Scalene Hypertrophy

I recently evaluated yet another Major League baseball player with the “yips,” or what I like to call thoracic outlet syndrome.  I really don’t believe in the yips at all and feel that thoracic outlet syndrome is almost always to blame.  Telling a professional athlete it’s all in their head or some mysterious mechanical flaw is just insulting.

One of the major reasons that thoracic outlet syndrome occurs in baseball pitchers is from hypertrophy of the scalene muscles (and sternocleidomastoid).  Throwing a baseball causes many adaptations to the body, including this increase in scalene size.

Here is a video of the athlete inhaling with his head turned to each side.  Notice the significantly larger scalene and sternocleidomastoid on his right side.

scalene hypertrophy

I wish I had a magic trick to help in this situation.  I will perform manual therapy on the scalene muscles, surround musculature, 1st rib, and thoracic cage, however, it’s hard to combat the hypertrophy associated with throwing.

Understanding what to look for is the first step, though.  Scalene hypertrophy is a subtle finding to detect on examination.

 

 

Updated Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  This is actually an update on one of my most popular webinars in the past.  I am doing a couple new things and wanted to assure everyone has my newest thoughts.  In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

Are We Missing the Boat on Core Training?

A lot of attention has been placed on core training over the last several years, both in the rehab and fitness industry.  I recently watched my friend Nick Tumminello’s latest product Core Training: Facts, Fallacies, and Top Techniques and it made me think (more on Nick’s product, which is on sale this week, below).

We’ve made exceptional progress in our understanding of the core and have shifted away from isolated ab training to integrated core training.  My DVD with Eric Cressey on Functional Stability Training for the Core discussed this at length and showed a nice system to effectively train every aspect of the core.

However, the more I read on the internet the more I wonder if we are still missing the boat a little bit.  I’ll chalk this up as a another pendulum swing, but while we have progressed away from isolated abdominal exercises like sit ups, I wonder if we have swung too far to an extreme and started to focus only on isometric anti-movement exercises for the core.

 

Anti-Movement Core Exercises

Realistically the core helps stabilize the body and allow a transfer of energy.

Anti-movement exercises, such as planks for anti-extension, should be the foundation of the basic levels of core training.

Plank - core training

Once your baseline ability to maintain an isometric posture with the core is obtained, the next progression is to control limb movement with a stable core.  This involves combining upper body and lower body movements while maintain a stable core.  An example of this would be an anti-extension drill with TRX Rip Trainer.

However, the core does need to “move” during normal function.  It rotates, bends, flexes, extends, and all of these at once!  Should we train this?

 

Don’t Forget the Trunk is Designed to Move

I would say we should.  I think the difference here is to train these movements within a stable range of motion.  We should be training the body to work within it’s normal mobility, but to stabilize at end range of motion.

We get into problems with core movements, like rotation, when we depend on our static stabilizers, like the joints and ligaments, to control end range instead of our muscular dynamic stabilizers.

Perhaps the goals should be to train to control the core at end range of motion.

 

End Range Core Stability

These types of drills would include chops, lifts, push-pull movements on a cable or Keiser system, and medicine ball drills.  You are probably doing these already, right?

They all involve a transfer of energy from the limbs through the core.  The core needs to move during these exercises, but you are working in the mid ranges of motion and controlling end range.  These should also progress to include functional movements patterns like swings, throws, and kicks.

In the video above, I combine the act of throwing and decelerating in the half kneel position.  This takes the lower half out of it and requires the core to stabilize.

I guess the point is that we shouldn’t be afraid to move the core.  That is not beneficial to teach our patients, clients, and athletes.  Rather, train the core to move and stabilize at end range of motion to take stress off the structures of the spine.

 

Core Training: Facts, Fallacies, and Top Techniques

If you want to learn more about training the core, Nick’s program Core Training: Facts, Fallacies, and Top Techniques is on sale this week.  I watched Nick’s presentation last week and enjoyed it.  Nick does a great job discussing some of these concepts.  Click below for details:

 

Is Perfect Squat Form a Myth?

Over the years I have helped 1000’s of people squat better.  As a physical therapist, my career has evolved over the years from working with injured people to working with healthy people looking to optimize their body and maximize their performance.  In fact, I’m starting to refer to it more as “performance therapy” than “physical therapy.”

Lately, I’ve seen more and more people come to me to learn how to improve their squat.  Often times it’s one of two reasons why they can’t quite get find perfect squat form:

  • Something hurts when I squat
  • I can’t squat with perfect form

After going through a full body assessment, I always assess their squat form.  I don’t mean a rigid deep squat test, such as the one within the FMS of SFMA assessments, but an actual loaded squat.  I don’t say a word, I just observe.  Well, I actually record a video of it, but the point is I don’t want to cue the squat at all so I can see how the set up and how they perform their squat without my coaching.

