed to improve the resiliency of the tissues.  Make sure to consult with a medical professional who understands these concepts in order to return to a high level of function.

Common movements that people with knee pain feel worse with are lunges and squats.  Yes, there are other exercises that may bother knee symptoms, but these are the two most common.

Without delving too deep into exercise technique, loading, volume, etc., here are some options that if you are dealing with knee pain, how to still maintain a training effect.

Squat Variations

For squat variations, if the typical back squat bothers your knees, try performing these variations.

Front Squat

The front squat can be a great option as it changes the position of the bar from the back of the body to the front.  By changing the position, it requires an increased demand by the core musculature to remain upright. Anecdotally, athletes will find an improvement when changing the bar position from the back to the front potentially due to increased core recruitment.

Goblet Squat

The goblet squat is another great variation as well.  Similar to the reasons for the front squat, this is usually the option I go to first when someone is rehabbing or trying to return to squatting after knee pain or a knee injury.

Goblet Squat with Pulse

The Goblet Squat with Pulse is another option.  This can be a way to incorporate the core musculature into the movement by performing the pulse at the bottom.  By performing the pulse, it can help to train the core to stabilize the spine and entire lower body at the bottom portion of the squat.

Goblet Squat with Breath

The Goblet Squat with Breath can help train the body to control the bottom position of the squat as well as focus on maintaining proper technique.

Barbell Squat to a Box

The Barbell Box Squat is another option to place a great emphasis on the posterior chain ie. glutes and hamstrings.  Barbell squats, whether they be back or front, can sometimes bother athlete’s knees. By performing them to a box, it can minimize anterior translation of the tibia and can decrease strain on the knees while still maintaining a training effect.

Goblet Squat to a Box

The Goblet Box Squat is similar to the Barbell Box Squat as shown above except that the load is more anterior and can be more of a challenge to the core musculature.

Posterior Chain Variations

Hip dominant movements are typically much more tolerable for athletes and clients with knee pain.  That is not to say that all hip dominant movements are pain-free for all athletes, but here are many variations to train the posterior chain while minimizing symptoms at the knee.

Glute Ham Raise

Trap Bar Deadlift

When athletes perform trap bar deadlifts, some can experience knee symptoms.  The trap bar deadlift uses more quad activation than a conventional or sumo deadlift.  When performing, focus on hip hinging and “pushing the hips back” to promote more hamstring and glute activation vs just flexing through the knees to reach the bar.

Sumo/Conventional Deadlifts

Cable Pull Throughs

Lunge Variations

Lunges can occasionally be painful for someone trying to train around knee pain.  It can vary from athlete to athlete in that some have pain with forward lunges while others have pain with reverse lunges.

For forward lunges, try minimizing the amount of anterior tibial translation initially to allow you to train pain-free.  If you find that your knee travels forward and this increases your symptoms, try lunging towards a bench or other similar object.

This next video is of a split squat, but the same principles can apply. Try incorporating a slight forward lean as this can decrease strain on the joints of the lower body and delegate the stress to the muscles of the lower body.

For reverse lunges, also try minimizing anterior translation initially if having knee pain.  Utilizing a bench or hurdle as shown before can help.

As shown before with the forward lunges, incorporating a slight forward lean is another option for reverse lunges as well.

Another option that works for some is incorporating slow eccentrics into your lunges.  By incorporating slow eccentrics, it allows your body to control the movement better and decreases the amount of threat to the nervous system and can improve pain symptoms.

If you are dealing with knee pain, there are still many options to utilize in the gym in order to get a training effect.  Try some of these options if you are dealing with knee pain.


#1 Biggest Mistake

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Stretching

Stretching is one of the most common routines done with exercise.  Some individuals perform it prior to exercising, during exercise, after, or part or some combination of all 3.  

Look at most well-structured training programs and there is some form of mobility work implemented in.  When used correctly, it can be a major staple to help improve and maintain mobility in order to decrease risk for injury and improve performance.

One of the biggest mistakes that accompanies stretching is only performing stretching.  To be more specific, performing a stretch or mobility drill is important, but not training the Central Nervous System (CNS) to be able to stabilize and control this “new mobility” is only setting an athlete up for failure.  This failure can include:

-Continued “Tightness”

-Injury

-Weakness, etc.

In the worlds of rehab, strength and conditioning, and performance, we need to make sure that our clients and athletes are training their bodies/CNS to be able to utilize this “new” found mobility in order to provide benefits to their training, sport, and/or everyday life.

For most people, just performing a stretch is spinning their wheels.  The stretch feels good, but eventually that tissue may “tighten up” and continue to feel tight until it is stretched again.

