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,
All too often the answer is “I just run my first half mile slower and then get into my running pace”.
Paula Radcliffe, one of the greatest female marathoners in English history, does a warm up for 45-50 minutes before a marathon race! That’s longer than most of us will run for our work out.
So why is it that elite runners and athletes put such an emphasis on warming up and we do not? There are a few factors that can lead to the lack of using a warm up.
We’re going to try and solve these issues with the warm up and put something together that you can do in a short period of time (15 minutes) before your next run.
Here’s the strategy in a nutshell: we need to get tissues opened up that can be primary limiters of running mechanics and we need to get muscles firing that need to be working for proper movement. Let’s start with opening up the tissues we need for running.
One of my favorite pre-run mobilization for runners to do is a quick pressure-based technique for the bottom of the foot. All you need is a lacrosse ball, baseball or some other type of hard ball to step on. Do not use a racquetball or a tennis ball, it’s a waste of your time because it’s not enough pressure. We want to open this area up before running because every little bit of increased ankle dorsiflexion will be a mechanical advantage for us in particular on hills.
Do this technique below for 1 minute on each foot
Next, we want to open up the hips, in particular hip extension. This allows us to get our leg behind us while we run without having to compromise our back to do so. This is also a huge area of emphasis because of the amount of time most of us spend sitting. When we sit we are in a hip-flexed position. When we run, we drive into the opposite range, hip extension. If you sit all day in hip flexion, your tissues get tight in that range and cause you to lose hip extension.
This is essentially a hand brake that you have with your forward movement. By opening up your hip extension, it allows increased ease of movement in the running gait. Here is what you’re going to do. This stretch is called the world’s greatest stretch and it really might be!
Perform this sequence twice on each side. It should take you about 1 minute to go through this sequence on each side. This gets things moving at the upper back, front of the hip and hamstring/calf. It’s really a catch all for many athletic movements but in particular running.
Alright, we should have those done in about 5 minutes. On to the priming of the movement that we want to perform.
I’m a big fan of working on the skill of running. That’s right, running is a skill and if you treat it that way your body will thank you and your finish times will be better. Practicing certain movement prior to running can help us ingrain good moving patterns while we are running.
The first drill is a pulling drill that I use all the time with my athletes. Do 1 minute of pull drill work like Nate explains in the video. After that, run for 1 minute trying to emphasize the same exact pull feeling that you got doing the drill.
The last drill will be to work on your cadence. Cadence is how many foot strikes you have in a minute. Coaches and researchers have found that having a cadence around 180 foot strikes per minute is a very efficient place to run. This allows for you to pull your foot quickly off the ground and minimize some of the elongated ground reaction force that happens with a very slow cadence.
Download a free metronome app on your phone. Put the beats per minute at 90. You’ll try and have your right foot hit the ground every time it bets. This will equal 180 foot strikes per minute since you’re only counting the one side. Run for 1 minute at this cadence but try and keep a slow to moderate pace. Don’t go bananas and try to run a 4 minute mile because you’re increasing your cadence. Stride length plus high cadence is what allows us to run really fast efficiently. Shorten your stride and keep your cadence high during this drill. You should imagine you’re running on hot coals.
In summary your warm up should look like this:
Don’t be surprise if you’re breathing a little harder after your warm up. That’s why it’s called a warm up! You’ve got to prime your body for what you’re about to do. This could be the single most important thing you can do to maintain your body as a runner and improve your skill of the movement.
If you’re a runner, triathlete or CrossFitter that wants to improve your running or are dealing with a run-related injury let us know. We’ve literally helped thousands people with knee, foot, hip and back issues related to running. Don’t wake up every morning wondering if this is the day your knee will stop hurting when you run. There are answers out there and we can help.
