Aaaah, the holidays! Most people’s favorite time of year. And yet, the time of year that gives most people 87% of their yearly quota of anxiety (*not scientifically backed but pretty close). Whether that be over shopping, family, or the endless social engagements, the struggle that seems to be the most common is FOOD.
Let me start by saying that I think anyone's fears and anxiety regarding food, drinks, routine, exercise - what have you - are valid and not silly. It would be easy for me to sit here and tell you to not worry about your weight, sticking to your macros, or to tell you to just chill out and enjoy the family time! But I would be a hypocrite if I said that, because I, like everyone, struggle with this time of year. Not as much as I once did, but there are still lingering feelings and anxieties around this time where my daily routine of meal prep and CrossFit gets thrown off, usually in exchange for richer foods and less activity.
In a society where morality is given to foods, we tend to feel guilty for eating or overeating something that we’ve deemed “bad,” that we’ve failed and “fallen off the wagon.” What wagon? This isn’t the Oregon Trail! Sure, there are foods that are higher in antioxidants, vitamins, etc., but there are no "good" or "bad" foods. And overeating isn’t bad. I think it can even be a necessary tool in our arsenal. I’ve overeaten when I’m bored; when I’m having a great time with friends; when I’m upset or anxious; and when something is just really, really delicious. If you can identify why you are overeating (eating to the point of being uncomfortable or sick, having feelings of guilt, etc.) and then use that information to address the cause and your feelings around it, then you can begin to unravel any negative emotions you are associating with certain foods and their quantities. This is necessary year round, but it seems especially important around the holidays, since that is how we celebrate - with highly palatable foods that are usually deemed “bad” and are in abundance.
So, ask yourself: Did you have a great time with friends? Did it affect other activities? Did it snowball into feelings that were less than positive? Identifying those feelings and WHY a food made you feel a certain way is a necessary step on the path to mending your relationship with food and freeing yourself of this good/bad mentality. It will make events and gatherings more enjoyable when you stop labeling foods, and especially yourself, in this way.
(Chill out, Susan!)
Stress is real and absolutely affects how we feel physically. The holidays are a time to be present with our loved ones, with nature, with Netflix - hey, whatever brings you joy! If you don’t feel great, then drink more water, go on a walk, eat more veggies. That’s a simplified approach to feeling better anyway - that doesn’t change around the holidays!
Look, I get it. This blog could be, and probably is, someone’s thesis. There’s so many nuances and variables that come into play with human beings and how food and culture have evolved into what they are now. I could easily go down a rabbit hole on several related topics. But one thing remains true: Relationship with family and friends, and the memories you make, are most important. Nobody is going to remember (or care) that you skipped out on your run to watch a movie with family and friends, nor that you went over your usual calorie intake for the day. But they will remember spending quality time with you and how you made them feel.
Have a second slice of cheesecake. Go on a walk. Or don’t. Just don’t beat yourself up about it. You aren’t “bad” - and you deserve better!
Thanks for reading,
Holiday season is upon us, which means travel time to visit family and friends. This can be a very stressful time for a lot of people due to being out of your normal routine – whether that’s training, nutrition, stress, etc. This post is intended to equip you to handle some of these changes and provide some tips to take with you while you’re traveling for the holidays.
MOVE: This seems self-explanatory but just remind yourself to move over the holidays and don’t beat yourself up about not getting in your typical training or workouts. If you’re stuck on a plane for some time, try to get up and move as much as you can. Or, if you’re in the car, try to focus on making some stops along the way to move and stretch out. If you’re looking for some go-to movements to help keep you moving and supple, look no further:
2-3 sets x 8 breaths each direction
Half-Kneeling T-Spine Windmill
2-3 sets x 6 breaths each side
1-2 minutes each side
Lateral Hip Mobilization
1-2 minutes each side
90/90 Hip Rotations
2-3 sets x 8 rotations each side
You can even create a movement flow and roll through a circuit of these different movements. For training and working out, just make sure you squat, hinge, push, pull, carry something heavy, and test your lungs a little bit.
