While structured breathing work may seem simple-even silly- to some, we know that it is a powerful tool for the pregnant and postpartum woman. Deep breaths have the ability to calm the nervous system which can affect muscle tension, heart rate, and blood pressure. Additionally, the respiratory diaphragm can mobilize muscles in the pelvis and back due to anatomical connections. Muscles, including those shown in the photo below, are big players in midline stabilization and support. A great place to start is the 90/90 breathing drill (seen below). Try this out for 10-15 breaths at the end of your day.
Many postpartum women do not know all of the details after birthing their baby. Some have told me they were not aware they had stitches down below until the 6-week check-up when the doctor wanted to make sure they were healing well! The check-up at 6 weeks can be quick so arrive with questions. It is helpful to know about any tearing, episiotomies, tools used during the birth, etc. These factors are all great to bear in mind as you return to exercise and daily functioning.
Another question to ask-- “Is there a pelvic health PT that you would recommend?” They may know someone in the area or have worked with them prior. However, do not become discouraged if they don’t have a name to offer. A Google search for “women’s health PT” or “pelvic PT” should show professionals in the area. Compare websites and reviews to see if the PT would be a good fit for you and your goals!
Pelvic Health Physical Therapy
Once you have been cleared by the doctor for “usual exercise” and intercourse, I highly suggest visiting a pelvic health or women’s health PT. They will be able to further answer any questions about symptoms you may experience immediately postpartum and later.
A pelvic PT is specialized on evaluation and treatment of the pelvic floor musculature. They can perform internal evaluations to test the strength and endurance of your pelvic floor, check for prolapse, address any soft tissue issues, etc.
For the evaluation, the therapist will use a gloved finger to palpate muscles internally. While a great deal of information can be gathered from an internal evaluation, it is not necessary for visiting a pelvic PT. The therapist can then prescribe exercises to help relieve the symptoms and provide hands-on work to hips, back, sacrum and other involved areas. Your PT should be a huge help in getting you back to fitness postpartum! Other areas they can treat and improve are bowel/bladder issues, painful sex, and pelvic pain.
Focus on healing and strength rather than weight loss
Social media and advertising may be all about “getting your body back” and fixing “mummy tummy,” but that is not the focus when you are postpartum. The first step in returning to fitness is addressing foundational strength and continuing to heal from the pregnancy and birth. Your body will go through so many changes in the months following your pregnancy and the timeline is different for every single woman.
Steer clear of programs that say at week 8 you do blank. It should all be self-paced and based on symptoms, your birth story, and prior activity level. Do you need help starting out? This was the number one question I received from women in the clinic. “What can I do? Where do I start?” So I developed programming to recover and rebuild your core after having a baby. Check out the THRIVE: Rebuild Bundle programming HERE.
Find a community for support
Returning to group classes or running groups can be challenging because you will not be jumping right back into the level you were previously exercising. Having a group of women who understand your needs and have been or are currently at the same stage as you is tremendously beneficial. If this sounds like something you would be interested in, please join my Back to Fitness Postpartum Facebook page. We have posts nearly every day and a lot of great discussions- some serious and some silly!
Once you return to group classes, be sure that the trainer knows you are postpartum and if there are any symptoms with movements. If they offer other movement suggestions that still do not feel great, then modify further! Symptoms (leaking, pain, heaviness in the vagina) are a signal to decrease the workload by resting or modifying or both!
Getting back to fitness postpartum can be challenging but it is not impossible! With a holistic plan and support you will be able to recover and rebuild to get back to your favorite activities. If you are looking for help with learning more about postpartum fitness, the pelvic floor and how to reach your goals, then please reach out at Athletes’ Potential.
Thanks for reading,
Dr. Jackie, DPT
Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning.
Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint.
Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.
Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder.
Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better.
Although your pelvic floor and your feet may seem as though they are different and non-related structures, this is not the case. The connections are fascial, neural and biomechanical. Your feet are your foundation; how they contact the ground dictates all movements at your ankle, knee and hip. Soft tissues and fascia in your feet have vast connections to the legs, hip and back. The feet and pelvic floor, despite the distance from each other, also share neural input!