In order to maintain this “new mobility,” we want to make sure our athletes and clients are utilizing it and training their body to control it.

Here, we will discuss, joint by joint, ways to train the body to control mobility.

Shoulder

The shoulder is an inherently mobile joint.  Whether it be in the sagittal, frontal, or transverse planes, the shoulder is structurally and functionally very mobile.  Often times, mobility can be limited in the sagittal plane (flexion) or with external and internal rotation.

If you are finding that you are continually feeling “tight” into shoulder flexion, ER, or IR after performing your mobility drills, try implementing some of these drills.

Back to Wall Shoulder Flexion

Quadruped Assisted Reach, Roll, and Lift

Supine AROM Shoulder Flexion with Weight

 

Supine AROM ER/IR with Weight

 

Supine PVC Pipe Drags

Thoracic Spine

The thoracic spine is a super common area for mobility drills to be performed at.  Many people do have limited thoracic spine mobility. More often than not, they feel “tight,” but they have full passive mobility.  

If you are constantly performing thoracic spine mobility drills, but your “new mobility” isn’t sticking, give some of these drills a try.

Quadruped Assisted Thoracic Rotation

Seated Assisted Thoracic Rotation

 

Sidelying Assisted Thoracic Rotation

Hips

The hips are another area where mobility is important.  Stability, or control of that mobility is just as important.  If you are having difficulty maintaining mobility in any of the areas of the hip, give these drills a try.

Hip Extension

Cook Hip Lift

Quadruped Assisted Hip Extension

Tall Kneeling Core Activated Hip Hinge

Hip ER/IR

 

Supine Assisted Hip ER/IR

Quadruped Assisted Hip ER/IR

Tall to ½ Kneeling Hip ER/IR Walkouts

Hamstrings

 

Supine Core Activated Active Straight Leg Raise

 

Assisted Leg Lowering

Leg Lowering Progression

Ankle

The ankle is another important area for mobility.  It is necessary to have adequate ankle mobility for squatting, deadlifting, and any other athletic endeavor.  If you are dealing with ankles that improve in mobility, but then regress, give these options a try!

Bilateral Plantarflexion to Single Leg Eccentric

 

There you have it!  Now, before you go off and start just doing all of these “correctives,” two things!

  1. There are many variations that can accomplish the same thing.  If one does not maintain an improvement, try another variation.  Two people can present with ie. a hip extension limitation, but one exercise may work for one person and not for the other.

  2. The second, but most important is that these correctives are additive in nature.  Meaning, find the 2-3 areas that need work the most and use the exercises to help improve your movement quality.

Then, get after it!  Go train and lift heavy!  Lifting heavy with good technique is going to be one of the best ways to maintain any improvements made with self-myofascial release, mobility, and motor control drills.


 

 

3 Tips To Improve Your Hip Flexor Stretch

 

Stretching and mobility drills can be an important part of any rehab or strength and conditioning program.  When coupled with motor control drills and good old fashioned strength and conditioning, it can very effective for the athlete or client.

One common stretch that is performed by many is the hip flexor stretch.  Whether performed in standing or half kneeling, many people will stretch their hip flexors because they want to improve their hip flexor mobility or are experiencing tightness in this area.

To know if you truly have limited hip extension mobility/limited hip flexor mobility, try the Thomas Test.

 

Normal:

-Thigh reaches the table

-Knee is bent to 90 degrees.

-Knee is in line with the hip.

If any of these previous points aren’t present and the thigh cannot reach the table, the knee is not bent to 90 degrees, and/or the knee is not in line with the hip, then you most likely have limited hip flexor mobility.

For the brevity of this post, we will be addressing the half kneeling hip flexor stretch for the Iliacus and Psoas Major/Minor.

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Commonly, this is how the half kneeling hip flexor stretch is performed.

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Most people will feel a stretch in their hip flexors during this particular stretch/position, but it not ideal.  It is not ideal because you are most likely stretching more than just your hip flexors.

You are stretching ligaments and capsular tissue in the hip joint itself and in most cases, this is not something we want to be stretching.  Also, performing the hip flexor stretch like so is not the most effective use of your time and effort.

Here are 3 Ways to Improve Your Hip Flexor Stretch

Tip #1:

“Tuck Your Tailbone” or “Bring Your Belt To Your Chin”

This is a great cue that I use with people to make sure they are feeling a true hip flexor stretch.

Key Points:

-Make sure ear, shoulder, hip, knee are all stacked on top of each other in a straight line.

-“Tuck your tailbone” or ”bring your belt to your chin”.

-Stretch should be felt in the front of the hip.

