There are a few things in life that everyone knows to be true. We all have to pay taxes, we all will die one day and if you have poor extension in your upper back you will have a poor overhead position. Maybe the third one isn’t quite as obvious as the first two but it’s absolutely true!
Why is it that your upper back causes so many problems for the shoulder? That answer is very complex and for the sake of you borderline ADHD people like myself, I’ll keep this to one simple concept, scapular tilting.
Scapular tilting occurs anytime that we raise or lower our arm in front of us. In the picture below you can see the the shoulder blade of the person on the right is tilted forward more than the person on the left. This forward tilt is called anterior tilting of the shoulder blade. Anterior tilting is a problem because it creates a bone block as the arm raises overhead. You can’t push through this and force it into a better overhead position.
We can see in the person on the left in the same picture that the shoulder blade is now perpendicular with the ground. This is a good thing and called posterior tilting of the scapula. We need to get the shoulder blade into this position in order to achieve a full overhead position. This posterior tilt of the shoulder blade is primarily allowed by our upper back's ability to extend or flatten out. This is why people that have rounded or what we call kyphotic upper backs have a very difficult time with achieving a fully locked out overhead position.
So how do we get that thoracic spine to flatten out and allow the shoulder blade to tilt posterior? It's not easy if you have lost a ton of mobility, but here's a simple two-step process to start improving this movement.
1. Get the hell out of your chair!
If you sit for a long period of time everyday, chances are you have really poor mobility in your upper back. Get a standing desk or put your chair on your desk and force yourself to get out of that position. If you sit for 8 hours with a rounded upper back and think 5 minutes of mobility work will negate that, you're completely wrong.
2. Work on mobilizing to improve thoracic extension.
This is the hard part. You have to chip away at this problem daily if you have a significant loss in mobility. The good news is there's a ton of great video content out from my boy, Kelly Starrett on improving upper back mobility. Here's a great video to give you a better idea of what types of mobility techniques you need to add in to your training.
Good luck and leave us a comment if you have any questions.
“Price is what you pay, value is what you get.” Warren Buffett
I’ve written on this topic a bit recently. If you haven’t read part one check it out here. (Link is currently inactive; our apologizes. We're working to fix this.)
I feel the perception of cash based physical therapy is a bit skewed. The overwhelming sentiment from people I meet is that cash based PT is only for the super rich. That actually couldn’t be further from the truth. In fact, I see more teachers and students then CEOs, lawyers and doctors. Why is it that students and teachers think going the cash based route is better? They base their decision off value, not price.
Let’s do another cost/value comparison like we did in part 1.
I recently had a client come to Atlanta clinic that had a subacute neck injury. She aggravated it doing power cleans and had already seen two different physical therapists. The injury occurred 7 weeks ago and she had been to a total of 6 PT visits. Her copay is $70 per visit. This is on the high side of copays for physical therapy as most are between $20-70 per visit. She’s already paid $420 for physical therapy and states about 20% decrease in symptoms when I saw her.
So far I have only seen her once and we will only need a second visit to look at her power clean technique(because this is how she hurt herself to begin with). On evaluation she demonstrated what’s called a facet joint sprain. Basically she sprained a joint in her neck and it can be very painful/restricting. We used a variation of what’s called a mobilization with movement. In 10 minutes we were able to get full range of motion back with 75% reduction in pain. The rest of the visit we worked on improving the movement of the joints in the neck and then went over her homework which was a variation of this video post.
Let’s do the actual math. She paid $420 for 6 PT visits and got a 20% reduction in symptoms over a course of 6 weeks. We will see her 2 visits for a total of $350. She got a 75% reduction in symptoms and full range of motion back. Not only that she has the knowledge to maintain and continue to improve her neck.
Is cash based physical therapy really more expensive? In this case no. Also, I don’t want to give off the impression that all physical therapy clinics that take insurance suck. That’s not the case at all. Here’s my main point. If a physical therapist with the same skill set, knowledge and training get’s 2-3 times more hands on time with a patient they will get better faster. That’s the beauty of the cash based model. It’s just one on one with a physical therapist. If you want to get better as fast a possible, cash based is the way to go.
-Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.