Fascia is the thin covering of your muscles that looks like a spider web. The posterior fascial line runs from the bottom of your feet, up the back of your legs and torso and to your head. Along the path, the fascia connects to the ischial tuberosities, or the “sit bones”. Muscles from your pelvic floor also attach here! So tension along this fascial line will directly impact your pelvic floor. Essentially, any joint the fascial line crosses and soft tissue in the area can be effected. A great place to start is the feet! Use a lacrosse ball to mobilize the fascia and tissues in the bottom on your foot and around the ankles.
The nerves that are responsible for function around your pelvic floor—sphincters, PF muscles, deep hip rotators—are also responsible for the function of your intrinsic foot musculature. Signs of foot weakness may by indicative of pelvic floor weakness, and vice versa. So, strengthening the foot musculature and stimulating these nerves may help with pelvic floor function. Unfortunately, many athletes wear big, padded shoes which decreases the amount of work the foot musculature must do! Neglecting to walk around on bare feet is robbing your feet of their natural ability to stabilize and form to the surface but also decreases in amount of neural input.
We suggest barefoot walking and running to increase the input through your feet and begin to re-strengthen the small foot muscles. The best way is to find a grassy area, about 50-100m in length and run repeats barefooted. Your feet will be challenged much more than when running in squishy shoes, so ease in. You will also notice that your running form is probably different (better). Heel striking when barefoot in quite painful, so the body will automatically shift to more of a midfoot strike—which is good!
The ankles drive the movement of the whole kinetic chain- the knee, hip and pelvis and spine. Dysfunction or pain in any of these areas can be stemming from faulty foot mechanics. For example, walking with the toes pointing outwards will cause your ankle joint to perform on a slightly different axis than it was designed. This will be demanding on the ankles and all the way up the kinetic chain.
The knee tends to be stuck in the middle and pushed around. The ankle dictates the movement of the lower leg and then influences the upper leg. The knee is just where these two units connect. So you will notice, we do not focus on biomechanics of the knee.
The hip has a direction connection with the pelvic floor. One of the deep hip rotators, the obturator internus, connects to the pelvic floor. With this connection, the amount of hip rotation will change (increase or decrease) the tension of the pelvic floor.
Putting it all together: Our feet control the movements of the joints above it. If your arch collapses (flat feet), the lower leg will rotate inward and the knee will follow. Up the chain, the thigh will also rotate inwardly which changes the tone of the pelvic floor. The angle of the knee will change with all of this, but remember it is not the driver of the dysfunctional motion, rather the passenger. Living with faulty biomechanics (however slight) can perpetuate back, hip and/or pain and dysfunction. Rather than starting with an MRI for the back or kegals for the pelvic floor, why not see if changing how you move can decrease symptoms?
A simple way to put this into practice is a slight change during a body weight squat. Move your feet to a comfortable squat position. Before sending your hips back and down for a squat, screw your feet into the floor. That is, acting as though you are moving your big toes further apart but your feet are not moving. Keep the toes on the ground! This creates torque at the hip. By engaging the external rotators, you are creating tone at the pelvic floor--remember the connection? You may also notice that the arch in your foot becomes more pronounced. Hello intrinsic foot musculature! This motion is also helpful for those with hip pain, especially pinching at the front.
In the photos below, my feet are not in a squat stance, but I am showing the subtle external rotation. You can see the largest differences at my knee caps and the direction they are facing. Also, notice my arches after the external rotation (bottom photo). They are higher! You can see a greater difference on my left foot. My whole foot stays in contact with the ground.
Recap: The foot and the pelvic floor have more connections than you may realize. They share fascial connections as well as neural. Taking the time to mobilize tight tissues and allow for more input with bare feet can have positive effects on hip, back and pelvic floor issues. The ankles largely drive the entire kinetic chain from the bottom up. So, taking care of the foundation of movement will be the most beneficial!
Thanks for reading,
Dr. Jackie, DPT
Guess what? Physical therapists sometimes have pain and dysfunction too! We are only human. Often times, people will see me wrapping a voodoo band here and there, or digging a lacrosse ball into my shoulder. It usually strikes up a conversation starting with, “What would you do if…..?”