By performing this cue, you are posteriorly tilting your pelvis or tilting it backwards and working on muscular mobility versus stressing joint structures as shown above.

Tip #2:

“Press Down Into Your Knee”

Another tip I like to use is if someone can’t feel a stretch with the tip from above where they tuck their tailbone or bring their belt towards their chin, I instruct them to push down into their front knee. By doing this, you are activating the anterior core musculature. These muscles attach on the pelvis and have a direct relationship to pelvic position as well as feeling a hip flexor stretch.

Key Points:

-Make sure to stack ear, shoulder, hip and knee on top of each other.

-Take both hands and press down into front knee.

-Stretch should be felt in the front of the down leg hip.

By activating the anterior core musculature, this can assist in posteriorly tilting the pelvis as attempting to do in tip #1.  This tip can also help those who don’t feel a stretch with tucking their tailbone or bringing their belt to their chin.

Tip #3:

“Press Down Into The Knee and Reach for the Sky.”

This last tip is for those who have difficulty feeling a stretch with the previous 2 suggestions.

Key Points:

-Make sure to stack ear, shoulder, hip and knee on top of each other.

-Press down into front knee with up leg arm.

-With down leg arm, reach for the sky.

By piggybacking on tip #2, reach for the sky with the down leg arm.  By performing tip #2 and combining it with the reach, it can help some people feel a better stretch.  By reaching with the arm, it can help to improve the stretch/effectiveness of the drill by working on mobility in the deep and spiral lines of the body's fascial system.

Without going into too much detail, as coined by Thomas Meyers of Anatomy Trains, there are lines or “trains” throughout the body of tissue that connect muscles in different areas.  By incorporating the reach with this stretch, this can improve the stretch by placing tension through the shoulder and in turn at the hip.

If you have trouble feeling a good hip flexor stretch or just want to improve how you’re doing it, try “tucking your tailbone”, “bringing your belt toward your chin”, activating the anterior core musculature, or incorporating a reach with your stretch.


3 Cues to Stop Using with the Squat

The squat is one of the exercises in the strength and conditioning, physical therapy,  and performance worlds that can be a valuable part of any well developed program.

It can be used to train pure strength, power, athleticism, etc.  It is not an exercise that is mandatory to have in a program, but it can be a good “go-to” exercise for a bilateral knee dominant movement.

Over the years, there have been cues used to help athletes and clients improve technique, decrease pain, and improve performance.

Since learning how to squat myself, I have found there are some cues that need to stop being used or be used less.

Here are 3 cues to Stop Using with the Squat:

Cue #1: “Knees Out”

The cue “knees out” can be an effective cue to help those who squat who have a tendency for their knees to go into knee valgus.

But, this cue can be overused and the extreme opposite can occur where the knees are too far outside of the feet.

A good cue instead is to “Find the Outside of the Heels.”  This can place the lower body in a better position instead continuing to instruct someone to drive their knees out.

Cue #2: “Arch Hard/Big Arch”

This is another cue that is used for the position of the back, specifically, the low back.  Unfortunately, this can put most athletes in a poor position when squatting because of the excessive lumbar spine extension.  In turn, it can put an athlete into anterior pelvic tilt, decrease the amount of space for hip flexion and can affect mechanics as well as depth for the squat.

Instead of instructing someone to arch hard and in turn, putting them into a poor position, try stacking your body.  As shown in the video below, stack the shoulders, spine,and hips directly above and below each other. By doing this, you place your body in a better position to move and squat.

This can help with issues at the thoracic spine, lumbar spine, hips and knees.  By stacking your body, you are delegating load and stress better throughout the body versus distributing it unevenly.

Cue #3: “Sit Back”

 

The cue “sit back” has been used for some time to encourage athletes to avoid forward weight shifting.  This is understandable, but cueing someone to “sit back” can over correct and sometimes create another issue where the athlete is sitting back “too much.

In a box squat,

This can be an effective cue to promote a posterior weight shift and decrease stress on the knees in someone dealing with knee pain or in a rehab client.

But, in order to promote a good squat pattern, “sitting back” can affect the normal squat pattern.

Instead of using the cue “sit back”, I like to use “sit down between your knees and feet.”  By instructing someone to do this, it can help promote a proper squat pattern.

 

If you are using the cues mentioned above and you are still seeing a squat that you don’t like, try using these 3 cues instead to help clean up a squat pattern.


Are your Hip Flexors really “Tight”?

This is a common question or sometimes a statement made my clients and athletes.

The anterior hip musculature, for this post, the hip flexors, can be a common area that lacks mobility and can be “tight”.  They can play a huge role in the function of the lower body, upper body, and can impact many orthopedic diagnoses throughout the chain.

