The Cause (of injury) Lies Elsewhere

There are several factors that contribute to performance and risk of injury, among them is skill and fitness. For the purposes of this article I would like to focus on fitness and its affect on risk of injury. It is often hard for me to help people understand that a hip that is not working well can lead to a shoulder problem. In other words, a seemingly unrelated body part (through the kinetic chain) can affect the performance of a body part that is on the other end of the body.  A study published in 2013 (1) performed on high school and collegiate baseball players who had ulnar collateral ligament (UCL) tears (elbow ligaments on the inside of the elbow), illustrates this concept. This study compared healthy baseball players to those who had been diagnosed with Ulnar Collateral Ligament tears.  To quote from the article, they found, “Participants with a UCL tear demonstrated decreased performance for their stance and lead lower extremities during the Y Balance Test”. “In addition to balance, the Y Balance Test is reflective of lower extremity strength and neuromuscular control.” Neuromuscular control is the ability to control the body in motion. Neuromuscular control requires the coordination of the qualities listed below:

  • Flexibility – The ability to for joints to move. Can your body get in the best position needed to perform the task/activity at the highest level needed without exposing you to increased risk of injury.
  • Stability – I like Dr. Charlie Weingroff’s definition – Control in the presence of change. Can you control your position well enough during the task/activity to allow your body to express its flexibility, strength, and power without undue fatigue.
  • Strength – Can you produce the force necessary to perform the task/activity without compromising your position.
  • Power – Can you produce the force quickly enough to perform the task/activity.  Most people think of this as a purely athletic part of fitness, but it also would include recovering from a stumble without falling. Your body has to produce the force quickly enough to keep from falling.
  • Endurance – Can you sustain adequate force development to maintain proper position during the task/activity.

These qualities are all affected by and expressed through neuromuscular control. Missing one of theses qualities can cause dysfunction in other qualities. While the findings in this study do not prove cause and effect, they do present strong evidence of a relationship between limitations in the lower body, and upper body dysfunction and injuries.

Another example of a seemingly “unrelated” body part is presented by Greg Dea, a sports physiotherapist from Australia who recently worked for the FIVB World Cup Winner’s, Chinese Women’s Volleyball team. In his article, “Knee injury- Bulletproofing The Volleyball Knee”, (2) he shows a case study of how dysfunction in a “distant” body part causes problems elsewhere. In this example Chinese outside hitter Yang Fang Xu injured her right knee. This knee injury is set up by the painful dysfunction of her left shoulder.  Because she cannot strike straight overhead (check out the video and freeze frame included in the article, she is forced to lean her upper body to the right. The position forces her into a single leg landing (instead of a double leg landing) on her right side. In addition, the posture she lands in makes it more difficult to recruit muscles that support the knee. The result is not pretty.

Many great athletes are so great at compensating for their dysfunctions that we don’t notice it until they get hurt. Therefore fitness along with other factors (ie. Sleep, recovery for stressors, nutrition, etc.) are not only part of performing well, but also avoiding injury. You can’t participate very well when hurt, at least not for very long. Dr. Charlie Weingroff explains it this way, “When someone requires physical rehabilitation, it indicates that one of more systems in the body were not resilient to a stressor of some kind.” (3) While this article has referred primarily to athletes, the same principles are true for everyday activities. All activities require fitness, the more aspects of fitness we posses, the fewer compensatory movements we will have, and the less likely we are to suffer injury or even breakdowns in our health. Make sure when you begin your fitness program to have a professional screen your movements and monitor your progress. Doing so will ensure that your fitness professional and you will know what kinds of training you can do at a high intensity, what others need to be done at a lower intensity, if the program you are using is helping you reach your goals while maintaining a high quality of movement, and if you need help from a healthcare professional.

  1. https://www.ncbi.nlm.nih.gov/pubmed/24256174
  2. http://www.otpbooks.com/greg-dea-volleyball-   knee/?ref=15&utm_source=Facebook&utm_medium=Social+Adv&utm_campaign=Content+Greg+Dea+Knee+Injury&utm_content=Ad+14
  3. http://www.out-of-network.com/blog/why-rehabilitation-and-fitness-should-be-delivered-in-parallel

 

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Exercise is Like Medicine

I once overheard part of a joke where two guys were talking about what drug to use.  One of them said, “yeah, but what happens if you take the wrong drug”; “you just get the wrong high”, the other responded.  It got me thinking that like the two drug users, people exercising can get very different results if they have the wrong “prescription”.  Some approach exercise with a “just do it” attitude as if you can’t mess it up.  The problem with this is that giving the wrong prescription can have negative effects.  Just like drugs, exercise can end up producing no results, or even worse, bad results.  This is one of the main reasons the vast majority of people quit an exercise program.  If the wrong drug is given, the dosage is not appropriate, or the purity of the drug is not controlled, the desired results will not be achieved.  Below I will talk briefly about each of the three areas and how they can affect your results.