My ol’ volleyball knees tend to get creaky and achy sometimes, just as many athletes and patients often describe. So, what do I do if I have knee pain?
These are my 5 favorite “quick fixes” for knee pain. Obviously, management of knee pain is more comprehensive than 5 quick tips. However, these are for when you are in the middle of weightlifting, running, playing your sport and you get that nagging knee thing. Ideally, you would consult a PT or watch a video of yourself moving to see what is causing the knee pain. But understandably, sometimes we just need it to feel better RIGHT NOW.
#1 Modified Couch Stretch- This is a great stretch for the front of the hip! It is important that you stay tall and do not let the band pull your hips forward so that your back is banana shaped. Propping the foot up on a ball takes up more slack in the quad and intensifies the stretch. If you squeeze your booty, you will feel the stretch even more. Please kneel on something soft! Prolonged pressure on the front of your knee will only exacerbate the issue.
#2 VooDoo Band- Using a voodoo band, wrap your knee beginning below the knee and leaving a gap for your kneecap. Be sure it wrap it tightly! After it is wrapped, any knee movement will be beneficial. I like to do air squats and butt kicks to get deep knee flexion. You could also sit down and bend and straighten your knee. Leaving it on for up to 2 minutes will give you the best bang for your buck.
#3 Soft Tissue to quad- Often times, tension in the quad will cause knee pain right at the top of the knee cap or on either side. Pressure to the soft tissue in the thigh area can help the quad relax and allow more pain-free range. My favorite tool for this is the handle of a kettlebell. It allows more direct pressure than a foam roller and you can easily push down and then move it side-to-side for some release. Another option is a lacrosse ball. Just lie on your stomach, pin the ball on a sore spot on your quad, then bend and straighten your knee. Spend at least 2 minutes on this one.
#4 Knee Gapping- Everyone’s favorite! We like to use Yoga Tune Up Balls for this (as seen in the photo) but a double lacrosse ball or even a towel rolled up will work. Simply put the balls in the bend of your knee, then use overpressure form your arms to bring your heel towards your booty. This should feel good- like a stretch to your knee. Two minutes of oscillating between overpressure and releasing it will do the trick.
#5 Modify- Some days, the knees just aren’t on board. If you have completed a thorough warmup and tried some self-management but the knee still feels iffy--- modify, modify, modify. Don’t work through the pain! There are plenty of ways to change a workout that will still be beneficial but not aggravating to the knees. A great example is the box squat. If I have knee pain, it’s usually with heavy back squats- ol’ volleyball knees, remember? Box squats are a good option. I am still loading in the pattern I want, hitting the lumbopelvic muscle groups, but allowing my knees to stay back further so that the shear force is less.
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Last week I outlined some mobility restrictions that are likely the culprit if you have pain or trouble with squat pattern. Hopefully you have tried those mobility exercises out, even if you think you are flexible. There is sometimes a lingering asymmetry here and there from past injuries and such.
So, you checked your mobility and you have the ideal mobility for a squat. What else could it be?
The “butt wink” is a pelvic reversal or loss of the lumbar curve at the bottom of the squat. A few things can cause this—bony architecture and tibia to femur ratios, lack of mobility usually in hip flexion or internal rotation, and/or poor motor control throughout the squat pattern. I will not get into the debate of the first possibility. Yes, we are all unique snowflakes, but let’s make sure our mobility and control are up to par before we blame our parents.
To be sure you are setting yourself up for success, check and see if your foot placement is ideal for your bony make-up and mobility. This is best done on your hands and knees with a partner watching and preferably filming. Make sure that your hands are below your shoulders. Rock forward and backwards the finally settle at the center—ask your partner to confirm that you are actually centered. From here, slowly push your hips back as if moving to child’s pose.
Watch your pelvis; when you notice that is starts to rock backwards, this is where your butt wink starts when you are standing with this foot distance. Now widen your knees out a few more inches and repeat. Did the pelvic reversal look the same, better or worse? If better, a wider stance in the squat would work better for you. If worse, stay narrow. If the pelvic position was the same, check in with how your hips felt during each of the two foot positions. Say in the wider squat you felt a bit of pinching, then stay narrow.
