This post is for everyone. Technique Tuesday 8 explores hip hinging. Learn to move and lift correctly from the hips to avoid excessive pressure on the low back. I do want to mention that arching from the lower back to bend forward is not going to blow out your back, this is a natural movement. However, if you do it repeatedly, over and over again (due to work or any other reason) or you lift heavy weights with that posture, you could increase the chances of injuring your lower back. Here you go-
The thoracic spine (T-Spine) is an interesting part of the body. In recent times it has taken the brunt of the modern sedentary lifestyle of being hunched over on a chair and working on a computer for hours in a day for many months and years. These modern sedentary lifestyle changes and new work/office setups have had implications on our musculoskeletal system. What is interesting is that the T-Spine itself presents only with a few symptoms like mid back myofascial pain, stiffness, loss of mobility etc. However, other joints in proximity of the T-Spine are affected adversely due to this. Here is a list of problems we often see in an physiotherapy office that our closely related to an excessively stiff kyphotic T-Spine.
Shoulder impingement- An excessively kyphotic mid back places the scapula in a downwardly rotated, anteriorly tipping and protracted position. This position of the scapula has shown to decrease the sub acromion space in the shoulder when performing overhead activities leading to a common problem we see often; shoulder impingement/pain. Try this little test, try elevating your arm up to the maximum flexion elevation with a straight Tspine and shoulders pulled down and back and then with an excessive hunched over position. Which one feels better and which is worse? See the video below and try it yourself.
Neck pain- A kyphotic hunched over posture tips the head (weighing about 10-12 lbs approx.) anteriorly and extends our line of sight downwards to the floor. For compensation, we tilt the head backward which increases Cervical lordosis and causes upper cervical spine to go into extension to have a regular straight field of vision. This causes increase tone/tension in the cervical extensors often compressing the greater occipital nerve and other important cervical structures causing symptoms like neck pain, headaches, radiating symptoms etc.
Low back pain- An excessive kyphotic T-Spine pushes the thorax anteriorly and causes compensatory increase in the lumbar lordosis due to increased tension in the lumbar extensors causing pain at the low back. This is the classic presentation of the ‘Lower Crossed Syndrome’.
Breathing- Along with the above compensation, the thorax lifts up due to inability of the abdominal muscles to provide inferior stabilization (lower ribs flaring) decreasing overall chest expansion and causing poor breathing quality and control.
Furthermore, if you follow the joint-by- joint model of training by Cook and Boyle, you can see that the thoracic spine is meant to be mobile but has a tendency to get stiff.
So, here our some strategies/exercises we can use to maintain general T-Spine mobility. The angles drawn in the video are not exactly accurate and are used for demonstration purpose only-
Bench/chair thoracic spine extension with stick-
T-Spine extension on foam roller
T-Spine windmill rotation
Four point T-Spine rotation
Threading the needle
Closing thoughts, the mid back is meant to provide mobility but tends to get stiff and excessively kyphotic given our contemporary lifestyles. This can open the floodgates to a myriad of musculo-skeletal problems. It is paramount to keep working on its mobility.
As we already know, the problem of glutes amnesia has reached epidemic proportions. Our lifestyle is not like what it used to be. More work gets done sitting on our behinds all day than ever before. Spend too long in sitting and we slowly start to lose the important movement of hip extension. In this blog post I would like to discuss two conditions that I have often seen in the past which can be directly or indirectly related to loss of hip extension (both lack of active control and loss of ROM). Seen in the general population and often perpetuated in runners. Lets begin-
Low back pain– while the causes for LBP could be endless, we will discuss the role of inhibited glutes and lack of proper hip extension in LBP. If we spend 8+ hours a day sitting on a chair (hip flexion), the glutes will be in an overstretched position and often inhibited. To add to those woes, the hip also gets stuck in a flexion position with classic ilicaus and psoas tightness. Now to maintain a upright posture and to compensate for tightness caused by excessive prolonged hip flexion which would put our trunk in a forward lean, the back extensors have to work harder to keep us upright. This often manifests as an increased lumbar lordosis (low back curvature). Prolonged time in this position can cause increase in tone of the lumbar erectors and could potentially cause low back pain. I see this often with recreational runners or those who are new to running. During running, if your hip do not go in to enough extension, the back begins to arch and the erectors being part of the posterior chain have to work extra hard. Remember the body is a great compensator but over time this catches up. This, I believe is often one of the common reasons why recreational runners come to see us for low back pain with running. If you are an athlete or a runner, this is not the best situation for running. Your glutes have lost their VIP status. No one likes weak glutes, unacceptable.