First, you must pick the right exercise(s)/drug(s). Based on an individual’s health history, movement history, movement screens, goals, and needs the appropriate exercises should be chosen.  The squat maybe an appropriate exercise for many people looking to improve their fitness, but for the person who lacks proper mobility in the ankle or hips, or thoracic spine, (along with many other reasons) it may actually do more harm than good.

Second, the right dosage must be given.  There is a target dosage (volume: how much is work is performed, and intensity: how much effort is involved) of exercise that will provide desired results.  Too little exercise and you don’t get the results you want; too much, and you not only may not get results you want, but you may hurt yourself.

Third, proper technique for exercise is as important as the purity of a drug.  Impure drugs not only deliver poor or no positive results, but can cause harm.  Poor technique not only reduces the effectiveness of the exercise, but also increases the risk of injury, sometimes in seemingly unrelated places.

Here are some other general considerations:

  • The more accurate the prescription the better the results.  Nobody is perfect, but we should always be striving for excellence.  Obviously, the bigger the error the more likely to either produces little or no results, or injury.
  • The size of the error that can be tolerated and still achieve results without losing results, or causing harm varies.  Individuals with more health/movement issues and those with high performance/fitness goals will tend to have less room for error.
  • Some errors, usually bigger ones, show up quickly.  These usually end up as acute injuries or health problems.
  • Other errors, usually smaller ones, take time to show up.  These errors usually show up as lack of results, or chronic injuries.

This illustrates the importance of a thorough review of history, movement, goals, both before beginning a training program as well as during.  If you would like to make sure you’ve got the right prescription for exercise, give us a call at Movement Training by Design.  860-970-8575

Hip Hinge Part 4: Stability

Welcome to the fourth segment of our Hip Hinge series.  Performing a proper hip hinge effects not only sports performance but also movements you perform daily.  We offered a quick review of the importance of the hip hinge in our opening article, Hip Hinge.  We discussed how Movement Training by Design will work with you to diagnose any issues that will hinder this movement in the second part of our series, Hip Hinge Part 2: How We Diagnose an Issue.  In this installment we will review another movement that can help to correct any issues.  Review Hip Hinge Part 3: How to Train the Hip Hinge to see the T-Spine Mobilization exercise.  We continue here in our 4th installment of the series with another exercise we often use to correct spinal issues that inhibit a hip hinge.

Sometimes a client can achieve an upright posture so that the dowel rod can touch the back of the head, between the shoulder blades, and the sacrum (butt), but cannot maintain that position as they hinge at the hip. When we see this, one cause is often a lack of stability. One exercise we use to train thoracic stability in a position where the hip is flexed is the quadruped posterior rocking against resistance. The purpose of this exercise is to teach spinal stability, while the hip is being flexed. Usually we will use a stability ball for resistance. Like the Bench T-Spine mobilization drill, it involves a hip hinge pattern in a quadruped (hands and knees) position which makes it easier to control the spine.

Key points to remember these cues when performing quadruped posterior rocking:

  • Start on all fours with the hands underneath the shoulders, elbows straight, and knees underneath hips.
  • Place a stability ball between your hips and a wall.
  • Push your hips back into to the ball while maintaining your normal spinal curves (a stick should be able lay along the length of your spine  so that it touches your head, between your shoulder blades, and on you  butt/sacrum)
  • As you begin the push, inhale through your nostrils into a belly breath, hold your breath as you push back, and exhale as you hold the back position
  • The spine should retain its normal curves

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  • Avoid rounding off the back the back, like a camel

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  • Or arching your back, like a cat

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To see this exercise please click here.

 

If you would like help diagnosing if you have a hip hinge issue or how to correct issues you have with the hip hinge, please give us a call to schedule an appointment.  860-970-8575

It’s All In The Timing

The wise man once said, “There is a time for every purpose and for every work”.  Implied in this saying is there is also a wrong time.  The value of an event is often established by “when” it happens.

