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So you made the switch to a standing desk. Congratulations, you are on your way to breaking free from the ball and chain that is your computer chair. Here's a scenario I often hear from the clients I get to switch to a standing desk. It's day one at their standing desk and the client is feeling great. Finally liberated from their chair and ready to reclaim their athletic prowess! After an hour their knee starts to ache a little bit but no worries, the body has to adjust right. After the second hour their back starts to ache a little bit. No problem, it's not as bad as sitting all day. By hour four they're leaning against their desk as if they just finished a marathon trying to off load as much body weight as possible on to their new desk. No worries guys, there are some simple fixes to help you with your transition to a standing desk. Here's the deal people. Standing desks are awesome, but you also have to understand that standing is a skill! This second part to our standing desk series goes over how to stand at your desk and techniques to be comfortable standing all day long. If you haven't seen part one, check it out. Also, keep your an eye out for Kelly's new book Deskbound! It's going to cover a ton of strategies to help keep your body healthy while you spend all day in your wonderful cubicle. Dr. Danny, PT, DPT
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Since “retiring” from volleyball, my fitness regimen now consists of weightlifting, rowing, body weight movements, running (let’s call it casual jogging), and so on. What are all of these movements missing? Rotation! I have become very strong in the sagittal plane—cleans, jerks, rowing, squatting, pull-ups. No wonder when I play a pick-up game, I am sore as all get out! This one goes out to those athletes who continue to be competitive in overhead rotational sports. Tennis players, softball-baseball-volleyballers, I’m looking at you! You guys hang out in the transverse plane a lot so this is where you need strength and control. This is why shoulder and spinal rotation is so vital for power and longevity in your sport and how to begin to maximize your performance. The Anatomy of Rotation Rotation in the thoracic spine is normally about 35 degrees but can be difficult to differentiate from lumbar rotation. However, the bony structure of the lumbar vertebra allow much less rotation than thoracic vertebra so we will focus there. The two major anterior rotators are the external and internal obliques. The external oblique (EO) attaches to the last 6-7 ribs, to the upper fibers of the serratus anterior and lateral fibers of the latissimus dorsi (on the right in picture). Due to these connections, you see how rotation strength would also affect shoulder stability. It acts to cause contralateral rotation; so the left EO turns your trunk to the right. The internal oblique (IO) acts to rotate the torso ipsilaterally, or to the same side (on the left in picture).  Another muscle group that we cannot forget about is the multifidi. These small muscles live on the posterior vertebra and have short connections at each level. Rather than acting as a strength muscle that creates movement, they are stability muscles that control rotation. So as my torso rotates left, my right side fires more than my left to control the amount of rotation allowed.  Training these muscles for strength and motor control are important to maximize power through rotation and decrease the rotational load on the lumbar spine. Rotation at your hips, trunk and then arm are the secret to a powerful throw/swing and minimize damage at these joints. If your thoracic spine is not mobile, the hips and shoulders will take the brunt of the force. This often results in early rotator cuff damage and impingement as well as issues up and down the kinetic chain in the elbow, back, hips and knees. Spinal mobility and strength is the foundation of overhead sports. Check your thoracic mobility: kneel on the floor, hands and knees. Put one arm behind your head and then rotate your shoulder and torso on that side up toward the ceiling. How far do you get? For an overhead athlete, it would be ideal that you elbow and shoulder could be straight up. Be sure not to just crank your elbow back, its more about the thoracic spine and shoulder position!  “Wow, people can really rotate in this position?”--if that’s you, then it’s time to begin some thoracic mobility work! Check these out: Better Upper Back mobility: This one is great for those who sit the majority of the day or who tend to have poor posture (that should have covered 98% of us!) All you need is a double lacrosse ball or Yoga Tune Up balls like those that Danny has in the video. The thoracic rotation mobility drill is great to perform as part of a warmup. Beginning in position A, take a deep breath and open up the shoulders, lowering the top shoulder down towards the floor to reach position B. On exhalation, try to sink further into the stretch. Stay there for about 5 seconds then back to A. Move through this with your breath 10 times in each direction. “That was easy!”—if you said this then let’s focus on your strength and control. Try these versions a Pallof Press. This exercise as described in the video is great for anti-rotation. The picture depicts another form that works on anti-extension. Just be sure that when you move your arms overhead, your ribs remain stacked above your pelvis. We want to avoid overextension of the back and the ribs poking forward. What I mean by “anti-“ exercises is that you are resisting the band tension that is trying to pull you into rotation and extension, thus working the muscles we highlighted earlier. As I mentioned before, thoracic mobility and torso strength are just the beginning to a successful and long career as an overhead athlete. Hip complex rotation and shoulder rotation will be highlighted in later posts! But for now, it all starts here! All of this overhead sport talk has me missing volleyball. So for that, here’s a #ThrowbackThursday.  Thanks for reading!