Increased tightness in the hip flexors can limit hip extension and can in turn affect the ability of the gluteus maximus to control the lower leg.  It can create limited mobility into hip extension that can force the lumbar spine to have to compensate and move more. Lack of hip extension mobility or tightness in the hip flexors can cause compensations and adaptations at the upper body for certain athletic endeavors.

Overall, limited hip extension mobility or “tight” hip flexors can play a major role on the entire kinetic chain.

But, here’s the more important question, “Are they really ‘TIGHT’?”

One quick way to determine if there is true “tightness” or lack of mobility is by using a test called the Thomas Test.  See Below:

In this test, sit on the edge of a table.  Lie back and bring both knees to your chest.  Then, let one leg drop down towards the ground.  

Normal Hip Flexor Mobility: thigh is parallel to the ground, knee in line with the hip joint, and knee flexed to 90 degrees.


Not “Normal”: knee not flexing to 90 degrees, thigh above parallel, or knee outside of the hip (not in line with the hip).

As shown in the video, the left leg, or 2nd leg to be tested has a positive Thomas Test, or has increased hip flexor tightness.

What if your Thomas Test was “normal”?

What if you dropped your legs down and they looked fine?  Everything was where it is supposed to be, but you still feel “tightness” in your hip flexors.
 

Did you ever think the hip flexors may be “weak”?

If you want to see if your hip flexors are “weak”, try the Standing Hip Flexion Test.

Stand and pull one knee up to your chest as far as you can go while maintaining a tall posture.  Once you have your knee up as far as it can go, take control of that position using your leg muscles and let go of your leg with your hands.

Ideally, the leg should stay where it is.  Basically, wherever you brought it up to with your hands, the leg should remain once you let go and take control of with your leg muscles.

If it doesn’t, this can mean there is some weakness in those hip flexor muscles, specifically the Iliacus and Psoas Major/Minor.

 photo credit: http://drpeggymalone.com/stretch-hip-flexor-muscles/

photo credit: http://drpeggymalone.com/stretch-hip-flexor-muscles/

Commonly, tightness is seen in the Rectus Femoris (Quads), Tensor Fascia Latae (TFL), etc.  But, hip flexor weakness at Iliacus, Psoas Major/Minor can play a major role in anterior hip tightness.

Iliacus and Psoas Major/Minor are active for hip flexion above 90 degrees of hip flexion.  Below 90 degrees of hip flexion, Rectus Femoris is  largely responsible.

If a muscle feels “tight”, it potentially could be not short at all, but is working very hard to maintain strength or stabilize something.  Eventually, it can feel “tight” when in fact in may not be tight at all.

Now that we have gotten hip flexor tightness or weakness out of the way, what do we do about it?

Here are a few simple exercises to start with:

Supine Psoas March No Resistance

Key Points:

-Lie on your back.

-Bring your knees up above hip height.

-Maintain a flat back to the ground.

-Slowly extend one leg down to the ground without letting the other knee drop below hip height.

-Alternate side to side for 5 reps per side for 3 sets.

Supine Psoas March Light Resistance

Key Points:

-Lie on your back.

-Bring your knees up above hip height.

-Maintain a flat back to the ground.

-Slowly extend one leg down to the ground without letting the other knee drop below hip height.

-Alternate side to side for 5 reps per side for 3 sets.

-Use a resistance that you can perform with proper form.

Supine Psoas March Moderate Resistance

Key Points:

-Lie on your back.

-Bring your knees up above hip height.

-Maintain a flat back to the ground.

-Slowly extend one leg down to the ground without letting the other knee drop below hip height.

-Alternate side to side for 5 reps per side for 3 sets.

-Perform with a resistance where you can maintain proper technique.

The goal should not be to try and go with harder and harder resistance.  Here are a few options to try and help alleviate anterior hip tightness.  Give these a try and see if they can help.


Exercise "Thought Viruses" That Must Stop!

 

Exercise and training are wonderful things.  It is great to see people moving and trying to better themselves.


There are certain claims or ideas that are out there that are still being perpetuated by either professionals and/or people who may not know otherwise.  Everyone is entitled to their beliefs, but today’s post is here to discuss why certain “thought viruses” must stop in order to help move the professions of physical therapy, strength and conditioning, and performance forward.

Exercise Thought Virus #1: Don’t Let Your Knees Go Over Your Toes When You Squat

IMG_6646.jpg

I don’t know about you, but it is pretty hard not to let your knees go over your toes when you squat.  This idea has been around for a long time and was most likely perpetuated with a study about the increase in patello-femoral forces with anterior (forward) tibial translation.