LOAD MANAGEMENT: I’ll keep this concept simple. Your body has a certain threshold and capacity before you start getting some soreness, aches, and pains. While traveling, it’s normal to do more walking or activities that are not normally within your element. We get a ton of people who get back from trips with different aches or pains. It’s totally normal. Imagine trying to run a half marathon when you’ve only trained for a 5k. The same concept can be applied to walking around a city or doing a long, strenuous hike. If you walk for 6-7 miles and you’re only use to 1-2, you’re going to be sore. If you don’t give your body time to recover, then that can become achy or even painful if done repeatedly. This doesn’t mean you did something wrong. It just means that your body exceeded its ability to recovery due to too much volume. The point here isn’t to just take a rest day or immediately run to a healthcare professional if something is painful, but more that our bodies are resilient and robust – you’ll bounce back from it and it should go away with some TLC. If you give it some time and TLC, and there’s no improvements, then seek out some help from a healthcare professional.
STRESS: This can go many different ways. You’re off from work – emails are piling up. You won’t be in your gym doing your normal training program and you miss squat day. You’re traveling to your in-laws for Thanksgiving and you’re already dreading Martha’s passive-aggressive comments. Typically, stress is associated as bad or with a negative connotation. I’m reading this book called “The Upside of Stress” and there are a lot of great takeaways from this book. To keep it very simple, your perception of stress matters significantly. Stress is just something that happens to us and our perception of whether it’s good or bad based on different factors such as past experiences, genetics, culture, etc. determines our mental and body’s physiological response.
Here are three simple steps described in this book:
1. Acknowledge the stress.
2. Welcome it.
3. Make use of energy it gives you.
Try to attack some of these stressors by viewing them as good/growth for you. Instead of stressing about spending time away from work, think about the time you’ll get to spend with your people or that it’ll help you recharge and hit it hard when you’re back. If you’re feeling in over your head, breathing and meditation is always a good outlet - download the Headspace app and take a few minutes to dial in your breathing and calm down your system.
WASH YOUR HANDS: More than you think. Lots of colds and phlem. That shit is everywhere – better safe than sorry.
NUTRITION: No one is perfect during the holidays. I think that changing your relationship with food will make a huge difference here, not only for the holidays but even for life in general. Instead of deeming foods as good and bad, try looking at it all as fuel and focus on quantity and quality. A good phrase coined by Ph.D. and author Michael Pollan is: “Eat food, not too much, mostly plants.” With that said, eat some damn cookies, too. Just don’t eat 12 in one sitting. It’s the holidays, so sweets will be around. Don’t feel guilty - be happy.
SOCIAL MEDIA: You know what I’m going to say here. Limit your time to be on your phone/social media for a certain time of the day or total time in general. Try to challenge yourself with this. When you’re with friends/family, try to keep your phone in your pocket. Use travel and the holidays as an opportunity to disconnect and be present with your peeps or even during your solo time.
ALCOHOL:. Try to limit the Bud heavies and spiked egg nog. This can put a damper on your recovery process and research shows that a single alcoholic beverage can really impact a night’s sleep. All in moderation; right?
SLEEP: Use this as an opportunity to catch up on sleep. You might be traveling to different time zones, walking around a city, watching repeats of Friends’ Thanksgiving episodes. Aim for 7-8 hours of good quality sleep. Avoid any blue light one hour before bed. Make sure the room is cold rather than warm. Figure out a good routine that works for you.
At the end of the day, enjoy this time to decompress from your “normal routine," while also not giving yourself a free hall pass to treat your body like garbage.
Move. Moderate load. Manage your stress. Clean your hands. Eat well, but also have some pie. Instagram less. Moderate your dranks. SLEEP. Be merry.
Dr. Ravi Patel, PT, DPT, CSCS
What’s up, everyone! Doc Jake here. In the spirit of Halloween, I wanted to take a moment to talk about some of the common “scary” comments my patients have heard from other providers, or seen on imaging, and why you shouldn’t be afraid at all. I know we’re all busy getting costumes and candy ready, so let’s jump right in:
“Worst case of bone on bone I’ve ever seen!”
If I’ve heard this once, I’ve heard it a thousand times. “The doctor said I’m bone on bone!” “Worst case of arthritis he has ever seen!” Most often your physician or other healthcare provider is referring to something called osteoarthritis (also called Degenerative Joint Disease or DJD) in situations like this, and guess what… it is totally normal to have arthritis! More and more studies are coming out that show many active adults have some form of DJD and that calling this a “disease” is incredibly misleading.