Dr. Jackie, PT, DPT In the words of Jay-Z, “I’ve got 99 problems but wrist pain ain’t one.” Well, maybe those aren’t his exact words but since I’m actively giving up using profanity (which is very hard to do) we’ll keep this quote the way it is. We know that Jay-Z doesn’t have wrist pain but in the last CrossFit Movement and Mobility Trainer Course I taught, about half of the class had wrist issues. Usually when I informally poll the class to see what problems most people are having, back pain comes up number one. This weekend wasn’t any different until the Sunday course. Wrist issues were a plague for this group, predominately in the front rack position. So we spent a ton of time working on the wrists right? Wrong. We fixed their shoulders! How many of you have seen big strong guys/gals that can back squat a ton of weight but when you get them to front squat their weight drastically decreases? These are typically males that used to love bro'ing out at some globe gym where everyday is bench press day. They are pretty strong but have never put in some legitimate mobility work in their lives. Don't be this freaking guy! Let’s be clear on one thing: There are many reasons for why someone could have a very weak front squat compared to their back squat. In this example, however, we are going to focus on improving the front rack position and unloading the wrist. The higher you can keep your elbows during the entire range of motion of a front squat, the easier that movement will be. High elbows also allow for the wrist to be unloaded during the lift. How do we get those nice high elbows? By having enough shoulder flexion and lateral rotation. In coaching terms this allows us to keep our arms parallel with the ground and maintain a strong front rack position. There are multiple problems that occur when the elbows start to drop in the front rack. It’s a huge loss of force production potential but also puts the poor wrists in a terrible position.  A combination of these two movements at the shoulder makes up the front rack position. Here’s a quick test. Un-rack a decent amount of weight (75-90% of your 1RM front squat) and hold it in your front rack position like the example in the top section of the picture below. See how your wrists feel and see if you can hold it for 30-45 seconds. Now do the same test but hold the weight in the position like the athlete in the bottom of the picture below. No wrist wraps allowed! Which one were you able to hold longer? Which one felt more comfortable? For the majority of athletes the first position will feel dramatically easier when holding the load. If you have terrible front rack mobility you will always end up in some variation of the dreaded lowered elbow position. This is wrecking havoc on your wrists and costing you PRs. If your wrists hurt, fix your shoulders! Now how do we fix the shoulders? Here is an old school (2011) MWOD video of Kelly going over fixing the front rack position. If you haven’t checked out Mwod recently, you really need to. MWOD Pro is only $8 a month and has new mobility techniques to help improve your performance and resolve pain everyday. That’s about the cost of two lattes! In the words of Kelly himself, “make a better decision.” Take a crack at fixing this stuff yourself first! If you're still having issues, come and see us at Athletes' Potential! If you don't live in the Atlanta area, check out this out the 4 Keys To Picking The Right Physical Therapist in your area. - Danny, PT, DPT, OCS, CSCS Many people are willing to go the extra step to increase their efficiency and function when it comes to their sport: the latest and greatest running shoes, wrist wraps and weight belts to hit a PR or a personal trainer for the extra push. What if we could improve our function and decrease pain for free? I think I would have your attention. As we spend hours each week training, two very important muscle groups are ignored: the diaphragm and the pelvic floor. It is not for lack of use; every time you take a breath the diaphragm contracts and lowers to help fill your lungs. The pelvic floor works double time; these muscles are firing like crazy to keep you stabilized with each breath and during movements. If they work all day long, they should be strong - right? Not always the case. The “core”: Often times the “core” and “abs” are used interchangeably. The abdominal muscles that you see in a six pack are just the most superficial muscles of the core. The deep core is comprised of the diaphragm, pelvic floor, transverse abdominis and multifidi. These four muscles make up the “canister” of the inner core. As you see in the picture below, the glottis is also included in this as it has direct function with the diaphragm, and thus the pelvic floor. The transverse abdominis is a deep core muscle that is often referred to as a corset. It attaches to your pelvis and lower ribs and even has connections to the diaphragm through fascia. The multifidi are small back muscles that attach your vertebra and also connect to the pelvis at the lower levels. See how it is all connected? It is important to keep in mind that these are endurance muscles.  