Top picture: no butt wink, so a good foot position.
Bottom picture: butt wink, so I will likely have a pelvic reversal with a squat to this depth or deeper.
Going a step further, you can move to your forearms to mimic the forward inclination of the torso during a squat. Perform the same steps. In the picture below, this is right before I start to have a pelvic reversal, so this is my target depth with loaded squats.
After finding the correct foot placement, stand up and try a few more squats. Is the butt wink still there? Yes: if you are in the correct foot position and have ideal mobility, keep reading!
Many of the athletes that I treat fall into these categories:
Very flexible and can squat with their booty to their ankles
Report feeling tightness in their hamstrings, even though they can bend forward and put their palms on the floor
Have back pain with squats that increases at the bottom of the squat, often one-sided but not always
Always sore in the quads after squats, rarely glutes or hammies
Does this sound like you? Here are two of my favorite exercises to start working on motor control of the lumbar spine, hip and pelvis under load as well as posterior chain strengthening.
The tempo goblet squat: This exercise forces anterior stabilization by adding a weight at the chest. The deep core must fire to offset the kettlebell. With a 3 second count lowering to the box, motor control of the lumbopelvic area is even more challenged. Additionally, squatting to a target allows the athlete to sit back more in the squat, engaging the glutes and hammies. This is often a new input for these athletes who are quad dominant. Check it out here: Goblet Box Squat
The banded bird dog: Practicing moving your extremities while under the load of a small band is important before you try to move big weight. The bird dog requires hip and midline control with movement, made a bit harder by adding a band. Again, having a partner for a form check or performing this by a mirror is ideal. Many people will have a movement fault and not even realize! The goal is to keep the back and torso in the neutral position throughout. As soon as your form falters, take a break. Check it out here: Banded Bird Dog
Add these exercises to your strength days and/or warm up a few times each week. Maintaining your core and pelvic control throughout the range of motion is the first step to easing back pain and improving your strength in the squat!
If you try to self-manage for a few weeks and still see no change, let us know. We would love to help you here at Athletes’ Potential!
Whether you are looking to PR your squat, want to squat without pain or are just sick of nagging lower extremity pain—this is where the change needs to begin.
This week I posted a picture on social media of a patient who started the session with a squat that deviated to the right and then after some mobility she was centered. This started a lot of conversation from athletes asking for help with this exact issue. First, check out your mobility. Remember: symmetry is important in a squat so be sure to check both sides and compare!
Pain and dysfunction in the back, hip and lower extremity can absolutely be caused by a laundry list of issues, but sometimes we make it more complicated than it needs to be. The best way to begin to decrease pain and improve function is to find the low hanging fruit and start there.
At Athletes’ Potential we use a group of movements to screen every patient with lower extremity complaints. The last movement is always a body weight squat. Not because every patient we treat is a weightlifter and wants to improve their squat, but because it is a foundational movement that everyone should have the requisite mobility and strength to perform.
The first two places to look for a mobility restriction are the ankle and the hip.
A few indicators of ankle restriction during the squat often comes in two forms: the people that feel like they will fall backwards if their chest is up any higher (pic 1) OR those who look like they have a solid squat but on closer look, their ankles are collapsed and spin outward (pic 2&3).
Ankle dorsiflexion is essential to have a deep squat with an upright torso. The best way to check your own ankle mobility: place your foot a hand width from a wall (in a lunge position), with the foot in that position drive your knee toward the wall making sure that your heel stays down. Can it touch the wall? If yes, move on to checking hip mobility. If no, your ankles are limiting your squat!
