Shoulder Pain Prevention – Should You Even Be Lifting Overhead?

This article was originally posted on SportsRehabExpert.com by Andy Barker – head physiotherapist for Leeds Rhinos Rugby team in the U.K. This article is about preventing shoulder pain, but also would fit right in with our series on preventing back pain.  Cheating with the spine to create more shoulder mobility is a great way to get hurt. 

In this article, Andy shows a great way to assess shoulder mobility with the spine locked out of the equation.  Enjoy!

by Andy Barker PT

A great quick and easy test to use to clear overhead lifting in rehab/training. Begin seated on the floor, tuck your thumb into your hand, keeping your elbows straight and lower back and head against the wall take your arms overhead to touch the wall behind you.

From this video you can clearly see the subject is able to touch the wall whilst being able to keep the head and lower back in contact with the wall. As a result this would constitute a pass and as a result the subject would be cleared to lift overhead in the gym.

A fail would include inability to touch the wall overhead and/or any visible compensation (usually lumbar extension) needed to allow increased shoulder flexion to occur.

 

I wrote a similar article on wall posture shoulder mobility exercises here:  http://elitepttc.com/blog/?p=362.  These are standing exercises meant to address deficiencies in the test above, but they may be a challenge to start with.  Probably should use a supine version like the one below first.  Once your arms hit the floor with good spinal control, then move to the standing versions. 

 

 

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The Bird Dog – A Core Stability Classic

The ‘bird dog‘ exercise is a core stability classic in the physical therapy world, and is certainly a favorite of ours here at Elite Physical Therapy.

That being said I see this exercise done incorrectly more often than not.

The whole idea behind core stability is to resist unwanted movement through the pelvis and spine when moving through the hips and shoulders.  Watching most therapists, and even yoga and pilates instructors, teach this exercise you would think just the opposite.  Check out the video below to see the exercise performed incorrectly (first 3 reps) and then done correctly (next 3 reps).

When performed incorrectly you can see how much movement is occurring through the lumbar spine.  Many folks are stuck in excessive lumbar lordosis (too much inward curvature) which can become painful especially with prolonged standing and walking.  A majority of the athletes I work with, including the dancers and gymnasts, would fall in this category as well.  Going into even more lordosis is only going exacerbate the issue.

As you can see when performed correctly, nothing moves through the pelvis and spine.  It’s only my shoulders and hips.  Performing a bit of a posterior pelvic tilt (think tucking the tailbone) will bring the person out of the excessive lordosis and help to stabilize the trunk.  Also notice there is much less excursion with the upper and lower extremities.  There is no way you can lift the arms and legs as high as in the first example and maintain any type of stability.

There are times however that a bit of lumbar lordosis (arch) may be necessary to maintain throughout the exercise.  Sometimes this is just the more comfortable position to be in.  If that’s the case then that is going to be the appropriate position for your body.

To learn to stabilize in this position, using a water bottle either across or along the spine is a nice trick (the latter being the more challenging).  Focusing on keeping the water bottle from rolling off your back will reflexively fire more muscles and with the correct timing to keep your spine and pelvis stable.

Adding a resistance band would be a higher level challenge. Do not attempt to add resistance until you are able to control your body weight.

Give the bird dog a try yourself and see how much more challenging it can be when you actually stabilize the core!

If you have any questions, contact me at joe@elitepttc.com or at 231 421-5805.

 

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Taping for Plantarfascitis/Foot Pain

In this blog post I wanted to discuss the benefits of taping, specifically a technique known as ‘low dye’ taping, for relieving foot and heel pain while allowing the soft tissues of the foot time to heal. This is a technique we commonly use here at Elite Physical Therapy.

Plantarfascitis is the common term for the pain in the arch of the foot or even in the heel.  It’s usually worse during walking or running – activities that really stretch that tissue on the bottom of the foot.

Our treatment model for plantarfascitis includes:

  • soft tissue work using Graston Technique to the plantarfascia, as well as to the muscles of the foot and calf to promote healing and greater extensibility of the tissues.
  • low dye taping to support the foot in weight bearing and to allow for tissue healing.
  • therapeutic exercise to increase mobility through the foot, ankle, and calf, as well as strengthening for the musculature of the lower leg.
  • corrective exercise to address movement dysfunction or lack of stability further up the chain including the hips and trunk.  The underlying reason for your foot pain is often found here!

Orthotics can be an important piece to the puzzle here as well, but they are quite expensive and not always a slam dunk to work.  A successful trial of low dye taping along with physical therapy is either going to eliminate the patient’s pain to the point that orthotics are not really necessary, or it’s going to relieve the symptoms enough that I feel more confident recommending orthotics as a more permanent solution.

Check out the video below to see how we do it here at Elite Physical Therapy.  If you have experienced these types of symptoms and they just won’t resolve, feel free to contact me to see if physical therapy would be an appropriate intervention.