The diaphragm is the second largest muscle in the body! It attaches from the chest bone, to the ribs and down to the upper three lumbar vertebra. The pelvic floor is a group of smaller muscles that act as a hammock in the bottom on the pelvis. They attach from the sacrum to the inner ring of the pelvis. The diaphragm and pelvic floor have an intimate relationship of synergy during breathing. With inhalation, the diaphragm draws down and the pelvic floor drops simultaneously. It is essential that they have the endurance to move with each breath, but the pelvic floor must also have the strength to withhold increases in intraabdominal pressure. When the diaphragm and pelvic floor are stacked one on top of the other, you are able to more efficiently breathe and manage the pressure in your core. This is best achieved through optimal posture. When you are unable to manage the pressure, it will push towards the weakest area: often the pelvic floor. This leads to stress urinary incontinence, or peeing during jumping, running, laughing, sneezing, etc. This can be exacerbated by poor postures. Can you imagine how each of these poor postures affects your canister? Both sway back and increased lordosis move the core out of the optimal stacked position. Thoracic kyphosis, rounded upper back, puts your diaphragm in a shortened position, thus making it less efficient. Breaking or bending the canister is easily identifiable in poor overhead lifts and poor running form. The picture below shows that with a poor finish overhead, her diaphragm and pelvis are no longer stacked. This affects her breathing efficiency, the internal pressure and work of the pelvic floor. Not to mention, this puts her big movers, specifically the lats, at a disadvantage and can cause back pain. You have probably also observed runners moving their core out of the optimal position. Those who run bent over at the waist or those who lean their torso back as if running downhill are essentially bending the canister. When you lift something, the deep back and abdominal muscles will contract for stabilization and the pelvic floor should slightly lift to help secure the lower abdominal organs. However, if you hold your breath and bear down, the pressure pushes the pelvic floor down. This can make you more susceptible to leaking or pelvic pain. So I should never hold my breath? No, you absolutely must hold your breath or brace with certain athletic movements. Especially lifting heavy weights! How to Brace: Bracing or breath-holding is common for many athletes. Learning how to properly brace will ensure success in the movement and the proper distribution of tension throughout the body. Many times, tension is increased but only in the superior and inferior directions, or up and down. Remember the picture above: this means that the diaphragm and the pelvic floor are receiving most of the force. Luckily our diaphragm is big and smart, it knows that in order to live it must work. Unfortunately, the pelvic floor then becomes the weakest link and may be overtaken by the pressure. This results in SUI, or leaking during exercise. Focusing on sending the tension in 360 degrees will be helpful to reduce this downward pressure. Rather than just bearing down through your thorax, add tension to your hips and shoulder girdle. But what if you’re a runner? Obviously you do not want to hold your breath throughout a long run or even periodically. Then it is important to either down train or strengthen your pelvic floor, depending on your issue. If you experience problems with bounding or impact such as a box jump, exhaling on the landing will help to decrease the pressure in the thorax and load on the pelvic floor. Whether you have an underactive, overactive or normal pelvic floor, learning to properly brace with the diaphragm and pelvic floor engagement is important. By spreading the tension throughout your body, you are able to sustain more tension for greater loads. Pulling it all together: As you train, don’t neglect two important muscle groups: the diaphragm and the pelvic floor. They are often forgotten since you cannot see them in the mirror. But if you optimize their function, then your workouts will improve! Maintaining optimal posture is a great start; this applies to quiet standing, as well as during workouts. When you brace, be sure to spread tension throughout your body to avoid pushing it all to the pelvic floor. If you continue to experience issues or wish to have someone closely screen your movement with breathing and bracing, come by and see us at Athletes’ Potential. This is just the tip of the iceberg! Thanks for reading,