Contact us below if you would like to set up a free talk with one of our Doctors of Physical Therapy to see how we can help you run pain free
Thanks for reading,
Full disclosure, I hate to run. There, I said it and now I feel much better. I actually have more of a love/hate relationship with running. I love the science and technique of running mechanics. I’m actually fascinated by how you can squeeze more speed and efficiency out of someone that just assumes they are a bad runner.
When it comes to my personal desire to go for a run, it’s just not there. I blame the Army. They kind of ruined it for me with the whole wake up early and do a forced run almost every morning. Because everyone in the Army is technically a runner, we would see a TON of running injuries. I would guess that 50-60% of what I typically saw was running related. That’s literally thousands of running related injuries that rolled through my office during my time on active duty.
Now that I’m out of the Army and have a private physical therapy practice in Atlanta, I’m still seeing runners. I’ve actually developed some good relationships with a few of the bigger running groups here in Atlanta and it’s been a blast to help these athletes get better fast. Healing from an injury is great but do you know what’s cooler than that? Winning!
As a runner you are competing against others when you run but for most of us we are constantly competing against yourself to get a personal record (PR) on a race. I recently had a runner come to see me for some plantar fasciitis. If you are reading this and have actually put some decent volume in training you probably cringe when you hear the words plantar fasciitis. It’s basically the kiss of death for a runner and will take you out of your sport for a long time, if not fixed.
This individual had seen everyone under the sun for this issue including, podiatry, chiropractic, massage therapy and a different physical therapy group. This problem had been going on for about a year at this point and he was obviously frustrated when he came in to see me. He was also very surprised when I told him that we had to watch him run. Can you believe that? This guy had been to multiple other medical professionals and not a single one took the time or even thought it was important to watch him run. This is crazy! What if you went to a mechanic and he didn’t actually drive your car around to see what the problem sounded like or how the car acted when it was running? That's basically what had happened to this athlete.
After watching him run it was pretty obvious he ran like crap. I won’t get into all the specifics of the running mechanics in the blog but just remember my professional diagnosis was not plantar fasciitis, it was you run like crap. My prognosis was good. It was forget about your foot pain, we are going to make you faster! He was also had really bad hip mobility and tons of hip weakness. We spent the first two visits working on run form and getting some of the pain down in the calf/foot with soft tissue techniques to include Hawk Grips work and Performance Dry Needling.
Over the next two visits we re-tooled his running form even more and added in strength/mobility work for his hips. Think of your hips as the engine of movement for running. If you have poor hip strength/mobility it’s like riding your bike around on flat tires. Sure, you can still ride a bike this way but it's a hell of a lot easier to ride with with some air in the tires. Running is hard enough, don’t make it harder than it has to be.
Below are the exact 3 exercises we nailed down for this athlete to do to help fix this chronic foot pain and none of them have anything to do with the foot directly. The order of completion was this.
Pre-run (videos below)
-Anterior Hip Mobility Opener 2 minutes per side
-Band Hip Pull Throughs 2 sets just to muscle fatigue not failure
-Band Hip Side Steps 2 sets just to muscle fatigue not failure
This athlete typically ran 3 days per week so that’s all the strength work we added in for him. He did complete the anterior hip mobility opener 2 minutes per day regardless of if he ran or not that day.
So what was the result? 4 visits over 6 weeks. 5 minute PR on his 10K time. Oh and no foot pain. If you’re having running-related problems, fix the cause of the problem not just treat the symptoms.
If you’re in the Atlanta area and are a runner that has been dealing with injuries we can help. We’d love to chat for a few minutes and see if you are a good fit for what we do. Fill in the contact request below and we’ll set up a free 10-minute phone consultation with one of our Performance Physical Therapists.
Dr. Danny Matta DPT, is a Physical Therapist and Strength Coach based out of Atlanta, Ga. He teaches on the topics of movement efficiency, mobility and injury prevention internationally. He is also the Director of the Tactical division of the renowned MobilityWOD group started by Dr. Kelly Starrett DPT.
Full bio here.