Plantar fascitis– I often find people with plantar fascitis have well developed calf muscles. It appears like its ‘calf raises’ day everyday for these folks however on further questioning you may find that they might not have been doing any calf strengthening exercises. If such is the case, I implore you to check for their active hip extension in walking or running especially during the midstance, heel off and toe off of the stance phase. This is the time when the leg should start to cross back behind the body due to hip extension. This is the primary movement that propels us forward. Now if the body lacks this crucial movement, due to weakness of the glutes max or tightness of the ilio-psoas etc the calf seems to become a more significant driver to push the body forward. Now multiply this a few thousand times a day (even more if you are a runner) over a few weeks, months or years and we have a overworked calf complex. As we all know, the calf exerts a pull on the plantar fascia (remember its a two joint muscle) and that irretates the PF blah blah, we all know this. So improving active hip extension and utilizing the full potential of the glutes is crucial to give the calf a break and in turn might relieve some stress of the PF.
The take home message is simple- Hip extension is a crucial movement for many daily activities and a lack of which might cause LBP or PF. When treating these conditions, don’t make the mistake of running after the symptoms like I have so often in the past. Here’s a little video to give you an idea of my thought process when analyzing hip extension in running.
(PS- this is not the only thing I look for, I’m only focusing on Hip extension here).
This blog post had a very organic origin. In the last few weeks I have seen/heard of too many people ‘pulling their hamstrings’ then I can recollect. In my little world, it seems to have reached epidemic proportions (not quite really, but thanks for indulging me). So let’s intervene. Now this is a big topic to tackle. For the purpose of keeping it short, we will only discuss exercises here. Before we start though I would like to make a disclaimer for my non-physio readers, please consult your physio if you have already injured your hamstrings. These exercises may not be the best approach to your rehab goals depending upon what stage of recovery you are at. For the rest of you proactive people who have no pain and want to train for injury prevention or just try some new exercises and are tired of the same old hamstring curls etc, give these a shot.
For the most part, hamstring injuries are seen more in a ‘generally’ active, athletic population. Research seems to indicate that most of the hamstring strains occur not when the muscle is contracting (concentric) but when it is lengthening under tension (eccentric). An example during running would be when the heel of the forward leg is about to hit the ground. During this motion, the hamstring muscle is lengthening under tension.
Now logic dictates that we train this muscle similarly (eccentrically). Over the years, more and more research seems to indicate that eccentric exercises are a good option for injury prevention and hamstring strain rehabilitation (other muscle strains too). Plus, your athlete patients will love the challenge as it breaks the monotony and are difficult to perform. So start slow and gradually progress. If it hurts, do listen to your body and stop.
So here goes-
Hamstring walkouts –
2. Bilateral hamstring sliders-
3. Single hamstring sliders-
4. Eccentric hamstring on physio ball-
5. Eccentric hamstrings on TRX
5. Nordic Hamstring Curls- This one is modified/ scaled down to make it easier. Its a difficult movement to perform so I begin performing this by not going down on the floor completely. Start small as you develop control and strength and then work through the full range of motion.
Worth a try? Now work those hammies.
Woods, C., Hawkins, R.D., Maltby, S., Hulse, M., Thomas, A. & Hodson, A. (2004) The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. British Journal of Sports Medicine. Vol. 38, No. 1, pp. 36-41.
Chumanov ES, Heiderscheit BC, Thelen DG. Hamstring musculotendon dynamics during stance and swing phases of high speed running. Med Sci Sports Exerc 2011;43:525
On this edition of #techniquetuesday we will discuss the Lunge. The lunge is a great lower body exercise that works some of the major muscle groups of the legs- the Quads, the Hammies and the glutes. In addition to this, it also trains dynamic single leg stability and motor control and depending upon the variation you chose to perform one could also throw in half kneeling stability work and eccentric quadriceps work into the mix. All in all its a great exercise.
However, it doesn’t seem to be the most enjoyable exercise as many seem to hurt themselves while doing it. So lets try to do em right.
Avoid these common mistakes-
WATCH OUT FOR-
Knees going past the toes
Heel lifting of the floor
WATCH OUT FOR-
Knees going past the inner border of the foot (aka excessive valgus)
INSTEAD TRY THIS-
TRY TO –
Shift your weight back on to your heel with the heel of the front leg flat on the ground.