Dr. Jackie, PT, DPT Pictures https://samanthaeiblingyoga.com/tag/pelvic-floor-muscles/  Two years ago was a huge transition in my life and the lives of my family. We decided to leave active duty service in the U.S Army. We did this so I could work with a mentor of mine, Kelly Starrett. I took a position on his staff as an instructor for a group called MobilityWOD and have had the opportunity to travel the world teaching people how to take care of their bodies and improve their movement. To keep me busy during the week we decided to open a small clinic in a CrossFit gym in West Midtown Atlanta. We still have this office and, it’s funny, looking back on what we started and how it has grown. We started in a room in the corner of a CrossFit gym. The room has no windows. It isn’t fancy and it sure as hell didn’t wow anyone when they walked in. What we did have was a desire to change the way people are treated in the healthcare system. We believe and still do believe that the most important person in healthcare is the individual that is seeking help. It’s sure as hell not the insurance companies or massive hospitals that are trying to consolidate clinics around them. We started with the idea that we wanted to have the time to listen to our patients. We wanted the time to not just find out their name but know their kids name. We wanted to know where they grew up and if they are a dog or a cat person. (I’m a dog person if you’re wondering, my wife is a cat person. Opposites attract!) This is developing a true relationship with someone, not just poking around on their shoulder and asking them where it hurts. With this dedication to serving the individual, we’ve seen extraordinary results with people that have had weeks, months, even decades of pain/disability. We’ve had mothers who couldn’t run without hip pain following their last child, return to and successfully complete marathons. We’ve had accountants with 20 years of sitting under their belt come in with terrible neck pain. They leave being able to breath better, get back into physical training and without numbness and tingling in their hands when they fall asleep. We’ve had military special operations soldiers come in from as far away as New Mexico and helped them resolve chronic issues that would have caused them to be discharged from the military. We’ve even been fortunate enough to help some true professional athletes continue to be successful in their sport and prolong their careers. We did all of this in a poorly lit room with no windows in the corner of a CrossFit gym. We helped not just the people referenced above but roughly 800 other people just like them. We did this by waking up daily and striving to be better than the day before. Learning and progressing is not optional, it’s the only way to truly help others in this field. Now we are growing and have expanded to a full stand alone facility in the Decatur area. We’ve been able to bring on more employees including another Physical Therapist (she’s insanely talented, by the way).  The real reason we’ve been able to do all of this is you. You, the person reading this right now that we’ve helped get back to CrossFit or running or tennis. The person that we’ve helped pick up their kids out of the bathtub without back pain. The person that told their friend they can trust us and they needed to come and give us a shot. We are so thankful for your support of our business. Your trust in us with your friends and family means more than you realize. Many people look around today and say the healthcare system is broken. We feel all of the changes and uncertainty with healthcare is an opportunity to creatively grow and go against the grain of high volume, poor quality care. We will never sacrifice our core values, make a decision that is not in the best interest of our patient or have third party insurance companies dictate how we can treat the people that seek our help. Thank you so much for being a part of the Athletes’ Potential family. We are excited to continue to grow and improve our ability to help you and your loved ones. We look forward to growing with you but will never forget where it all started. A windowless room in the corner of a CrossFit gym! - Dr. Danny, PT, DPT |
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