June 2014 July 2015
Testosterone- 802 Testosterone- 421
HbA1c- 5.3 HbA1c- 5.7
HS CRP- 0.9 HS CRP- 2.6
Let’s face it: we live in the information age. You can find out pretty much anything by searching for it on the internet. There has also been a massive shift toward data driven decisions. I see it first hand in my business when I look at our website analytics. We even see it with things like Wodify as athletes start tracking all their workouts, strength numbers, training sessions and making training changes based off actionable data.
Think of this blood panel like a snapshot of what’s happening internally. As part of the initial testing phase to work out the kinks, my wife and I both went through the process to get blood drawn and see how long it would take to get our results back. When I got my results back, I was shocked!
Last June, as part of my transition out of Army, I requested some blood panel work from my Physician Assistant. I wanted to start doing a more in-depth panel of blood tests yearly just to see where I stood and to gauge my nutrition/training based off that. For me, I used that as my initial data to compare this lastest to. Here are the tests that were grossly different:
A good number more tests were performed besides these three but these were the ones that had the most noticeable changes. What does this even mean? In the past year my testosterone production had decreased by 50%. Testosterone is very important for recovery, building muscle, maintaining a lean body and many more very important tasks. According to a 1996 study by Vermeluen et. al, the average testosterone levels for someone my age (30 years old) is 617. To make matters worse, in the same study he found that the average testosterone levels of males age 75-84 was 471. Talk about kicking me while I was down! This basically shows me that there’s a decent chance my 90 year old grandfather and I have the same testosterone production at this time.
Next is the change in HbA1c. This is a marker of average blood sugar levels over the past 3 months. Most of you have probably heard of diabetes. It’s basically a disorder of high blood sugar levels in the body. It can either be genetic type I or developed type II. The range for HbA1c is pretty clear. Anything below 5.7 is normal, between 5.7 and 6.4 is prediabetic and over 6.4 is full blown diabetes. My number is elevated quite a bit and it technically puts me in the prediabetic range.
Lastly, was the change in my HS CRP. This is a marker of global inflammation in the body. To be clear, inflammation is not a great thing to have in the body. Increased values on this test in particular have been drawn to increased risks for cancer, heart attacks, neurologic disorders and type II diabetes. My HS CRP was elevated compared to where it was a year ago going from 0.9 to 2.6.
Now, when you see these big changes in values your physician should ask you a few things. First, did you do some crazy workout that day or the day before? Did you go out with your friends the night before, end up at the Clermont Lounge and down PBRs all night? Have you had a week of really bad sleep before this test cluster? All of these things are important to know because it can give us false values. By the way, my answer to all these questions was no.
Here’s what all this means. In the past year my health, internally at least, has slowly been trending in the wrong direction. So how did all this start to go wrong? I would have to attribute it to a number of factors. First, I started a business. For any of you that have ever started a business I probably need no further explanation. For those of you that haven’t, it’s the most difficult and stress-inducing thing anyone could ever do. Not only that, but I teach for another group (MobilityWOD) and in the past 12 months, I’ve accumulated about 70,000 miles on an airplane. I also have two small kids under the age of 4 and I typically sleep an average of 5-6 hours a night.
It’s not all bad news though. Mom, if you’re reading this don’t freak out and call an ambulance for me! I’m glad I did these tests because I had been feeling fatigued and like I was recovering poorly from my training sessions for about the past 6 months. Now I have some quantifiable data to help me make changes and retest to see what’s working. Changes will be made and I will retest in about 1-3 months. All of these markers are reversible with some supplementation changes and behavior modification. I’ll write up a follow up post once I’ve done my blood testing again. It’s time to make some changes!