Our favorite ankle mobility drill uses a band to distract the ankle and then move it through range. Check it out-- Ankle distraction and dorsiflexion
Ankles can be a frustrating joint to mobilize because they are slower to change. It is important to work ankle mobility into your warm up and/or cool down as much as possible! As you begin to chip away at ankle restrictions, check out this older blog post about the best way for you to modify a squat until your mobility is improved: Is squatting bad for my knees? Part II
To self-check hip mobility there are a two hip movements that are important to check- hip flexion and hip internal rotation. When you are missing hip flexion and/or internal rotation, there may be a pinching sensation at the front of the hip during a squat or you have a “butt wink” at the bottom. To check hip flexion, lay on your back and pull your knee towards your chest. Ideally, you will be able to get your knee about a fists width from your chest. As you apply overpressure with your hand, you might notice your pelvis start to lift off of the floor. This is actually lumbar flexion, which is synonymous with a ‘butt wink’. The athlete below is experiencing this a bit, I think he was trying to show off for the camera. ☺
When checking internal rotation, sit on a table or box so that your feet are not in contact with the ground. Internal rotation is the motion when your foot moves outward from your body when your hips and knees are bent. We like to see 40-45 degrees, as in the picture below. Be sure that as you rotate your hip, you don’t bring your booty off the table and lean to make it go further!
Lacking hip flexion? Here is a great sequence to work through-- Hip Flexion Mobility
Is your internal rotation less than ideal? Is one side much less than the other? Give this a try-- Anterior Hip Opener with Internal Rotation
Maybe you check all of these areas and you have the ideal mobility. What else could it be??
Really bendy athletes are on an opposite end of the spectrum from more immobile athletes. In fact, banded mobility and banded distractions won’t help you at all! If this is you—stay tuned for Part II that covers the limiting factor of the squat for flexible folks.
Thanks for reading,
Appropriate shoulder rotation is essential for overhead athletes; I want to discuss this in the context of volleyball. My bread and butter. Think of a volleyball player hitting a cut shot or winding up to swing away at a set. You will see a great amount of external rotation during the cocking phase (the middle frame in the photo above). The greatest demand for internal rotation range of motion would be the follow through for a cut shot or “thumb down” (as in the photo below).
The amount of shoulder rotation range of motion for a volleyball player is that of a normal individual but you need a balance of range of motion, strength and control.
A quick side note worth mentioning: as an overhead athlete, you are likely to have greater range of motion in external rotation and less internal rotation. This is normal due to the demands of your sport. The baseline that we look for is that total range of motion side-to-side is the same. So you may look like the guy on the right in the picture below. It is also common for volleyball players to demonstrate greater internal rotation rather than external rotation strength, which may lead to injury down the road if the ratio becomes too skewed.
Let’s go through the steps of an arm swing and see where a weakness may be and how to address it:
Check your external rotation by laying on your back, arm out to the side and elbow bent. See how far you can drop the back of your hand down to the floor. Lacking here? Try this out: Subscap Smash
The shoulder joint is one of the most complex in the body due to its high mobility demands that compromises the stability. For volleyball players, shoulder maintenance is key for longevity, pain-free function, power and control. I broke the attack down very simply to highlight a few major areas of weakness that is often found in volleyball players. Give these mobility and strengthening exercises a try and see what works best for you.
At Athletes’ Potential, we believe that self-maintenance should be the first step toward managing pain and recovering properly. But if you have a nagging volleyball shoulder and cannot seem to find that silver bullet, give us a call!
Thanks for reading,
What is your pelvic floor and why does it matter? The pelvic floor is a sling of muscles that runs inside the pelvis. It works dynamically with the diaphragm and abdominals to dictate pressure during breaths. The pelvic floor also has intimate connections to the sphincters of your urogenital structures. These structures are important for 3 vital human functions: peeing, pooping and sex.
Yea, I said it. The stuff that no one wants to talk about.
Some men and women experience incontinence or urinary urgency but think that is “just something that happens” with age or high level activity. This simply is not true. Others may have pelvic floor dysfunction symptoms including low back/hip pain, constipation, painful sex or feelings of incomplete voiding.