While DJD cannot be reversed, it’s often not the main pain generator and can easily managed with education on symptoms, appropriately prescribed exercise, and just plain out staying active. Walking the dog, playing with your kids, gardening… all great examples of non-exercise based movement that keep your joints moving. As cheesy as it may sound, the old adage of “motion is lotion” is spot on and is the reason that “worst case of arthritis I’ve seen” shouldn’t get you weak in the knees.
This one hits close to home. At the young age of 14, I actually had two knee surgeries. One to attempt to repair my meniscus and one to remove it once the repair failed. Looking back on it and relating my symptoms I was having to what the research is now showing, I had no business getting any of those surgeries and you most likely don’t need one either. Once again, a torn or frayed meniscus is a normal sign of aging and is often found on imaging with people who have NO knee pain at all.
Even in an acute situation where a tear is found on an image after injuring your knee, as long as you don’t have a physical “block” in your knee, where that meniscus has essentially turned into a door stopper and impeds normal motion at the knee, you will be absolutely fine without surgery. In fact, research consistently shows that conservative treatment will have equal to (or better) results as surgery AND you won’t be setting yourself up for future complications associated with missing portions of your meniscus.
I’ll keep this one short. Simply put, in most situations, herniated discs do not require surgery. In fact, multiple studies have demonstrated that you can take 10 random people off the street with no back pain, give them an MRI, and an average of 7 out of 10 people’s images will come back with some variation of a herniated disc. In fact, “large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years” (Jacobs et al). Our bodies are incredibly resilient and will heal just fine with appropriate treatment.
“You’ll never be able to do ‘X’ again.”
This is the most frustrating thing for me and the rest of the staff here at Athletes’ Potential. We are constantly hearing people come in and say something like, “My doctor said I’ll never be able to deadlift again,” or, “My physical therapist said I shouldn’t do CrossFit.” This is absurd and is a fallacy you shouldn’t fall for. We constantly get people coming into our office and we are constantly getting them back to the activities they love.
So, in review, there are a lot of scary phrases out there that, in reality, have no right to be scary. New research is being pumped out every day that our bodies are incredibly adaptable. If you’re in the Atlanta area and you’ve heard one of these phrases before, give us a call or fill out the contact request form by clicking the button below. We’d love nothing more than to help you get back to what you enjoy.
Thanks for reading,
Dr. Jacob, PT, DPT, CSCS
I remember the feeling like it was yesterday. A sharp popping sensation in my back and then an odd, almost warm tingling feeling down my left leg. I knew it wasn’t good, and I should have known better.
This was my first week at an infantry brigade I had been assigned to in 2011. I was the only physical therapist assigned to a group of 3,500 soldiers. My job was to treat all injuries, teach injury prevention classes, and help with human performance optimization. I was also attached to an infantry brigade so that meant a lot of physical training and ruck marching.
On my fourth day assigned to this group, I went on a Thursday morning ruck march. For those of you that don’t know, ruck marching is basically walking around while wearing a 50-pound backpack. This morning we had gone on an 8-mile ruck march. When I finished, I dropped my rucksack (i.e heavy ass backpack) and stood around talking with the other soldiers. As I was leaving, I bent over to pick up my rucksack and that’s when I felt the pop.
I immediately knew something was wrong, but the last thing I wanted to do was get hurt in front of all my soldiers. I was the guy assigned to this group to make sure people didn’t get hurt and there I was in excruciating back pain trying to act like I was fine. I managed to make it to my car before collapsing into my seat. I drove straight to the troop medical clinic to see a fellow physical therapist friend of mine. There was no unringing this bell… the damage was already done.
Over the next six months, I did everything to help fix this back injury I had given myself. Fatigue from the ruck march followed by picking something heavy up, like an idiot, was a recipe for a pretty serious disc injury. I had what’s called an L4-L5 disc prolapse. This caused me to have a lot of numbness and weakness in the back of my left leg.
With a combination of dry needling, hip joint mobilizations, and time, my pain resolved in about six months. It took me roughly another six months before I could get back into deadlifting heavy. 12 months of rehab/recovery from picking up a rucksack wrong. As much as this wasn’t fun, I’m glad it happened to me, and here’s why.
I learned a lot about why I had this back injury in the first place and was able to correct those issues. This injury lead me down the path of better understanding complex movements. I became obsessed with treating my own back and developing protocols to help other people with their back injury. Lastly, I can relate to anyone I see with a back injury on a much deeper level than someone who’s never hurt their back.
