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
I recently attended a continuing education course called Functional Range Conditioning (FRC). It was one that has been on my list for quite some time and it was awesome to finally check it out.
In this blog post, I’m going to expand upon some of the principles and techniques I learned and how you can start to implement this in your daily movement practice.
First, let’s define a few words. What is flexibility? What is mobility? Are they the same thing? We hear these words used interchangeably. However, they are in fact different.
The foundation of the FRC system is based on the acquisition and maintenance of functional mobility and articular health. It is very dependent on your passive and active range of motions.
Basically, the goal is to make your AROM and PROM the same. PROM is the prerequisite which will allow you to improve your AROM.
FRC utilizes a concept called “bioflow.” While I don’t get too caught up in systems or their coined terms, I’m cool with this one. It basically talks about tissue continuity (gross tissue --> cellular --> intracelluar) calling it STUFF. Stuff being cells, fibers, and ground substance. Composition of these components dictate the type and physical properties of a certain tissue whether it's bone, fascia, ligament, tendon, muscle, capsule etc. Cell signaling and progressive adaptation is how these cells change into these different structures. Think about an ACL graft that is harvested from a patellar tendon – do you think it stays a tendon over time or evolves to becoming a ligament just like the initial ACL? Yeah, science is pretty cool.
I could geek out on this stuff all day, but let’s move on to the application of improving your mobility – there’s a few techniques used to start working on making your passive movement more active.
Insert Controlled Articular Rotations (CARS) - Active, rotational movements at the outer limits of articular motion. There’s 3 levels for CARS which are related to isolated blocking, external resistance and amount of irradation. Irradation simply put is the amount of tension you create throughout your body – in nerdy science terms this is also called Maximum Voluntary Contraction (MVC) often expressed in percentages.
The best example of irradation is to give someone a hand shake. First, squeeze using your hand, then hand and forearm, then hand, forearm and shoulder, etc. Your grip gets stronger and stronger the more musculature you recruit. The more irradation, the more force you exert. You can use this to dial in higher levels of recruitment while doing your CARS or other FRC techniques. “Force is the language of cells” – one of my favorite quotes at the course.
CARS can be implemented different ways whether that is by focusing specifically on a certain joint or you can take part in the morning CARS routine to give all your synovial joints in your body some love each day.
The next step to continue to work on improving your joint integrity and control is via PAILS and RAILS. PAILS and RAILS are isometric contraction efforts (sometimes combined with stretching) used to communicate with both the connective tissue & neurological systems.
2-3 minutes of stretching to build stretch tolerance, then:
This is a great video by Joe Gambino from Par Four Performance going over the Hip 90/90 PAILS/RAILS.
I see PAIL/RAILS as a way to safely acquire and create control into these newly stretched positions without movement. Basically isometric holds to own a position with increased stretch tolerance.
The next and my most favorite part of the course and system is the End-Range Control techniques. End range is where we see a lot of injuries and tissues breaking down. Why? Well, from a physics standpoint, we’re just not able to produce as much force at these end ranges due to length-tension relationships. Another big factor is because we rarely go there. And when we do, we typically aren’t ready for it and are pushed there by accident – which is why we need to train these end ranges. It allows us to build better tissue resilience and reduce the risk of injury. Here’s how we break down end-range control:
End-Range Control: PALS/RALS
Passive Range Holds
Passive Range Lift-Offs
End-Range Rotational Training
My suggestion is don’t get too caught up on the wording of these different techniques, but understand the conceptual framework and you’ll be able to implement this immediately. We all know that we have certain aspects of our joints where our active and passive is not the same. If you’re wanting to improve your squat or overhead position, or if you just want to build up resiliency in different tissues, then give your joints some love with some of these different techniques.
Dr. Ravi Patel, PT, DPT, CSCS
It’s baaaaack. The largest fitness competition on Earth, the CrossFit Open, is finally here. Maybe you’ve trained all year for this, maybe you’re still new to CrossFit and are curious about all the excitement. Maybe you’re a seasoned vet, maybe this is your first Open you’ve ever participated in. Regardless of your CrossFit background, your fitness will be tested, your mental toughness will be challenged, and you will certainly have a blast working through these workouts with your crew at your local CrossFit affiliate.