If increasing tibial translation aggravates a client or athlete, find another way to load that person without increasing their symptoms.  But, in order to squat effectively with proper form and depth, the knees need to migrate forward.

In the case of a box squat,

There is very little to if any anterior tibial translation.  This would be the only instance I can think of where there is no forward translation.  In order not to fall backwards, the knees must move forward in order to counteract the weight shift posteriorly with squatting.

There are studies stating that squatting and allowing the knees to go forward is not detrimental to knee health.  As long as someone can squat pain-free and with good technique, the knees should relatively be allowed to go over the toes.  

Exercise Thought Virus #2: Strength Training Makes You Lose Flexibility

I don’t remember how long this one has been around for.  Coaches years ago would claim that if you lifted weights, you became big and bulky and in turn would lose flexibility.  The research has shown that someone’s flexibility is not hindered by someone lifting weights.

For the first 24-48 hours that DOMS (Delayed Onset Muscle Soreness) is occurring, someone may “lose” flexibility temporarily, but it is not permanent.

Many clinicians and coaches have spoken about the benefits of strength training for improving mobility.

Performing movements that consist of slow eccentric isometrics such as:

Slow Eccentric Reverse Lunges

 

Slow Eccentric Goblet Squats

 

Slow Eccentric Single Leg Deadlifts

 


Slow Eccentric 1-arm DB Bench

 

and many more can all help to improve mobility.  With any of those slow eccentric movements, a pause should be incorporated at the bottom position to include the isometric portion of the lift.

Exercise Thought Virus #3: Self-Myofascial Release(SMR)/Stretching Fixes All Mobility Problems

This is still a discussion point in the rehab and performance worlds.  There is one side of the debate that thinks stretching and SMR does not work whatsoever and the other side of the debate believes that is the best thing to implement into any program.

Like with most things…

IT DEPENDS.

SMR and stretching has it’s place in an athlete’s program.  It can be a great tool to improve soft tissue tone in problematic areas.  The idea that a foam roller or stretching is physically lengthening a muscle has been debated and the research has found that there is no actual tissue length changes occurring.  

What is believed to be happening is that SMR and/or stretching is neuromodulating tone at the level of the Central Nervous System (CNS).  With that being said, SMR and/or stretching can be a way to decrease tone in certain areas to allow for improved mobility and improved lifting and performance.

So, a well-rounded program should not just consist of SMR and/or stretching.  It should consist of SMR, mobility work, motor control drills, and strength training.  Consistent strength training when coupled with the other aforementioned parts can be a great way to maintain/improve mobility.

As mentioned before, there are countless movements that can incorporate slow eccentric isometrics to help teach the CNS to be able to control any “new” mobility so that it can be maintained.


Exercise Thought Virus #4: 3 sets x 10 reps

I’m not sure where the idea of 3 sets x 10 reps came from, but I figured it was an easy way to train clients and athletes and just tell them to do 3 sets x 10 reps for each exercise.  Think about it, do 3 sets x 10 reps of x weight and when that becomes too easy, go up in weight and do 3 more sets x 10 reps.

The problem is that this has continued and still continues to this day in the rehab and performance worlds.

Don’t get me wrong.  Athletes and clients can make gains and improvements in strength and muscular endurance with this method.  If someone is very weak or recovering from a surgery, there is nothing inherently wrong with this method.  Things with eventually plateau though.  You can only continue to progress linearly until changes need to be made in regards to reps, sets, weight, etc.

As professions, we need to elevate ourselves away from the 3 x 10 mindset.  We need to program intelligently for our athletes and clients and incorporate variations in reps, sets, weight, rest breaks, etc. 

Exercise Thought Virus #5:  Theraband/Pink Dumbbells Are All That You Need

If you plan on training and/or treating athletes or clients who wish to get back to an athletic lifestyle, you are going to need more than theraband and pink dumbbells.  If you have someone that comes in and they can back squat 300-400 lbs or overhead snatch a significant amount of weight, you are going to need the equipment to help rehab and train them to get back to that.

To piggyback on my previous point, there is nothing wrong with pink dumbbells and theraband.  I use theraband or similar implements with some of my clients...when indicated!  Someone coming off a surgery or are flared up from a recent exacerbation, these tools may be needed.

Eventually, clients need to be loaded!  Whether it be with barbells, kettlebells, dumbbells, the body is resilient and in order to improve that resiliency, it needs to be challenged and loaded to withstand the demands of life and sport.

The physical therapy and strength and conditioning fields are always evolving and changing.  We need to be open to new ideas that may improve aspects of these fields as well as move the professions forward.