It’s 5am, you’re up and getting ready for work. You got 6 maybe 7 hours of sleep last night and you’re off to crush the day at the office! Coffee in hand and listening to your favorite podcast on the drive (most likely the Doc and Jock podcast). You get through your normal day and then sit in traffic for 45 minutes on the drive home (Atlanta traffic can be rough). Once you’re home it’s family time. You haven’t seen your kids or wife all day and all you want to do is hang out with them. Before you know it, it’s 7pm. Your kids are acting crazy because they don’t want to go to bed and you’re starting to get hungry. Once the kids get to bed you have a couple choices:
I know to many of you this example may or may not resonate. This is basically my schedule 3-4 days a week. For many people lacking time is a common frustration. For me, it happens to be dictated by owning a business, having kids, enjoying spending time with my wife and creating online content like this blog post.
Of all the options above I typically go with option 4 on a day like I explained. Hitting a short but intense workout before I eat dinner is an easy way for me to keep some regular training in my schedule on busy days like this. My preference for these late evening workouts after a hectic day- the kettlebell!
I feel everyone should have at least one kettlebell at their house. We have two at mine, a 24kg bell and a 16kg bell. They don’t take up much room, are pretty inexpensive and they give you a ton of options when doing a training session at home.
Here are a few examples training sessions I like to do that just involve one kettlebell.
As many rounds as possible in 20 minutes. 24kg bell for men and 16kb bell for women.
-10 overhead swings
-run 200 m
-5 power clean and jerk each arm https://www.youtube.com/watch?v=bjKGrZ7-pWQ
-run 200 m
-10 goblet squats
-run 200 m
Perform 5 rounds of
3 Turkish Get Ups each side
20 russian swings
10 head cutters https://www.youtube.com/watch?v=tJA07NpN7pM
Rest 1 min
Every minute on the minute for 15 minutes
5 single arm KB snatches https://www.youtube.com/watch?v=g3c73NahdjU
Complete each round as fast as possible.
Throw in some midline stability work at the beginning or end and you have yourself a respectable little training session. Not only that, but in the time it would take you to drive to the gym and back, you completed a training session.
You may not be headed to the CrossFit Games doing just these type of workouts alone. Chances are, if you’re reading this you aren’t going to the CrossFit Games regardless! Staying committed to regular training sessions is important for moving well, staying fit and being able to keep up with two crazy kids.
One year ago, I was sitting at a desk in an office in the Troop Medical Clinic next to the U.S. Army Airborne School at Ft. Benning. I remember my last day as a Physical Therapist in the Army. I didn’t see patients that day. I had to go around the post and make sure I was cleared to leave and was fully out processed. This requires a lot of waiting as many other soldiers are doing the same thing. Waiting in long lines affords you an incredible amount of time to think and in my case worry about the future.
As I sat in the endless lines to finish my out processing from the Army, the same question kept running through my head. Am I making the right choice? I would think anyone that has started a business has had the same doubts. This same question constantly ran through my head for about the first six months after I separated from the Army.
I had spent 7 years in the Army. I was literally born in the Army since my dad was a career Army officer. I grew up on military bases, I had a high and tight haircut for the majority of my life and I knew little in regards to how the civilian world differed from the military.
To make things more complicated I had a family to provide for. When I left my comfortable job with great healthcare benefits it was at a time when I had a 2 year old son and a 6 month old daughter. My goal was to leave the military, move to Atlanta, Georgia, open a physical therapy practice that didn’t accept insurance and do it in a CrossFit gym!
As I write this, my plan sounds reckless. Obviously most of my friends and family thought my plan sounded crazy and they voiced their opinions/concerns to me up until the day I got out of the Army. The reality is that they were worried about me. They didn’t mean to be negative because they didn’t believe in me or what I was doing. They didn’t understand what I was doing or why I was leaving a steady paycheck and good benefits. It was hard for them to accept and their anxiety over the transition manifested itself in questioning my decisions.
This is something you have to come to terms with quickly if you want to be an entrepreneur. That’s exactly what you’re becoming if you decide to open a physical therapy practice. You may be a physical therapist but above all else you are a businessman/businesswoman. Get used to people doubting you. Get used to people questioning your decisions. You have to embrace it and the faster you do it the better you will feel.
