Elite PT Exercise of the Week – Landmine Front Squat to Press

Joe Heiler PT and Nick Lucius SPT

At Elite Physical Therapy and Sports Performance we’re always looking for new ways to challenge our patients and athletes.  The landmine squat to press is one of those exercises that can be used to really stress the entire system without having to utilize a lot of loading so it fits in nicely in higher level rehab and during the training process.

Reasons to use this squat variation include:

1)  Having the weight in front allows the athlete to sit deeper into the squat with a more upright trunk which is great for those dealing with, or recovering from, low back pain.

2)  Keeping both hands on the bar keeps things more symmetrical with the squatting and pressing movement.  Stability requirements are increased with the use of this exercise but are balanced right to left.

3)  Hold the bar in one hand for an asymmetrical loading pattern.  This will load the body differently demanding greater stability throughout the movement.  This is a more advanced technique so 2 hands on the bar to begin.

Technique:

1)  Do not squat lower than your mobility allows!  The weight in front often allows for a deeper movement but do not let the pelvis tuck under and low back to round out.

2)  Heels must stay flat on the floor.

3)  Elbows between the knees (this keeps the knees wide).

4)  When using the asymmetrical single arm loading pattern, you must keep the body centrally aligned – no shifting, leaning, etc.

Give this one a shot and you’ll see what we mean!

BIO

Nick Lucius PicNick Lucius SPT is completing his final year in the physical therapy program at UM-Flint.  Nick is a certified strength and conditioning specialist (CSCS) through the National Strength and Conditioning Association (NSCA), and also works as a strength coach at Barwis Method in Plymouth, MI.  After graduation Nick plans on returning to Barwis Method to work with patients affected by orthopedic and neurological conditions.

Nick played Linebacker at Grand Valley State University in his undergraduate days, and now enjoys anything active from running to weight training, and is always going through a good book.

 

 

 

 

 

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Go to the Ground to Improve Your Strength and Mobility

Nick Lucius SPT, CSCS

If you were to ask anyone what constitutes someone as “strong,” most would think of the man squatting 800 pounds or the 225 bench press test. While these are great measures of raw strength, they do not paint the full picture of that individual’s ability to move in a dynamic and fluid fashion. Far too often we get stuck on the “big lifts,” including the bench press, squat, deadlift, and countless shoulder/arm workouts. While the classic strength training movements are effective and involve a great degree of motor recruitment, it does not provide a dynamic environment to make mistakes and learn better movement. If you have eight hundred pounds on your back, the room for error is small. If you are un-weighted and performing dynamic movements, a mistake is relatively pain-free and it provides you with ample information to correct the movement.   You have to move wrong in order to find out what is right.

A book I would recommend to anyone looking to improve their quality of training or to challenge their ability to move better is Original Strength by Tim Anderson. In this book he completely re-vamps the standard belief of strength, trading the bench press for rolling patterns and a heavy squat for a crawling progression. This is not to say however that you should not participate in more traditional strengthening movements. If anything these crawling movements will amplify your training, if done responsibly.

Below is a short video describing some basic progressions of the crawling pattern. In the clinic I love to incorporate these movements for patients of all physical impairments. It’s an incredibly challenging movement that can go great as a recovery day during your training week or in combination between your sets of standard lifts. In the video I begin by demonstrating the prone crawl, which will resemble the “army crawl” that some may have done in gym class. Remember how easy it was back then?

The second progression is the forearm bear crawl. Cues I keep in mind while coaching this movement is to keep your forearms at a 45 degree angle to mimic a child crawling and to maintain a slight posterior pelvic tilt throughout the exercise. A posterior pelvic tilt is best described as “tucking your butt”.   This provides a stable thoracic spine and pelvis, improving our quality to complete the movement without too much side-to-side sway.

The final progression is a full crawl. In this movement the goal is to stay as low to the ground as possible while bringing each leg forward. This crawling progression definitely tests your hip mobility and trunk motor control. Once you feel comfortable with a crawling movement forward, begin to incorporate backwards and side crawls. Maintain the same positioning and reverse your movements. This is testing not only mentally, but I can promise you it will challenge you physically.