What I often find is that many people are trying to squat with perfect form, or least what they believe is “perfect form.”  Perhaps they just picked up a copy of Starting Strength, or just attended their level 1 weekend certification, or just went through a foundations course at their box.  The quest for “perfect squat form” probably isn’t that simple.

I’m starting to wonder if there really is a such thing as perfect squat form.

 

Is Perfect Squat Form a Myth?

Don’t get me wrong, you have to start somewhere.  I personally recommend people read Mike Robertson’s article on How to Squat and the book Starting Strength is worth every penny.  My point isn’t that you should throw away any attempt to squat with perfect form, there are good ways and bad ways to squat, you have to start somewhere.

But I almost feel like we are over-coaching and using the same coaching cues during the squat with everyone.  Yes, there are many faults the can occur during squatting that should be avoided.  Bret Contreras has a nice article about solving 7 squat dilemmas.    But there is a big difference between correcting faults and overcorrecting people without faults.

Here is a good example, imagine you are squatting with your knees caving in towards each other, or tracking medially into a valgus knee position.  This would be a great time to cue someone to force their knees out.  However, it is possible to force your knees out too far and I’m not sure I want to cue someone that is squatting with decent form to aggressively force their knees out.  It’s a good thought to prevent knee cave in, but don’t go too far in the opposite direction.

But more importantly, I’m not sure there is a textbook way to squat, simply because we are all built different and have different daily habits.  There is a textbook perfect squat form for YOUR body, but it may be different for the person next to you.

This is why proper coaching and an individualized program built for you is the best way to succeed at perfecting your squat form.  There are several limitations that we all have that may be limiting our ability to achieve a perfect squat form.

 

Anatomical Limitations

The first thing we need to understand is that everyone’s anatomy is unique.  Bret Contreras does a nice job discussing our how our anatomical differences impact our squat mechanics and Ryan DeBall has a great article as well.  In fact, our pelvis and femurs are completely and vastly unique.

Look at these photos of several different pelvis and femur bones by Paul Grilley:

Femur neck variations

Femur Torsion Variations

Acetabular pelvic bone variations

Looking at these photos, it is striking how different we all really are on the inside.  The angles of how the femur bone forms as well as how it sits in the socket can be dramatically different between people.

This is what I find to be the biggest factor impacting why people can’t perform a squat with perfect form.  How can you say there is one way to squat when you look at these photos?  The spectrum of variation is so wide.

Unfortunately there isn’t a quick fix for anatomical limitations.  Rather, a detailed biomechanical assessment can be used to determine what may be the best squat mechanics based on your anatomy.  Sometimes this means that you will need to limit depth.  People never want to hear this, but sometimes you just simple run out of anatomy and can’t physically flex your hips enough to achieve deep squat form, at least without significant low back compensation.

 

Mobility Limitations

Luckily, not everyone has significant underlying anatomical variations.  Some just have mobility restrictions of their joint capsules and muscle tissue.  This is common in the person that assumes a frequent postural position over several years, such as sitting.  Most adults will have postural and mobility limitations that can be improved and subsequently improve their squat performance.

So, keep this in mind if you are a coach at a gym with adult fitness clients that are looking to start squatting.  Chances are they won’t be immediately able to perform a squat well until you clean up some of their movement patterns.  Rushing this process is how newbie adult fitness clients tend to hurt themselves while squatting.  They don’t have the mobility to squat with proper mechanics, and without this mobility, you are just going to compensate and put extra stress somewhere else, like this guy, who probably doesn’t have the mobility to be squatting:

YouTube Preview Image

 

A detailed assessment process can accurately determine if you have an anatomical or simple mobility limitation.

I also want to briefly comment on squatting like a baby.  I know many people have commented that if babies can squat perfectly, why can’t adults?  Dean Somerset wrote about this recently, but this concept is really ridiculous.  There are many factors that make babies able to squat well, including their head to body size ratio, femur height, acetabular position, but most importantly the simple fact that their bones aren’t fused!  Adults will never have the mobility of a baby, this has nothing to do with motor control.

 

Motor Control Limitations

perfect squat formAnother possible area of limitation that can be negatively impacting your squat performance is poor motor control.  I again tend to see this in adults that have been sitting for the majority of the day the last 10-30 years.  When you sit all day, you don’t need abdominal control, lumbopelvic control, or posterior chain activity.  The chair simply does all of this for you.  You essentially learn how to turn all of these off!

This can be seen in someone that has poor movement patterns, however during my clinical assessment have no real mobility restrictions of their joints or muscles.

Sadly, however, I also see this often in my younger athletes.  I’m amazed at how poor our high school students move.  I blame it on sitting and staring at the TV, Xbox, or iPhone all day, but kids can’t even touch their toes anymore!

We have close to 100 high school athletes training with us at Champion Physical Therapy and Performance, and a large portion of them are performing corrective exercises and goblet squats until their motor control improves!