Every time you breathe, your pelvic floor is moving and contracting. The way in which you stand and move has a direct effect on the ability of the pelvic floor or contract and work in synergy with the rest of the deep core. What if you could change a few daily habits and have decreased pelvic symptoms? Check out these 7 common habits and see what applies to you:
1. Ab gripping- Whether it is to make your tummy look flatter, for stabilization during everyday movements or due to overtraining abs at the gym, ab gripping is adding constant and unbalanced pressure to your pelvic floor. When you are simply moving throughout your daily activities, your belly should be relaxed! I give you permission to fight the social stigma of a less-then-flat abdomen and give your pelvic floor a break. Let the belly go!
2. Preventive peeing- Many people have the habit of trying to urinate when their body is not signaling that they need to void, usually right before leaving the house or on a scheduled break at school/work. This “peeing just in case” can also lead to pelvic floor dysfunction or worsen existing issues. Your bladder will now have a different set point of when it thinks it’s full! Now the pelvic floor muscles never have to be coordinated to control a full bladder and fight the urge for 30 minutes before you get home.
3. Hovering- Believe me, I’ve been at music festivals and used a porta-potty that was so gnarly I didn’t want to touch the handle! What I am about to say does not apply to that situation--I would not recommend that you ever sit in that. However, when using the restroom in public, many women will hover over the toilet while urinating. This is not doing your pelvic floor any favors. Remember, the hip musculature and pelvic floor have connections so while you are holding an isometric air squat, do you think your pelvic floor is relaxed? Hell no, it’s holding on for dear life. Take your time when peeing and try to sit whenever possible. Most bathrooms these days have those little paper covers for the toilet seat. Use that! And take your time, giving your pelvic floor time to relax and the bladder to completely empty.
4. Breath-holding- As I mentioned before, the diaphragm and the pelvic floor work together. So breath holding will also increase pressure on the pelvic floor and increase the likelihood of leaks. Those who use breath holding as a strategy while moving light object or bending over, usually do so to avoid a leak or feeling of urgency. However, this increased pressure increases the likelihood of a leak! I understand that there are times breath holding is essential- lifting heavy weights. There are alternate strategies to avoid leaks in these situations—outside the depth of this post!
5. Butt clenching- This goes right along with ab gripping- relax! Deep hip muscles have fascial connections with the pelvic floor, so a tight booty = a tight pelvic floor. But tight means strong, right? No, in this sense I mean tight as in over-recruited. Your pelvic floor is on high guard all day from increased pressures and over-recruitment. Then you expect it to hold on tighter with a violent sneeze or a couple dozen box jumps? It is tired! The pelvic floor function and intimate relationship is more about timing and synergy than strength. Ladies- be careful when are trying to look sassy in those heels on Saturday nights. High heels can also cause women to unconsciously hold their pelvis in a tucked position or butt clench.
6. Poor posture- So I have said a lot about pressure, particularly imbalances and increased amounts. However, posture is often the prequel to the alternate recruitment strategies discussed above. If your diaphragm and pelvic floor are not stacked on top of each other, then they are at a disadvantage for working together. In appropriate synergy = pelvic floor dysfunction. The best way to check this is to look at your posture in the mirror or have a friend take a picture. You want your rib cage and your pelvis in line. Poor posture indicators are your lower ribs poking forward, nipple trajectory pointing upward rather than straight, hip bones much further forward than your lower ribs.
7. Sitting all day- Sitting is just bad for you, plain and simple. But it has particular effects on the pelvic floor from both a myofascial and alignment standpoint. The glutes and your pelvic floor are buddies, they like to work together. When you sit on your glutes all day, the fascial layers become compressed and unable to slide as easily. As far as alignment, who can actually sit with good posture for 8 hours? Not me. I don’t think I would trust someone that could- they are probably an alien. Those deeper hip muscles that have connections to the pelvic floor can become tensioned and tight which could lead to a tighter pelvic floor- remember tight doesn’t equal strong! That being said, as you sit slumped over a computer, your alignment of ribs over hips is likely disrupted. Then we are back at the beginning with an imbalance of pressure. Don’t you see, it is a never-ending cycle?!
** Allergies/coughing/sneezing- Ok, so this isn’t a habit per se but worth noting on this subject! Women and men with persistent allergies causing frequent cough and sneeze episodes may also see increased pelvic floor dysfunction due to the frequent pressure changes. If this sounds like you, be sure to find some medicine that works for you or talk to a physician about possible allergies. If the coughing is from smoking, well that is absolutely a habit that you can direct effect!