That being said though, this is typically a time where we start seeing an uptick in the people we see coming in for CrossFit related injuries. Having an athletic background, where I had to personally sit out multiple seasons due to injuries, I speak from experience when I tell you there is nothing worse than working all year towards a goal/competition/test and not being able to perform at an optimal level, if at all, because of an injury. And, look, I get it. There is inherently an increased risk of injury when you're pushing yourself in a competitive environment. However, there are some very important things you can do to minimize this risk and allow you to perform your best. Let’s take a look at the three easy things you can do:
#1 Don’t Be Reckless
This is huge and something I see year after year. If you’re a CrossFit coach, or even just an observant CrossFit athlete, I’m sure you’ve seen what I’m about to explain...You’ve worked all year to create movement patterns that are both safe and effective. You know the importance of good, quality movement. However, throw in the element of an international competition and it seems like all these lessons about technique go out the window.
For example, last year’s first Open workout (18.1) consisted of three movements: toe-to-bar, dumbbell clean and jerks and rowing. Can you guess what type of injury we saw coming into our clinic after this workout? If you said back pain, you’re correct. But why? Well, with this workout people were trying to perform as many rounds as possible for 20 minutes. To get better scores people weren’t maintaining core control for a solid hollow position with their toes-to-bar, they stopped getting full hip and knee extension for optimal power production during the drive portion of the clean and jerks, and/or they started to over-extend during the rowing component. All of these create situations that are destined to increase stress on your low back. Keep in mind that this was just the first workout! Now you’re either completely unable to participate in the other workouts or will not be performing at an optimal level because you’re trying to grind through an injury.
#2: Protect Your Sleep
There are four main pillars of health care that we look at with every patient who walks in the door at Athletes’ Potential: Movement, Stress, Sleep, and Nutrition. Sleep is easily on of the biggest problems that we see out of these pillars. And check this out: Sleep affects everything you do and everything you do is positively affected by quality sleep. Good, quality sleep literally improves everything: every marker on a blood panel, weight management, sport performance and recovery, productivity, and numerous types of disease management. The list goes on and on, yet the percentage of sleep deprived Americans, particularly in Urban areas, continues to rise at an alarming rate. In fact, the U.S Centers for Disease Control and Prevention reports that more than 30% of Americans are sleep deprived getting fewer than 6 hours of sleep per night.
If you’re not getting enough sleep, you’re not giving your body a chance to recover. If you’re not recovering appropriately, then you're leaving yourself at risk for injury and decreased performance. So, bottom line: create an optimal sleeping environment, protect your night time routine, and get some good, quality sleep.
For more info on how to optimize your sleep, check out this article we wrote.
#3: Maintain Perspective
This comes full circle with tip #1. For those of you trying to make it on to Regionals, those extra few reps I mentioned could be the difference in making the cut vs staying home. However, for the vast majority of athletes competing in the CrossFit Open this is not reality. You all have careers, kids you need to take care of, and numerous other responsibilities that you need to keep rocking with once you leave the gym. Is bouncing off the top of your head to get an extra rep or two really going to mean that much if by doing so now you can’t look over your shoulder while driving? (yes, this is a real scenario that we’ve worked on at our clinic...I’m looking at you 17.4). Or is that two position jump on the leaderboard really all the important if now you can’t bend over to pick up your kids?
CrossFit is meant to be a competitive, fun, and challenging way to make all aspects of life outside the gym a little easier. This time of year is huge for all CrossFit athletes and it is truly impressive to see the physical accomplishments and PR’s that happen every single year in the Open. However, the Open isn’t an excuse to throw all safety out the window, but it isn’t something you should be afraid of either. Following these three easy tips will ensure that you have a great time, reduce your risk of injury, and maybe even hit a PR or two.