I also shot a video demonstration of using Graston Technique to treat the foot a few weeks back.  You can find that video here:  http://elitepttc.com/blog/?p=415

 

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Video Introduction to Functional Dry Needling

Functional Dry Needling can be used to target and treat trigger points in almost any muscle of the body.  The benefits are a decrease in pain, improved tissue extensibility (flexibility), and improved function (i.e. getting you back to doing what you want to do most).

Check out the video for a brief explanation of Functional Dry Needling plus see how I would use it to treat the upper trapezius muscle.  This muscle can be a contributor to neck and shoulder pain as well as headaches, but responds very well to the technique.

Questions?  joe@elitepttc.com

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Graston Technique and Plantarfasciosis

I can’t believe it’s taken me 3 years to think of this but I decided it would be helpful to shoot an educational video about Graston Technique and how we use it here at Elite Physical Therapy.  More and more doctors in this area are recommending Graston Technique specifically, but often the patient has no idea what it is.  Hopefully this video will help to explain.

I also show a quick demo of how I would treat plantarfasciosis (the chronic equivalent of the more popular term plantarfascitis).  I’ll be posting more examples of how we use Graston Technique, but for now this is one of the more common areas we treat.

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Back Pain Prevention – The Glute-Ham Raise

Low back pain is a huge part of what we treat at Elite Physical Therapy and Sports Performance.  Even folks coming in for treatment with knee replacement or shoulder pain (just a couple examples), will often complain of pain and tightness in their low back as well.   Dysfunction and pain in the lower back can certainly contribute and cause problems in other areas of the body.

This is article #2 in a series of articles written by Andy Barker (SportsRehabExpert.com contributor) and myself that discuss how to spare your lower back during the performance of popular strength training exercises.  Hopefully you’ll find some good tips to keep that spine healthy all the while making great gains with your training.

Enjoy and if you have any questions feel free to email me:  joe@elitepttc.com

by Joe Heiler PT, CSCS

originally published on SportsRehabExpert.com

The glute-ham raise has always been one of my favorite exercises, but what I’ve realized is that most people are going to rely too much on their spinal erectors to complete the movement at the expense of the glutes and hamstrings. Over the past couple summers I’ve worked with numerous athletes with sore backs from performing this movement, or they just felt this movement was supposed to work their backs because this is where they feel it the most.

It’s called a glute-ham raise for a reason so finding a way to lock out the lumbar spine is critical. Performing a bit of a posterior pelvic tilt will allow the athlete to ‘lock the ribs to the pelvis’ on the front side, and then place all the emphasis on the glutes and hamstrings as in the video below.

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Training to Prevent Low Back Pain – Feet Raised Bench Press

Low back pain is a huge part of what we treat at Elite Physical Therapy and Sports Performance.  Even folks coming in for treatment with knee replacement or shoulder pain (just a couple examples), will often complain of pain and tightness in their low back as well.   Dysfunction and pain in the lower back can certainly contribute and cause problems in other areas of the body.

In the coming weeks I’ll be posting a series of articles written by Andy Barker (SportsRehabExpert.com contributor) and myself that discuss how to spare your lower back during the performance of popular strength training exercises.  Hopefully you’ll find some good tips to keep that spine healthy all the while making great gains with your training.

Enjoy and if you have any questions feel free to email me:  joe@elitepttc.com

 

by Andy Barker PT

originally posted at SportsRehabExpert.com

I think we do a great job at cueing and coaching good pelvic position when using standing based gym exercises.  Equally, cueing the same position in supine in an unloaded state we also get it right.

However, when adding load to supine based exercises good pelvic form is often lost.

A great example of this is the bench press. Often when the load goes up so does load through the back as compensatory lumbar extension assists the lift. This is especially so when the feet are placed on the floor either side of the bench.

One easy way to reduce the effects of possible lumbar compensatory extension is to raise the feet to put the pelvis into posterior tilt and hence out of lumbar extension. This is shown in the video below:

Feet Raised Bench Press

One potential problem with the above technique is that athletes may feel less steady with the feet not placed on the floor and hence unable to shift as much load. This might be particular so the wider the athlete and/or the narrower the bench used.

As a result an alternative way to increase support whilst also raising the feet is using plyo boxes to act as foot platforms. Using the boxes allows athletes to push into the floor, via the boxes, as they would in a standard bench press, although in a much better pelvic position. This is shown in the video below:

Feet raised bench press (plyo boxes)

Have a blast and let me know what you think

BIO

Andy is the current head physiotherapist for the Leeds Rhinos first team squad and has been involved with the club for the past six seasons.

He graduated in Physiotherapy from the University of Bradford with a first class honours degree which followed on from a previous Bachelor of Science degree from Leeds Metropolitan University in Sports Performance Coaching.