I also got to see first hand that disc injuries do heal. Even when I was in school, the thought process was that a disc injury wouldn’t heal. I have an MRI from one month after the injury and three years after the injury. The MRI from one month post injury shows a significant disc prolapse that’s pressing on a nerve. The MRI from three years post injury looks completely normal. The body heals on the inside just as it does when you get a cut on your skin. It fills in, heals, and you have a scar as a reminder of the thing that happened.
Dealing with a disc injury can be extremely frustrating. Here’s my advice to you if you’re currently dealing with one from my own experience and from all of the back injuries I’ve seen:
I hope this helps and I hope you realize that you can heal. Your body is incredible and often times it just needs time and the right approach to do so.
If you’re in the Atlanta area and are currently dealing with a back injury, we need to talk. We’ve helped thousands of people in Atlanta get back to a pain-free, active life, and we can help you as well.
Click the “Get Started” button below, leave us your information and one of our team members will reach out to find out if you’re an ideal fit for what we do.
Thanks so much for reading,
So, let’s talk about the shoulder:
It is a very dynamic joint with little surface area between the humeral head and the glenoid fossa. The analogy we often use is a golf ball on a golf tee. There’s a reason why you hear more about shoulder dislocations than hip.
We have numerous muscle attachments and ligaments that surround the joint itself. These can be broken down into active (muscles/tendons) and passive stabilizers (ligaments). When we are going through different movements at the shoulder (whether that’s an overhead press, push up, clean, etc.), if we do not have the requisite range of motion, coordination or strength, then our passive stabilizers take on a lot of that stress. As I’ve said before, every single tissue (muscle, tendon, ligament, bone, etc.) in our body has a certain capacity and threshold. Stress is how we build those thresholds up. Stress is also how we break those down. When those thresholds are surpassed significantly or repeatedly, pain and injuries start to pop up. The dosage is the difference in having the poison or the antidote (- quote from someone smarter than me).
Now, how can we create more buffer room or bandwidth to withstand these stressors?
Smart and well thought-out training. Sure.
But, what about creating more freedom and control at the shoulder joint? Then, those tissues are less prone to getting overstressed and everyone is doing their jobs.
Today, our focus will be on the overhead archetype – which is an expression of shoulder flexion and external rotation. This can be anything related to pressing, reaching overhead, hanging, or throwing overhead.
I see people in the clinic every day that have pain with these movements and when we break these positions and joints down, we tend to see a limitation in one or both flexion and external rotation. Next, we’ll go through a test that you can utilize to see how your overhead position checks out.
Common faults we see related to this are:
Try to avoid these mistakes and see where your true baseline overhead position is. After the techniques provided below, come back to this test and re-test the movement. Can you go further? How does the quality of getting there feel?
Next, we’ll look at some strategies to improve the mobility aspect of the shoulder joint.
Shoulder Overhead Opener:
When discussing the shoulder joint, I would be remiss not to mention the thoracic spine. The shoulder blade and thoracic spine/ribcage are very intimately related which directly impacts shoulder mechanics and position. Next, we’ll go through some techniques to address the thoracic spine.
Half-Kneeling Wall T-Spine Rotation with Lift Off:
Lastly, we will cover my favorite component in the performance process which is the strength and control of the shoulder joint for the overhead position.
Supine Eccentric Shoulder Flexion – Dowel or Single Arm with Plate:
Dowel Shoulder Flexion PAILS/RAILS:
Chaos Overhead Band Carry:
Now, you may be thinking, "These are great exercises, but how do I implement them?" Try them as movement prep prior to an overhead workout, accessory work on upper body days or even on recovery days. Do you have to do all of them? Nope. Find the ones that you feel had the best impact on you via the test-retest on the Wall Test and start implementing them in consistently. An active approach tends to work better in the long term compared to the passive approaches and exercises. You’ll be surprised how quickly your overhead position will improve and your overall shoulder health.
If you’re dealing with an injury, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before.
Dr. Ravi Patel, PT, DPT, CSCS
Tennis is a sport that demands an incredible amount of strength, stability, and performance out of one of the most unstable joints in the human body… the shoulder. Not only do you need to drive your shoulder through some truly incredible velocities with something like a serve, but you need to be able to control that power through finely tuned movements in multiple planes of motion with an almost endless list of types of swings.