As with any movement, if you feel any pain or instability it is recommended to consult a Physical Therapist for conservative musculoskeletal care. In the state of Michigan we now have direct access, meaning that you are able to directly seek a Physical Therapist for any musculoskeletal pain/deficit. Check with your insurance provider if your plan covers the direct access Physical Therapy Evaluation and subsequent treatment.

Thank you for reading and Nick Lucius Picgood luck!

BIO

Nick Lucius SPT is completing his final year in the physical therapy program at UM-Flint.  Nick is a certified strength and conditioning specialist (CSCS) through the National Strength and Conditioning Association (NSCA), and also works as a strength coach at Barwis Method in Plymouth, MI.  After graduation Nick plans on returning to Barwis Method to work with patients affected by orthopedic and neurological conditions.

Nick played Linebacker at Grand Valley State University in his undergraduate days, and now enjoys anything active from running to weight training, and is always going through a good book.

 

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Running Performance and Injury Prevention Clinic

Are you a runner? Are you interested in preventing annoying injuries that may sideline you from training? Are you interested in improving your performance? If you answered yes to any of the above questions, the Running Performance and Injury Prevention clinic sponsored by Elite Physical Therapy and Sports Performance, Crystal Lake Clinic, and Running Fit is where you need to be on June, 6th from 9:00am to 12:00 pm!

This clinic will give attendees information on common running injuries, ways to prevent them from happening, and ways to manage injuries while training. This clinic will also give insight on race day performance, proper warm-up techniques, and foot typing to make sure you as an athlete are in the right shoes on and off the course.

This clinic will be split into two sessions. The first half will be a lecture and discussion format while the second half will be divided into break-out sessions to learn by performing.

Everyone is welcome whether you’re a weekend warrior, an avid runner, a coach, or someone looking to begin running. This clinic is for everyone!

Where: Traverse City West High School Practice Gymnasium

When: June 6th, 2015 9:00 am-12:00 pm

Cost: Prepaid: Adult=$10, Students= $5
Door Price: Adult= $15, Students =$10

What to bring: Clothes to exercise in, water bottle, energy, notebook and pen for notes, and your energy!

Speakers/Topics: 

Jake Flynn MD (Crystal Lake Clinic) – Race Day Performance

Scott McKeel SPT (Elite Physical Therapy and Sports Performance) – Common Running Injuries

Joe Heiler MSPT (Elite Physical Therapy and Sports Performance) – Optimizing Movement Quality for Running Performance Enhancement

Victor Sellinger (Running Fit) :  Happy Feet – Foot Wear and Foot Typing

Breakout Sessions:

Dynamic Warm-Up

Self Myofascial Release Techniques

Foot Typing

Adults – use the button below:

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Students – use the button below:

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Barefoot or not Barefoot… That is the Question

Originally posted on SportsRehabExpert.com

Andy Barker PT

Barefoot training has taken off in recent years. Whether in the gym or out on a track or field, the number of people training barefoot has increased. But why? This post will look at the benefits of barefoot training and in addition the importance of foot position when training.

Barefoot training

As the name suggests barefoot training involves wearing no footwear. This could be to lift weights in the gym or indeed used for running training. There has been many a discussion in the training community as to the advantages and disadvantages of such training, although there isn’t much decent clinical evidence on whether this type of training is beneficial or not.

Why use barefoot training?

Having bare feet ultimately is going to give you and your body a heightened level of body awareness due to increased contact with the floor. This can be
advantageous in many ways especially in drills involving foot and ankle mobility
and stability. A great example would be the use of an ankle mobilisation. I would always conduct such exercises involving the foot and ankle in a barefoot state.

Stick Ankle Mobilization

I like conducting such drills like this as you can feel the movement better in this position and in addition, if I was teaching such a movement I can actual see and feel what is happening which might not be as apparent in a training shoe.

I also at times like athletes and clients to lift, i.e. squat and deadlift variations in barefeet. In addition to the reasons mentioned above, for some, being in a barefoot position enables the foot to generate more torque and have a greater influence on knee and hip position during lower limb movement.