Thanks for reading,
Dr Jake, DPT, CSCS, CF-L1
Have you ever been in the middle of a workout and feel an ache or pain? It’s completely normal if it’s something small and goes away. It’s another story if it continues to bother you or increase in pain.
Sometimes we just do too much (or too little) and it pisses off some part of our body.
You may start to realize it’s impacting the way you move and you may even avoid a particular movement that causes the pain altogether.
Often times, people see this as a sign to take some time off and rest. This may be the case in some instances, but it’s not always the best solution.
Some people go to a healthcare professional to find out what’s going on. Quite frequently, they’re told to stop that activity or exercise. We hear it all the time from new patients.
“Squats are bad for your knees.”
“Running will wreck your body.”
“Stop doing CrossFit. You’ll get hurt.”
But, what if you’re an Olympic weightlifter who has a competition coming up? What if you’re a runner who loves a good 5k? What if you have a stressful job and CrossFit is your outlet to relieve that stress?
Come on, healthcare - we can do better.
If these are your goals, we want to help you get there.
Here’s 5 different ways to train around pain and decrease stress on that painful area:
MAIN GOAL: MAKE THE LEAST CHANGES POSSIBLE TO THE MOVEMENT
Now, let’s break down each one of these using knee pain with front squats as an example.
Here are a few other examples for you:
Here’s the overall concept:
Pain comes on --> scale back movement slightly --> train movement --> adapt --> progress difficulty --> adapt --> back to prior level --> continue training pain-free --> hit PR
I believe that any great coach or physical therapist should be able to modify and progress/regress any movement or activity.
If you have given these methods a shot and pain continues to impact your life, then find a healthcare professional who understands your goals and doesn’t tell you to stop.
Dr. Ravi, PT, DPT, CSCS
The CrossFit Open is finally here. After all of the countless hours spent in the gym perfecting your craft, it’s time to see just how far you’ve come in year’s time. I’ve got some good news for you too, simply by signing up for the CrossFit Open you’ve set yourself apart from your peers as only approximately 20% of CrossFit members worldwide have the moxie to put their money where their mouth is and actually sign up for the Open.
Now that you’re here though and you’ve made it through that miserable 18.1 workout, it’s time to grind through another 4 weeks designed to push you to your absolute limit. As daunting as that sounds, there’s a secret out there that elite athletes figured out a long time ago, yet it still gets ignored by most people in the gym. Recovery.
No matter how much you train, most of your hours during the day will be spent recovering. Recovery is undoubtedly the most overlooked aspect of training. Tell me if this sounds like something you (or let’s just say somebody you know). You rush from work to get to the gym, get there barely in time to hear your coach going over the day’s workout, then after blasting through a max level workout you rack your weight, grab your keys and head out to your car to get to the responsibilities waiting for you at home. Rinse and repeat throughout the week.
I see this all the time in the gym, and quite honestly I’d be lying to you if I said I haven’t had this happen to me as well. The issue with this all-to-common scenario though is that when you do this, you are skipping out on arguably the most important aspect of any training program. If you are not recovering appropriately then you’re leaving performance on the table and setting yourself up for injury.
Elite athletes and their trainers know exactly how important it is to recover appropriately, they spend endless resources monitoring their athletes’ bodies vital signs and other physiological functions in order to objectively determine when they are ready to go full throttle. However, for those of us who don’t have the ability to measure things like heart rate variability 24/7, there are a few things you can do to optimize the speed and effectiveness of your recovery:
1. Post Workout Cool-Down: Immediately following a workout do some form of very light activity (ex: walking, light row, light bike, etc) and then take another 10-15 minutes to work on soft tissue and joint mobility. Doing these things will not only decrease the soreness you experience after workouts, but it will allow your body’s heart rate, blood pressure, and nervous system to return to baseline levels. All of which are crucial to optimizing recovery. While you should choose which soft tissue and joint mobilizations you should do based on the movements performed in the WOD, some of my favorites are listed below. Perform each drill for 2 minutes.
2. Get Appropriate Sleep: I cannot overstate how important it is to get appropriate sleep. You should be getting approximately 7-9 hours of sleep per night, and during the open you need to towards the higher end of that range. To find out more information on how to optimize your sleep, check out our previous blog article "Top Two Ways To Improve Your Sleep."