 

Your Perfect Squat Form

It’s always going to be in your best interest to work on your mobility and motor control limitations to improve your squat form.  However, realize that we all have different anatomical factors that may also be limiting your squat form.  This is why getting a proper assessment and individualized program is important if you are serious about enhancing your squat performance and reducing your chance for beating yourself up.

A custom program of mobility drills, corrective exercises, and individualized squat mechanics can really help you.   Sometimes you have to work within your own unique anatomical limitations.  Perhaps you just need to toe out a little more or widen your stance by an inch.  That may mean that you don’t perform the textbook perfect squat mechanics, but that may be OK, it’s your perfect squat form.

 

Base of Support and Core Stability

I work with with a lot of youth athletes, especially baseball players.  I am often amazed at how some of our younger athletes have such poor movement skills.  Many are 6 inches away from touching their toes!  I’m sure this is a trend this is not going away as our society spends more and more time staring at our iPhones and less on long term athletic development.

The body is great at compensating and finding the path of least resistance.  Here is a quick tip that you can apply to many different exercises to enhance core stability.

 

Base of Support

When the core and entire lumbopelvic region has poor motor control and stability, especially in the transverse and frontal planes, a way the body likes to compensate is by widening the base of support.  Here is an example of a young athlete performing a medicine ball chest pass.  Notice his base of support in the first photo.  This was his natural set up position.

Base of Support

 

By widening his base of support, he can likely generate more power during the exercise by making it more stable in general.  However, in a training environment, I want to assure that we develop both power and control.

By narrowing his base of support, as you can see in the second photo, he has to stabilize his core during the exercise and work on developing power while controlling the force of the ball.  This is going to have a more functional carry over into his sport.

Building athletes isn’t always just about strength and power, it’s also about movement quality and control.  Watch for compensations at the base of support for signs of poor lumbopelvic and core stability.

 

 

A New Exercise for Shoulder, Scapula, and Core Control

Today’s post in a guest post from my friend Tad Sayce, who is a strength coach in the Boston area that specializes in swimmers.  Tad shares a great exercise video that works shoulder, scapula, and core control.  I’m a big fan of “big bang for your buck” exercises that promote strength and stability in one exercise, which is something we talk a lot about in Functional Stability Training.  Tad came up with one that I am going start trying with my athletes.

Band Resisted Horizontal Abduction with a Press

As a former competitive swimmer, I can closely relate to the overhead athlete and the complications that can arise at the shoulder. As a strength and conditioning coach working predominately with swimmers, I am constantly looking to improve the durability of the shoulder. It is widely accepted that the shoulder operates at maximum efficiency in the presence of a stable base at the core. While I am a believer in the use of isolated exercises, today’s focus will be that of a more integrated effort. The video below demonstrates an exercise that facilitates shoulder, scapular and core activation: Band Resisted Horizontal Abduction with a Press. 

YouTube Preview Image

As the name implies, the exercise combines resisted horizontal abduction with an anti-rotation press. It is encouraged to first master each exercise in isolation before attempting to combine them. This exercise is great for educating athletes about proper scapular movement, and also demonstrating the ability to maintain position in the presence of increasing tension. I particularly like this exercise because it incorporates both dynamic and static efforts. I typically program this exercise for sets of 5 holding for 5 seconds, or sets of 8 holding for 2 seconds.

About Tad Sayce

tad-sayceTad Sayce, Head Coach and Owner of Sayco Performance Athletics, located in Waltham, MA. Tad is a Strength and Conditioning specialist with a strong interest in the sport of swimming. Formerly, Tad was a competitive swimmer in the Big 10 Conference and Olympic Trials qualifier, as well as a USA Swimming club coach.  For more information please visit www.saycoperformance.com.

Enhancing Overhead Shoulder Mobility

Enhancing Overhead Shoulder MobilityOverhead shoulder mobility is one of the things that a large majority of people could all improve on if addressed appropriately.  This seems to be limited in a very large percentage of people, especially in those with shoulder pain and dysfunction.  Perhaps it has to do with our seated postures or our more sedentary lifestyles, but regardless limited overhead shoulder mobility is probably going to cause issues if not addressed.

 

Enhancing Overhead Shoulder Mobility

Here is a clip from my brand new educational program with Eric Cressey, Functional Stability Training for the Upper Body.  In the clip I am assessing someone with limited overhead shoulder mobility.  During the assessment it became clear that he had a few issues limiting his mobility, but I wanted to demonstrate how a few simple manual therapy techniques can clear up this pattern rather quickly if assessed and treated appropriately.

YouTube Preview Image

It really goes back down to a proper assessment and know what you are looking for when assessing people.  This is just a very small clip of some of the great information we cover in our new program, which is on sale for $20 off this week (sale ends Sunday May 18th at midnight EST).   Click here or the image below to order now before the sale ends!

Functional Stability Training for the Upper Body

Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Strategis for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

 

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.