For example, in a barefoot stance an athlete is more easily able to generate a
lateral directed force from the foot into the ground prior to a squat. This can be cued by asking the athlete to try turn the feet outwards without the feet actually moving. That torque created enables stiffness through the foot and ankle creating a stable platform to lift and in addition pull the foot out of a position of pronation. This cue has been particularly useful for those athletes that excessively pronate. Getting out of excessive pronation also benefits the knee and hip by preventing possible knee valgus and hip internal rotation stress respectively which are detrimental to knee and hip health and movement quality.

Tripod stance

Regardless of what lift or activity that is being produced, be it a squat, deadlift or running the aim is generally to gain a neutral foot position. Having equal amounts of weight distribution between to foot is key to being able to create a stable foot position or ‘tripod stance.’

A successful tripod stance position would involve equal distribution of weight
between the three points of;

  • Base 5th metatarsal
  • Calcaneus
  • Base 1st metatarsal

If weight can be distributed evenly between these three points then the foot is
likely to favour a neutral foot position and in addition will provide a stable
platform for movement.

Tripod Foot Position

Therefore in my opinion the reason for opting to go barefoot or not isn’t the
main issue. The question is with what footwear type or barefoot style
stance will enable you to get into a neutral foot position or tripod stance. This will differ between individuals.

Getting that tripod stance is the key. As a result it doesn’t really matter what’s on your feet if anything as long as we maximise and make use of a good solid foot and ankle position for movement.

Examples

The type of activity the person is partaking will be a major determinant of
what to use in addition to the ability to gain a stable foot and ankle position to carry out such an activity.

To use myself as an example of three different activities in with I will alter what I wear on my feet. The activities include:

1. Squatting in the gym</br>
2. General wear (at work, walking, and general daily activities)</br>
3. Road running

#1

Regarding squatting in the gym I lift barefoot. The reason for doing this is that I feel that I can use the floor and my foot position to gain a strong stable base of support prior to lifting. I am able to feel the floor and use it to my advantage. By almost screwing my feet into external rotation, without actually moving my feet, I can generate torque through the floor, bringing my feet out of a position of relative pronation and thus at the same time preventing knee valgus and hip internal rotation. In addition, I feel I can sit through my hips better and in doing so I am in a stronger position and as a result can shift more weight.

#2

Conversely, I tend to wear barefoot training shoes for general activites throughout the day. I have a pathological right ankle which needs regular rehab predominately through ankle mobility drills. I have found that wearing a barefoot training shoe has enabled me to maintain my ankle range of movement in comparison to before I started wearing barefoot style shoes. This is ultimately because I am using/maximising the range at my ankles even during everyday activites and thus complements my ankle mobility rehab.

#3

Finally, for road running, I feel more comfortable in a neutral training/running shoe as opposed to a barefoot shoe. I feel as though the additional support and cushioning of the shoe provides a better and more comfortable run and therefore I use such a shoe to run. In theory a barefoot shoe might seem more advantageous given my ankle pathology however this has not proved to be in case in my example.

Conclusion

To bring it all together, using I as an example, it is clear that different
activities require different footwear types. As athletes, weekend warriors or
practitioners we should be aware of the fact that differing activities require
different provisions and going one way or the other, being anti-barefoot or pro-barefoot, is maybe not the way to do it. Maybe being aware that different
circumstances require different training equipment is the way to go and adapting
our approach in that way.

Hope this has been of interest. Any questions just post them in the discussion forum.

Thanks for reading

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 please click the link:  http://www.rehabroom.co.uk

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Exercise of the Week – Single Leg Row

At Elite Physical Therapy and Sports Performance in Traverse City we are always pushing to find new ways to challenge our patients and athletes especially when recovering from an injury or surgery.

So to follow up on last week’s EOW post, the single leg row is another option to bring the lower quarter into play, along with core control, to a traditional upper body exercise.

 

Couple examples of where I would use this type of movement:

1) Athlete with a lower quarter injury, i.e. ACL reconstruction, to integrate balance and hip/trunk motor control with a traditional upper body exercise.

2)  Athlete with a shoulder injury/surgery not allowed to fully load the shoulder, can only do so much weight with an activity like this but still get some good work due to the overall demands on the body.  I’m sure there are many athletes that could easily barbell row 3-4x what they could single arm row.