The same is also true of the timing of muscles in movement.  Researchers have found that the timing at which muscles fire is very important.  Studies have shown that people with back pain engaged the muscles that stabilized their trunk muscles, after the muscles that move their shoulders or thighs, while people with healthy backs engaged the stabilizing trunk muscles before their muscles in the shoulders and hips.  What is probably even less obvious is that having the proper timing in one movement pattern is associated with a seemingly unrelated movement.  In my experience, I have seen a correction in the ability to roll on the floor take away knee pain in a squat.  Titleist Performance Institute has screened thousands of golfers at all levels and found that golfers who are unable to perform an overhead deep squat will have trouble with early extension during their golf swing.

This illustrates why movement screening is important in helping to design training program.  Picking the right exercise(s) and performing them correctly can help improve many other movements.  On the other hand, “putting fitness on dysfunctional movement patterns”, will often lead to frustration, injury, and pain.

Hip Hinge Part 3: How to Train the Hip Hinge

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Today we will discuss one of the exercises we often use with clients who are having trouble performing a good hip hinge because of a problem with Thoracic mobility.  First, if there is any pain involved in the movements we automatically refer to a healthcare practitioner.  If not, to help address thoracic mobility we often use the Bench T-Spine Mobilization exercise. This exercise requires the use of the hip hinge in a position that is usually easier for a client to perform.  It is performed in a kneeling position and supported in the upper body by the bench.  In addition to helping the flexibility and stability of the thoracic spine, this exercise also helps with the shoulders and hips.  Some clients who cannot get the dowel rod to touch all 3 points when they are upright (refer to Hip Hinge Part 2: How We Diagnose An Issue) are able to after the Bench T-Spine Mobilization exercise.

                When performing the Bench T-Spine Mobilization exercise:

  • Elbows a little in front of the head.
  • Elbows about shoulder width
  • Hands a little wider than the shoulders
  • Keep the shoulders away from the ears
  • Your spine should hold normal curves as when you perform a hip hinge.
  • Take a deep belly breath and hold
  • Push back on your hips keeping your spine in the same position.
  • Toward the end pull your hands over the head.
  • Hold the bottom position as you exhale.
  • Perform 7-10 reps

Hip Hinge 1 Hip Hinge 2 Hip Hinge 3

You should not feel any tightness in the lower back, or in the front/top of the shoulders. Clients often notice a stretch through the lats (below the shoulders on the back side), a loosening of the middle of thoracic spine (middle of the back), and hips.

You can view this exercise being performed here: https://www.youtube.com/watch?v=j5i7rnMvPOI

Hip Hinge Part 2: How We Diagnose an Issue

Because the hip hinge pattern is so integral to movement, at Movement Training by Design it is very frequently one of the objectives we identify to help a client with. The two most common impediments we run into when teaching a client the hip hinge pattern are limited mobility/stability of the Thoraic spine (the middle of the spine), and limited hip mobility/stability, usually identified with tight hip flexors (muscles that pull your knees toward your chest), which limits your ability to move your thighs backwards (extension), or your torso backward without extending through the spine.

A client should be able to stand upright with a dowel rod along the spine so that the dowel maintains contact with the head, between the shoulder blades, and the sacrum (buttocks).

Standing with Dowel FrontStanding with Dowel

Beginning in the upright position a client should be able to sit the hips back without the knees moving forward moving the torso toward the floor while maintaining all 3 contact points (photo below, left). If the client cannot get the dowel to make contact with all 3 points in the upright position, or loses contact with one of these points such as when we see the middle of the spine round off as the client flexes the hips, we suspect some kind of mobility issue with the thoracic spine (photo below, right).

Hip Hinge with DowelIMG_1106[1]

Read about some of the ways Movement Training by Design can help a client correct any issues in Hip Hinge Part 3: Training the Hip Hinge

 

Hip Hinge

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When we talk of the hip hinge being an important part of dead lifting, squatting, and jumping (we could also add lunging as a variation of squatting), we don’t just mean in the gym, or on the athletic field.

We use forms of dead lifting, squatting, and jumping in everyday life, whether it is picking up a child, carrying a suitcase, taking out the garbage, gardening, playing a pickup game of basketball or hopping and skipping to avoid a fall. It is important to have the hip hinge firmly established in your brain as a go to pattern. For this reason it is important to train it both for quality (how good is the movement) as well as a quantity (how strong, how long, and how fast you can do it).

Appropriate selection of exercises, as well as loading  of exercises that use the hip hinge will enable you to be ready to do activities in life that are important to you.