Our vision is very clear at Athletes’ Potential.
With a commitment to excellence we embrace our role as a cornerstone of the medical and strength and conditioning community. We strive to provide honest patient care and respect those that work with us in a way we would want our own family members to be treated. We serve others selflessly every day and aspire to become a lifelong resource to our clients, their friends and family members.
Leading from the front is the only way to lead. We embody our values both in the workplace and outside of it. We strive to live long, healthy and happy lives through clean nutrition, regular training and positive relationships with our loved ones.
Thank you for being a part of Athletes’ Potential during our first year in business. You are the reason we have succeeded and we appreciate your trust in us. Together we’ll make our second year even better than the first.
“80% of success is just showing up, the remaining 20% is based on knowledge, skill and execution.” Woody Allen
If you’re a coach/trainer you have entered a vitally important career. You get to help people be healthier, stronger, happier and live longer more fulfilled lives. It’s an amazing time to be in this career field as well. More than ever, wellness and health are being prioritized.
If you’ve chosen to be a coach, you’ve also chosen to be a slave to learning the rest of your life. That’s right, you will continually have to read, listen to podcasts, watch webinars and attend courses. You don’t just get your certification and that’s it. For some coaches, this is what they love most about their job (me included). They have an insatiable drive to learn more and become better and better. Others struggle to find time to continue learning. If you have kids, you probably know exactly what I’m talking about.
I’m a huge fan of reading. Not just physical therapy, medical or strength and conditioning material. I love reading personal development, business, psychology, marketing, sales and even fiction.
One of my favorite books is The Slight Edge by Jeff Olson. This is particularly important to read if you’re in a field like a strength coach or the medical field. Anyone can become a CrossFit coach, personal trainer or physical therapist. Within these sub-specialities there are different levels of knowledge level, skill and experience. If you want to be the best in your career field, use the principles of the slight edge.
1. Show Up
Think of people you know that aren’t naturally the smartest or most talented. I graduated no where near the top of my class in PT school. I know tons of PTs that are smarter than I am. The difference in my mind is that I show up everyday. I grind away at being the best I can be every day. I’m obsessed with being the best PT/coach in the country. Show up and do the work, everyday.
2. Be Consistent
This could honestly apply to any problem you are having in life. Having marriage difficulty? Make a decision to work on it consistently with your spouse everyday. Overweight? Clean up your diet, take a picture of every meal you eat and post it on Facebook everyday. Have a shitty job? Start studying a new career field. Read a chapter of a book everyday. Once you’ve finished that book, get another.
3. Have a Good Attitude
I love the book How to Win Friends and Influence People by Napoleon Hill (not Napoleon Dynamite or Napoleon Bonaparte!). This is actually the second best selling book of all time behind the Bible. If you haven’t read this you should. A positive attitude will get you very far in life. Try this, next time you go to the store. Smile at whoever is working the checkout lane you’re going to. Genuinely ask them how their day is going. Watch their face light up. You might just have made their day.
This is the same for our clients/members/athletes. It can be hard enough to drag your ass to the gym. It sure helps if you know your coach is going to be nothing be positive when you get their.
“Success isn’t owned, it’s leased and rent is due everyday.” JJ Watt
In part one, I went over the first 3 principles to one of my favorite books, The Slight Edge by Jeff Olson. In this post we will finish with the last 4 principles. These principles are time tested and the truth. Following them will do nothing but improve your coaching skill and life.
4. Be Committed For a Long Period of Time
Most people commit to things for a week at most. I love what I call the “Good Idea Fairies”. These are people that come up with great ideas all the time. They freak out over their awesome idea for about a week and then realize that it won’t happen overnight. Progress is slow, becoming great is a long process. You have to commit or you’ll end up being complacent and stalling. Give yourself a year. Commit to that year and set shorter term goals during the course of that 12 months. Starting is easy, finishing is hard.