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Exercise of the Week – Single Leg Overhead Press

Finding new ways to unload an athlete but still get in a good amount of work is always a challenge.  Finding lifts the athlete can do in a single leg stance position would be one way to do that.

I’m not claiming that I’m going to create any monsters (as Charlie Weingroff would say) with lighter weights here, but I am looking for ways to incorporate an injured limb with increased demands for trunk control and an expression of upper body strength.  This is a great way to bridge the gap in rehab back to the weight room.  It can also be a great way to unload an athlete from time to time to prevent over training.

Check out the video below for tips and progressions of the single leg overhead press:

 

Couple prerequisites:

  • full shoulder range of motion – you should be able to lie on your back with knees bent, low back flat on the floor, and arms should lie flat on the floor overhead.
  • hold single leg balance with a level pelvis 20-30 seconds statically
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2015 Sports Rehab to Sports Performance Teleseminar

In addition to owning Elite Physical Therapy and Sports Performance, I’ve also had the blessing to run the sports physical therapy website SportsRehabExpert.com.

It’s a site for physical therapists, chiropractors, strength coaches and others in those industries to learn from some of the best in the business.  Every year I run a teleseminar series where I interview 10 of the best clinicians and strength coaches in the world, and then post those interviews online for free.  A number of these interviews may appeal to you readers of this blog whether you are in the health care or training industries or not.

Here is this year’s list of speakers and topics:

Charlie Weingroff – Motor skill acquisition and long term athletic development, movement competency, and high performance programs

Donald Chu – The foremost authority on plyometric training discusses potential benefits, progressions, injury prevention, and more

Derek Hansen – Speed development qualities, hamstring injury mechanics and running rehab, front side vs. back side mechanics

Mike Cantrell – Exploring the mechanics behind sports hernia, FAI, and shoulder impingement through the PRI lens.

Rob Panariello – Single limb vs. bilateral training, Olympic lifts during performance training and rehab

Phil Plisky – Injury risk/prevention research, the state of current prevention programs, UE stability testing, and what’s new with the SFMA.

Gary Gray – Applied Functional Science (AFS) and it’s principles, functional soft tissue transformation, and functional movement screening systems

Linda Joy Lee – Thoracic Rings Approach and the Integrated Systems Model, finding the meaningful task and primary driver

Sarah MottramKinetic Control system, understanding the biomechanics of normal and abnormal function, and motor control retraining of uncontrolled movement

Chris and Jennifer Poulin – PRI principles in sports performance and injury prevention programs

Some of the topics can get quite complex but I’m sure there are certain interviews that will interest you whether you’re looking to get faster, stronger, or just get healthy!

The link to the sign up page is here:  http://www.sportsrehabexpert.com/public/982.cfm.  You’ll also find a more detailed explanation of each topic plus more info on each speaker.

Check it out and I’m sure you’ll pick up some tips that will bring you closer to your goals.

Joe Heiler PT

joe@elitepttc.com

 

 

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Band Walks and Hip Strengthening

Band walks (a.ka. Monster Walks) are a physical therapy staple for hip strengthening, and are often used with patients who have had knee injuries or are suffering from back and/or hip pain.

It has been shown in the research that weakness of the glute muscles of the hip can be a direct cause of poor alignment through the lower extremities creating problems such as patellofemoral pain (anterior knee pain) and also putting one at higher risk for ACL injury.

Weakness through the hips is also proposed to be a cause of lower back pain since one is using the hip inefficiently to stand up, squat, lift, etc then the tendency is to overuse the lower back muscles to perform these tasks.

So strengthening the hip muscles sounds like a great idea right?

It can be when done correctly.  In the video below I demonstrate the wrong way to perform these exercises along with some simple corrections (the corrections may look simple, but they make the exercise much more difficult – and effective).

Hopefully you noticed that I talked about the importance of the trunk remaining stable throughout the exercise.  Only through stabilizing the trunk can the hip truly generate efficient force.  This is the most common mistake made, and in my opinion, makes the exercise a complete waste of time.

Give it a shot and let me know if you have any questions.

Joe@elitepttc.com

 

 

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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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