Andy currently works privately in addition to his sporting work and has also previous experience within National League basketball and professional golf.

Andy has a keen interest in injury prevention and the biomechanics of movement in which he is continuing his studies with the start of a MSc degree later this year in Sports and Exercise Biomechanics.

Andy is also the creator and author of rehabroom.co.uk. RehabRoom is a free online rehab resource site aimed at but not exclusive to physiotherapists, strength and conditioning coaches and personal trainers. To visit the site, click here:  www.rehabroom.co.uk

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CrossFit and Injury Prevention

I recently interviewed Todd Nief, a CrossFit coach from SouthLoop Strength and Conditioning in Chicago.  It’s posted over at SportsRehabExpert.com on a free page here:  http://www.sportsrehabexpert.com/public/931.cfm?sd=2.  If you’re into CrossFit, or even just thinking about it, you’ll definitely pick up some good tips from Todd.

Teaching the Olympic Lifts, power lifts like the squat and deadlift, and kettlebell lifts are some of the things I enjoy the most about my job.  Unfortunately I also see a lot of athletes, and adults, that get injured performing them. I don’t know that most people understand how complex these lifts can be, and how easily things can go wrong.

Power Clean Start Position

So whether you want to incorporate these lifts into your program, or need to recover from injury and get back into hard training, there is no better place to go than Elite Physical Therapy and Sports Performance.

Learn to do these movement correctly and you’ll see some great results!

 

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Functional Dry Needling for Low Back Pain

Functional Dry Needling has been a great addition to my manual therapy ‘tool box’ especially for those with low back pain.  Recently, Nelson Min PT from Kinetacore (the group that trained me) wrote a short article on using dry needling for patients with spinal stenosis.

Spinal stenosis is one of the most common causes of low back pain in folks 50+ years of age.  The most common presentation is pain with standing and walking that is relieved with sitting down, forward bending, or lying down.

So here is Nelson’s article on Functional Dry Needling and the treatment of Spinal Stenosis:

“I listen for several things when evaluating a new patient with low back pain.  I take particular interest when my patient informs me that their pain increases with prolonged standing or walking versus pain that increases with prolonged sitting.  An older patient that tells me that their back pain increases with prolonged standing and walking, and is then relieved immediately with sitting, makes me suspect stenosis.  For someone younger, I am suspicious of spondylosis or some other instability.  I would confirm this with my biomechanical exam but this little detail in the patient’s history often steers me in the right direction.”

Listen to your patient — he is telling you the diagnosis.  – William Osler MD

To continue reading, head on over to Kinetacore.com

If you have questions on Functional Dry Needling or the treatment of back pain, feel free to email joe@elitepttc.com or call me at 231 421-5805231 421-5805

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Elite Physical Therapy Exercise of the Week – Standing Trunk Rotation for Golfers

Originally posted on SportsRehabExpert.com

It’s that time of year when we’re all going to start seeing more golfers coming in with injuries. The standing thoracic rotation assessment is one I picked up from TPI a few years ago, and what I’ve found is that is often a difficult pattern for many golfers to manage. This main objective of this movement is to look at the golfer’s ability to separate the trunk and hips, but what is often overlooked is the ability of the golfer to maintain cervical stability with trunk rotation.

The golfer is to assume a 5 iron posture – pretend you have a five iron addressing the ball – cross the arms over the chest, and then rotate the trunk as far as possible in each direction while stabilizing the pelvis and hips. There is no set ROM requirement in the assessment as it meant to look at the ability to stabilize and separate the upper and lower body, but I’d still like to see at least 45 degrees of rotation in each direction.

The other big thing to look at here is the ability of the golfer to keep his head down on the ball. This requires a significant amount of cervical spine rotation as the trunk moves ‘under’ the neck. As you can probably see in the video, its quite a chore for me to maintain this posture.

Obviously the qualities will improve the mechanics of the golf swing and contribute to more consistent accuracy. An inability to maintain optimal posture and control throughout the swing will not only be detrimental to the swing but can also create undo stress on the cervical spine, shoulders, and lumber spine.

Assessing cervical ROM and stability is crucial but often overlooked in this population, and it seems like I end up treating a few of these folks every summer. Establishing full ROM is the first step and then working motor control back into rotational patterns at lower postures is a prerequisite.

Poor trunk rotation mobility and motor control can also take it’s toll on the shoulders. The shoulders can be forced into excessive ranges of motion during the back swing and follow through, and over time can lead to injury here as well.

I recently assessed a high school golfer with bilateral congenital shoulder instability who was having shoulder pain during his swing. He was mobile as could be through his spine but was lacking proper control in standing thereby over reaching through the shoulders. Improving control in this standing patten went a long way toward eliminating his pain during the golf swing.

Standing trunk rotation with pelvic stabilization can be a great assessment for your golfers, as well as other rotational athletes, and can also be used as a corrective or warm-up activity.

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