TRY TO –
Keep your knees aligned over your feet
The above lunge exercises seem to work the anterior chain with the focus on quadriceps (Don’t get me wrong, you are still working all the muscles). As a variation, to get more of my posterior chain muscles (Hamstrings, glutes) or to avoid straining sore knees/quads I like this variation-
Keep at it, do it right and do it often. Until next time
The week ahead is long and there is much to do, its only Tuesday. So we like to keep it short and sweet on #techniquetuesday. Today we discuss the plank. Plank is a great core exercise but often faulty techniques negates the true benefits of the exercise. In my mind, the true purpose of the plank is to engage the core to brace and protect a ‘neutral’ spine. However, I often find when performing a plank that the hold time supersedes good form. There’s a lot of excessive arching, ribs flaring out, more than desired hip flexion, cervical extension etc all for the sake of getting that extra 30 seconds. Here are some example-
Excessive lower back lordosis and cervical Extension
Excessive hip flexion
Try this instead-
Remember, the spine is not perfectly straight so a little ‘natural’ arching is acceptable. A cue I often use is to gently pull the front rib cage down towards the feet, I’m not a big fan of the cue ‘drawing the belly button towards the spine’ because it interferes with normal diaphragmatic breathing (which is important for proper core engagement).
If the plank off the feet/toes is hard, regress it to ‘off the knees’ like this-
As I have mentioned before many times, my masters in exercise science was just what I needed after completing my bachelors in physiotherapy. To over simplify it, It gave me an insight into exercise selection, administration and prescription which was only brushed in my bachelors of physiotherapy program. I believe this was for good reason, the bachelors degree in physiotherapy is focused on rehabilitation. Not as much on improving performance or training otherwise healthy adults. It brushes over it, but not thoroughly enough in my humble opinion. No wonder physios in countries like the US and Canada often go through this path of exercise science/ Kinesiology before entering physio school. I went the other way, but the bottom line is, there was a lot to learn and it is fascinating.
One of the facets of training which I was fairly unfamiliar with was training for speed and agility. Before we proceed, this is what the NSCA describes in its book ‘The essentials of strength training and conditioning’ speed and agility in terms of training-
Speed- the skills and abilities needed to achieve high movement velocities.*
Agility- the skills and abilities needed to explosively change movement velocities or modes.*
Most athletes need these attribute, the ability to get from point A to point B fast, this could be chasing a football/soccer ball, a run up for a fast bowler, sprinting to the finish line etc. Also, the ability to accelerate, change directions, decelerate etc. like in tennis or basketball. The ability to produce force fast in a certain direction would still require baseline/foundation strength. But we must also train for that quick first step in a sprint or that quick change in direction which must be practiced with drills. Just lifting heavy things might not help with that. These drills reinforce the ‘brain-to-muscle’ connection that we often talk about that is learnt with repetition.
One of the common drills I often saw being used by strength coaches as a warm-up or on a low training volume day is ladder drills. Here is a video of one of my colleague performing some basic (not simple) drills on the ladder. She has a track and field background in high school and collage and has practiced these drill many times over the years. Enjoy-
Forward sprint (Variation)-
Lateral In and out’s-
4. Icky Shuffle-
5. Cross behind forward-
I also use some of these drills in our senior population. After all, what is one of the major reasons for falls in seniors with balance issues? I think its one of them is the inability to contract muscles fast enough to prevent a fall. An example would be if they have one of their legs caught in the cable/carpet at home, its the inability to put the other leg forward to prevent a fall. Why not train them to move faster or to be able to maneuver around objects at home with ease. It can also be a great multi-planer cardio-vascular exercise for them. But of course at their own pace, keeping their medical history in mind and keeping these drills simple. There are many more drills and exercises which I will discuss in later blogs. What are some of the drills that you like? Feel free to share.
On #techniquetuesday part duex, we discuss pushups.
In the 1st video you see some of the common mistakes when performing a pushup. Elbows are not close to the body but flaring out, not going deep enough and not going down and coming up as a whole but instead bending and arching from the back which might be indicative of weakness or improper engagement of the core.
2nd video shows corrections for the above along with finding a proper neutral starting position for the pushup
If you are unable to perform a push-up with proper form, regress by doing it off a bench, table or mats as demonstrated in the 3rd video.
4th video is another regression of the pushup off the wall.
The intention of #techniquetuesday is to highlight mistakes and demonstrate corrections for common exercises that I see often. For the very first one, we will discuss everyone’s favourite, the quadriceps stretch and the hip flexor stretch. Here goes-