I think it’s safe to say everyone could find at least one habit that applies to them. Take some time to be more aware of your posture and how you are holding your muscles when they should be relaxing! Stress urinary incontinence and urgency is not normal but it is common. You never know, a few simple habit fixes may resolve your symptoms. If not, reach out to us at Athletes’ Potential, we would love to help!
Dr. Jackie Varnum DPT
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!
Often times, external rotation is the focus in athletic movements. When the shoulder is externally rotated, it can be packed into the back of the capsule to improve stability and congruence. It also rotates the humerus in a way that the anterior structures of the shoulder have room to move without being pinned between bones. Many of the stretches people gravitate towards for the hip involve external rotation: sitting figure 4 stretch, pigeon, etc.
What is internal rotation and why do I need it?
Internal rotation is one of the movements of a ball and socket joint, such as the shoulder and hip. In the shoulder, it allows you to reach behind your back and pull your wallet from your back pocket or tie your bikini behind your back. More importantly for athletes, it allows you to keep the bar close to the body during Olympic movements and arrive at the bottom of a ring dip safely. Hip internal rotation is needed for athletes for proper biomechanics during any form of a squat or while running. Without full internal rotation, you will likely have a “butt wink” or your low back will slightly round at the bottom of the squat. It is also important for runners to have full internal rotation, coupled with extension, to allow correct biomechanics in the trail leg.
During internal rotation, the ball of the joint (humeral head and femoral head) will glide posteriorly and roll anteriorly. This movement can be restricted with a tight posterior capsule or muscles around the joint. Unfortunately, many people will have issues here due to increasingly sedentary lifestyles and desk jobs. As you sit all day, the hip rarely reaches full extension, allowing the posterior capsule to become tight. This in turn decreases the posterior glide and thus decreased internal rotation. The same deal happens at the shoulder when you sit all day at the computer with terrible posture.
Interestingly, hip internal rotation deficits have been correlated with low back and sacroiliac pain. It is better to start improving internal rotation now rather than trying to manage back pain!
How to check internal rotation
It is easiest to accurately check internal rotation of the shoulder with a buddy. Lay on your back, arm straight out to the side and elbow bent (as in the picture below). Your buddy should provide solid but comfortable pressure to the front of your shoulder to avoid it from raising off of the ground. Now move your palm down towards the ground. Ideally, you would be able to get at least a fists-width from the floor! Be sure to check both sides because noting an asymmetry is important. Also, be sure to do this same test after practicing the mobilizations below!
To check hip IR, lay on your stomach and allow your feet to drop out to the side. Again, we are looking for asymmetries and major deficits. Ideally, your leg will move about 40 degrees or roughly halfway down toward the floor.
Mobilizations to Improve Internal Rotation
Below are a few mobilizations for the shoulder and hip to improve internal rotation. They are by no means an exhaustive list but merely a starting point.
Bully stretch- used to mobilize the humerus into the back of the shoulder capsule, which increases internal rotation.
Pec smash- nearly everyone has a tight pec minor due to the poor postures we often keep throughout the day. This muscle is located in the front of the shoulder, so if it’s tight it can easily restrict the posterior glide!
Internal Rotation Stretch- start with your foot flat on the ground and the other leg crossed over. Slowly walk your foot out to the side until you feel a strong but comfortable stretch in the hip. You should feel this in the bottom leg.
Lateral Hip Opener- this does not have to be banded if you do not have access to one, you will still feel a stretch!
I hope this gives you a better understanding of what internal rotation means, how we achieve it and why it is needed. More importantly, I hope these videos give you a good idea of how to begin to manage internal rotation deficits!
At Athletes’ Potential we want to help every athlete remain healthy and meet goals. You don’t have to be in pain to come see us. If you find asymmetries with tests such as these or know you have movement deficits, we can help you with proper movement and self-maintenance. We also have recovery options to further augment your fitness and health. We look forward to hearing from you!
Thanks for reading,
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Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.