5. Have Faith and a Burning Desire
If you’re reading this you probably already have number 5 taken care of. If not, hopefully I’ve inspired you by this point to be the best coach you can be. I look at progression and learning as a competition. I hate losing more than I like to win. In college, I kicked a kid off my flag football team during the middle of a game (sorry Mr. Anderson, but you were killing us). Make being the best coach your competition. Get mad when another coach is better than you. Put that competitive drive to work to improve your skill set, get better results, and make more money!
6. Be Willing to Pay the Price
Being the best is not easy. As I write this my entire family is asleep. I had a 6 am patient this morning and I’ve already put in about 10 hours of work today. Progressing is not easy. You have to decide what things you can sacrifice to achieve your goals.
It can also be expensive. I recently went to a weekend course that cost me about $2000. That’s a lot of money to me. It’s important to invest in yourself and your progress as a coach/medical provider. Pay for continuing education, buy books, go to courses. Meet other coaches, build your network. Don’t just look at the price, think of education as an investment in yourself.
7. Practice Slight Edge Integrity
This is defined as what you do when no one is watching. Don’t be the kind of person that only wants to help or do something difficult when your boss/someone you’re trying to impress is around. We had a name for these people when I was in the Army, we called them Spotlight Rangers. I absolutely hate people like this and after a short period of time they become very transparent.
Work each day as if your mentor was standing right behind you. If you don’t have a mentor, get one. Do you think your mentor would approve of you surfing through Facebook for an hour looking at a bunch of worthless crap?
The coach/trainers are the tip of the spear. You’re so much more important than you may even think. You’re an integral part of our current medical model and fill a much needed role in our society. Don’t undervalue yourself and don’t assume that you’re just a coach. You have a profound effect on people’s lives. Follow the 7 principles from this book, you’ll be the best you can be for your athletes and they’ll love you for it!
There are a few things in life that everyone knows to be true. We all have to pay taxes, we all will die one day and if you have poor extension in your upper back you will have a poor overhead position. Maybe the third one isn’t quite as obvious as the first two but it’s absolutely true!
Why is it that your upper back causes so many problems for the shoulder? That answer is very complex and for the sake of you borderline ADHD people like myself, I’ll keep this to one simple concept, scapular tilting.
Scapular tilting occurs anytime that we raise or lower our arm in front of us. In the picture below you can see the the shoulder blade of the person on the right is tilted forward more than the person on the left. This forward tilt is called anterior tilting of the shoulder blade. Anterior tilting is a problem because it creates a bone block as the arm raises overhead. You can’t push through this and force it into a better overhead position.
We can see in the person on the left in the same picture that the shoulder blade is now perpendicular with the ground. This is a good thing and called posterior tilting of the scapula. We need to get the shoulder blade into this position in order to achieve a full overhead position. This posterior tilt of the shoulder blade is primarily allowed by our upper back's ability to extend or flatten out. This is why people that have rounded or what we call kyphotic upper backs have a very difficult time with achieving a fully locked out overhead position.
So how do we get that thoracic spine to flatten out and allow the shoulder blade to tilt posterior? It's not easy if you have lost a ton of mobility, but here's a simple two-step process to start improving this movement.
1. Get the hell out of your chair!
If you sit for a long period of time everyday, chances are you have really poor mobility in your upper back. Get a standing desk or put your chair on your desk and force yourself to get out of that position. If you sit for 8 hours with a rounded upper back and think 5 minutes of mobility work will negate that, you're completely wrong.
2. Work on mobilizing to improve thoracic extension.
This is the hard part. You have to chip away at this problem daily if you have a significant loss in mobility. The good news is there's a ton of great video content out from my boy, Kelly Starrett on improving upper back mobility. Here's a great video to give you a better idea of what types of mobility techniques you need to add in to your training.
Good luck and leave us a comment if you have any questions.
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.