The demands on the shoulder are pervasive in tennis and because of this we have successfully treated endless amount of shoulder related injuries from the tennis players we see at Athletes’ Potential. However, through all these injuries that we’ve worked with, we have started noticing some trends in common strength deficiencies and biomechanical limitations that, when addressed, can have serious impacts on reducing injury risk and improving performance.
Trend #1: Inadequate Shoulder External Rotation Range of Motion
Arguably the most violent swing in tennis is the serve. To generate the amount of torque required for this swing, you need to have an appropriate amount of external rotation at your shoulders.
The video below goes over a quick and easy drill to assess your shoulder external rotation. Essentially you should be able to lay on the ground and get the back of your wrist to the ground while keeping your low back pinned to the floor.
Some common mistakes to avoid when doing this assessment include:
If you can’t bring your wrist to the ground, or you have pain when you do or feel like you really have to fight to get there, then try some of my favorite drills to improve shoulder external range of motion.
Drill #1: Front Rack Opener
Drill #2: Lat Stretch
Drill #3: Upper Back Mobilization
Trend #2: Upper Back Strength
In order to have a strong, effective swing you need to have a strong back. This may seem a little counter-intuitive, but let me explain. Your body is innately intelligent and it’s not going to let you produce more force than it feels it can control. Therefore, to have a better swing, you need to have a strong back to be able to eccentrically control your arm as you go through the swinging motion.
Some of my absolute favorite exercises to make sure you have a strong upper back are listed below.
Exercise #1: Deadlifts
Exercise #2: Pendlay Row
Exercise #3: W, Y, Negative
Trend #3: Lack of Rotational Core Strength
Your power in your swing comes from having a strong core. If you don’t have a strong core, then you have no foundation to deliver a strong swing, and if you are trying to have a strong swing without a solid foundation, well, you’re begging for an injury. Check out my favorite exercise to improve rotational core strength.
Exercise #1: Med Ball Rotational Throws
Exercise #2: Deadbug Pallof Press
Exercise #3: Landmine Twists
If you’re a tennis player struggling with shoulder pain (and yes, even elbow pain) or are looking to improve your performance, these drills are a great place to start. They are the three main problem areas that we find ourselves addressing with the tennis athletes who come to us for help. However, If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before.
Thanks for reading,
Dr. Jake, PT, DPT, CSCS
Have you ever pulled a muscle or tweaked something playing a sport? Maybe overdid it in a workout and didn’t notice it till after or the next morning? Every single person has experienced a soft tissue injury before – that can be muscle, tendon, ligament, etc. There’s a lot of mixed information out on the internet about what’s the best approach to hand a soft tissue injury when you experience one.
For the longest time, it was RICE – Rest, Ice, Compression, Elevation – while this isn’t completely wrong, it doesn’t meet the full standards of what we know today with science and research.
Here’s a handy acronym to help remember the essential components of how to manage injuries better in the future: PEACE & LOVE
Immediately after injury, PEACE:
Once some days have passed, it’s good to give it some LOVE:
The thought to keep in mind is to try to play the long game. I see athletes often who come in and get out of pain then go right back to high-level activity without taking appropriate measures to progressively build it back up. What happens? Reinjury. Take the time to put in the work and I promise it’ll be worth it in the long run.
If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before.
Dr. Ravi Patel, PT, DPT, CSCS
Axe MJ, et al. Potential Applications of Hyaluronans in Orthopaedics. Sports Medicine. 2005.
What if you could experience less anxiety and less stress without a pill forcing your body to calm down? What if you could exercise your heart, lungs, muscles and bones without having to step foot in an LA Fitness? Seems too good to be true... but have you tried HIKING?
To some, hiking may seem like a pointless wandering through the woods, but for many folks the benefits are numerous and welcomed.
Hiking, or even a stroll through a nature setting, has been shown to decrease anxiety and lower risks of depression.
A Stanford study showed that “neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.”
That means that annoying repetitive voice in your head telling you that you don’t have enough time in the day can be quieted, maybe even silenced!
In the technology-driven world we live in, quiet and empty time is almost non-existent. By taking a walk through a nearby park during lunch or finding some trails on the weekend, you may notice mood enhancement and more productivity when working!