3. Eat the Right Food: As the saying goes, “food is fuel for your body” and you want to be giving yourself some jet fuel to optimize your CrossFit Open performance. What this means is you need to be eating the right foods in the right proportions to restore your body’s energy levels and to give it the needed energy it needs to repair and recover. You can find more info on how to do that by checking out out previous blog, "Which Diet is Right For Me."
4. Staying Hydrated: You should be drinking water constantly to maintain good muscle and vascular health. The general recommendations say to drink 8 eight ounce glasses of water a day. However there are plenty more variables that go into determining the appropriate amount of water for you to drink. Click here to go to a calculator that will give you a better idea of how much water you need to stay appropriately hydrated throughout the Open.
So, if you want to get your best possible score in this year’s Open AND decrease your risk of injury then you need to make recovery a priority. A lot of things factor into recovery periods that are outside of your control (age, genetics, training experience, etc.), but by doing what we covered in this article you will be setting yourself up for success by recovering like a pro and getting the most out of your workouts.
Thanks for reading,
Dr. Jake, PT, 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.
Dr. Jackie, PT, DPT, OCS, CSCS
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.
If you've been struggling with knee pain for more than a month, it's time to get some help from a professional.
We help people just like you get back to being pain free and back to the activities they love, everyday.
With our three step process, we eliminate pain, fix the root cause of the problem, and teach you how to keep yourself healthy.
Click the blue button below to get started or call us at 470-355-2106.
The Athletes' Potential Team
One of my patients woke up the other day with pain that started on one side of her lower back and radiated down her hip, hamstring and into the side of calf. She told me this while I was making pancakes on Saturday morning for our kids. My wife is my number one patient so I’m writing this blog post for her. I know that many of you suffer from some degree of pain radiating down a leg as well. My goal with this blog post is to teach you a few simple strategies to ease these symptoms.
Let’s start by defining sciatica. It’s actually an umbrella term describing pain that radiates along the course of the sciatic nerve. The sciatic nerve is a huge nerve that starts in the lower back. It comes together and courses down the hip, through the hamstring and then branches into two other nerves at the height of the knee. If you’ve ever sat on something hard like a wallet for too long on one side, you may have experienced some short term sciatica.
What sciatica is and what causes sciatica are two separate things. Sciatica itself is the pain/irritation you feel down the leg. The cause of sciatica can be a number of different things.
First, it could be coming from your lower back. This could be due to a bad disc herniation, poor movement at the small joints in the lower back, lack of mobility in the hip and even prolonged positional pressure like sitting on a plane to Australia.
Because of the many varying causes for sciatica, my goal is to give you a number of different self-management options. We’ll cover three different areas where you could improve and ease much of the sciatica that you do experience.
These areas are:
Step 1: Easing sciatica issues by getting out of positions that cause increased symptoms
This seems blatantly obvious to most people. The reality is that many people stay in pain producing positions for extended periods of time.
For instance, let’s take a traditional office-based job. Sciatica can be irritated with prolonged sitting, especially in a very flexed position. This puts the lower back into a flexed or rounded position. Because of this forward flexed position, the discs (think shock absorbers) of the lower back had additional stress placed on them throughout the day.
Take a look at the picture below. This shows the amount of pressure on the discs of the lower back in different positions. You can see that sitting in a forward flexed position increases the amount of pressure on the discs by 85% compared to standing. Even sitting in a good position increases the pressure by 40%.
What this shows us is your best option is to stand more, if possible. Even better, stand up and walk around more. Walking is like spraying WD-40 on the joints of the lower back and hips. Getting a standing desk is a good option for most people. They are becoming much more common in workplaces and even in schools. Stand Up Kids is a great reference for some of the other health benefits to getting a stand up desk.