Another mental health booster—try taking a friend with you sometime. Personal interactions, without large groups and distractions or cell phones in our faces can help build meaningful relationships that are valuable for mental health.
Do you train really hard during the week? Take a hike on your off day/rest day as a way to keep the blood flowing and body moving while also allowing it an exercise input that is not 100% intense the whole time. Your body will thank you!
Hiking also provides a unique challenge that we don’t see often- an uneven surface. Unless we are still playing some sports as adults, like soccer or lacrosse, we tend to exercise on and spend our days on flat, hard surfaces. Navigating uneven ground challenges our foot and ankle stability, single leg control, and balance, unlike conventional fitness routines.
You can search for hikes according to distance and challenge at websites or apps like “All Trails.” I suggest trying some longer and easier hikes as part of recovery from tough fitness routines or as an easy mental release. These trails usually have less obstacles so there is less focus demand for watching your step. Of course, they are not as demanding on the heart and muscles, but that may be desired for an off day! Depending on your fitness level, you can also try to push it to more challenging terrain with obstacles and steeper incline. This will get your heart pumping and lungs working hard!
As we get in our weekly routines of work, gym, dinner, repeat, I think we tend to forget to use our fitness. We are exercising to keep the heart and lungs healthy, manage a healthy body composition and release stress or worry but also to be able to continue being active throughout our lifetimes. So get out and find a nature-filled area to hike or a park to walk through! Your mental and physical health depend on it!
Thanks for reading,
Dr. Jackie, PT, DPT, OCS, CSCS
Shoulder volume. This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12 to 15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders!
With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able to move and potentially pretty damn fast, but you’re going to leave a ton of performance on the table, in addition to breaking down way quicker and more often.
In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like: “Keep a high elbow;" “Drag your fingers;” and “Point your elbow to the ceiling.” All are various cues for internal rotation.
The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is a big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster.
So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation.
(Internal Rotation Self-Assessment)
(Internal Rotation Superfriend Stretch)
(Banded Internal Rotation Stretch)
Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you.
Thanks for reading,
-Dr. Jake, PT, DPT, CSCS
It is not uncommon for a patient to come into the clinic and say they were told by a medical provider that they have unstable hips (generally referencing their pelvis). This is often followed by a laundry list of movements they “should not do”, possibly ever, to avoid making their pain worse. These patients often report frequent visits to have their body worked on and “put back together” in order to go through life without constant pain or joints “going out.”
Sometimes these patients haven’t seen any medical providers at all, but describe their pain as if something is unstable, slipping, shifting, etc. Perhaps they googled it and this is the best way they could find to verbalize the sensations they felt.
What this shows is a widespread assumption that our back/pelvis/hips can suddenly shift and change position and are “unstable." Look at all these strong and beautiful ligaments. The strength of these is so great, could bad posture or lifting something in a “bad” way really cause that much movement?
Research shows that we are unable to accurately palpate (feel with our hands) if a joint position is “out of place” or moving in an “unstable” way. The linked systematic study found that “current clinical methods utilizing palpation for diagnosing SIJ pathology have been found to be unreliable and invalid in the literature and may have limited clinical utility.” Through research, we know that the SIJ can move on average about 2 degrees or 3-4 mm. That is such a small amount, I challenge the notion that we can actually feel that with our hands- through skin and fat and muscles.
So why do some people believe that our hips and pelvis are all willy-nilly and unstable?
As humans, we relate to stories. However, pain is not something that is easily understandable for everyone and may not have a concrete explanation- particularly when one has been in pain for years and it affects their daily life. Humans want a WHY. An easier explanation is that your SI joint is painful because of instability and movement at the joint. This seems relatable to folks because it might FEEL just like that- like it’s moving too much.
While explaining pain in this way can be helpful in some respects, the problem is that it snow balls into the “things I can’t do” list because if my pelvis is unstable, then I probably shouldn’t workout and DEFINITELY shouldn’t run. But one thing that we DO have research supporting is exercise to decrease chronic pain and improve quality of life.
So if you have pain, don’t panic! Go MOVE. If you need guidance for where to start, find providers that will encourage you to be active and strategically help you return to the activities you love. (Pro tip: This rarely entails the word “never." As in “you should never lift weights or “you should never run."). Let us know if we can help you!
Thanks for reading,
Dr. Jackie, PT, DPT, OCS, CSCS
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.