If you are stuck sitting at a desk and you notice your back feels better when you stand, a lumbar roll may be a good option for you. These are firm rolls that are placed at the height of the lower back. They block the user into a more upright sitting position and deter much of the slouching that we see when people sit at a desk all day. You can also make yourself one of these pretty easily. Just get a gym towel, roll it up tight and duct tape around the roll. That’s it. It may not look as cool but it works.
Step 2: Easing sciatica issues by adding in self-mobility work to muscles in the lower back and hips
Let’s go over two areas you can start working on daily to help ease pain down the leg. For all of these areas our dosage is this: perform them twice a day, two minutes each technique per side. For all three techniques it should take you about 8-10 minutes with transitioning from one exercise to the next.
The first muscle is the quadratus lumborum. We’ll just call this muscle the QL because the actual muscle name sounds like a Harry Potter spell. The QL is a muscle that is one either side of the lower back and connects from the rib to the lower back to the pelvis. This muscle can refer pain down into the back of the hip region and is notorious for being irritated in people who sit all day or lack strength in their trunk.
The second muscle is actual a group of muscles. We call it the lateral hip complex but it includes fibers from the gluteus maximus, gluteus minimus, gluteus medius and deep rotators like the piriformis. These muscles, in particular the piriformis get blamed for much of the sciatica people experience. We’ll catch a little bit of all of these muscles with this one technique.
Step 3: Working on improving control of the lower back and hips
This step is often the one that people skip over. This is especially true if someone gets pain relief with some of the mobility techniques or a passive treatment like dry needling or massage. Controlling your own body is massively important. I love the saying, “Strength is never a weakness,” and it’s true in this case. Here are two techniques to get some control back in the right areas.
The first thing we want to do is account for a huge area of dysfunction in almost every patient I see. That area is breathing! I know, you’re obviously breathing if you’re alive and reading this article. Just because you’re breathing doesn’t mean that you haven’t started doing it in a compensated way. We take an astounding 20,000 breaths per day. Many of us who have had issues with sciatica or lower back pain tend to breath in a dysfunctional pattern.
The main dysfunctional pattern I see in my patients is chest breathing. These are the individuals that just raise their rib cage and shoulders every time they breath. What they neglect to use is the diaphragm to initiate the breath movement. This can happen for a number of reasons but for the purpose of this article let’s just leave it as something we want to try to correct.
Below is a breathing exercise you can start using to correct this problem. Try and get 5-8 minutes of this breathing drill in per day. You can break it up into 1-2 minute bouts or get the whole 5-8 minutes in at once if you want.
The last exercise you can add in is to help develop some control in extension between your lower back and hips. This is an exercise called the banded bird dog and it requires a significant amount of stability/control. It also connects the hip with the shoulder on the opposite side. This is very important because we function so much in rotational patterns. Think about throwing a ball. If you’re throwing with your right arm then your plan leg is your left leg.
This diagonal control is very important for the lower back and controlling torque through the spine. Getting strong in this pattern is one of the best ways to create long term function and decrease the likelihood of sciatica issues.
Try and do 3 sets to form fatigue with as much rest in between sets as you need. Form fatigue is when you can’t perform a perfect repetition anymore.
If you’re like me you probably read the highlighted bullet points and then you’ll read this last paragraph (I call it efficient reading!). Let’s go ahead and summarize everything and make sure we’re clear on what to do.
First, get out of positions that cause sciatica. Move to a standing desk if possible and if not get up and move around as much as you can. Next, start working on mobility to areas that can be problematic for sciatica. This includes the QL and the lateral hip. Last, start getting some control back in your hips and lower back. Control and strength in these areas will be a huge benefit to you in any physical activity you chose to do.
Give this stuff a try for a week or two. If you feel like you’re not making progress or are ready to get some one on one help, we can help. We help people just like you get back to running, golf, tennis, CrossFit and cycling without sciatic pain. Check out our testimonials pain to see what others have to say about the work we do. Stop avoiding activities because of pain, get some help and get back out there.
- Dr. Danny, PT, DPT, OCS, CSCS
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!
Dr. Jackie, PT, DPT, OCS, CSCS
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."
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,
Dr. Jackie, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention and sometimes other random thoughts.