How Neural Tension Influences Hamstring Flexibility

Many people think they have tight hamstrings.  This may be the case for some but there are often times that people feel “tight” but aren’t really tight.

I’ve been playing around with how neural tension influences hamstring flexibility and have been having great results.

Watch this video below, which is a clip from my product Functional Stability Training: Optimizing Movement, to learn more about what I mean.

 

How Neural Tension Influences Hamstring Flexibility

 

Learn Exactly How I Optimize Movement

Want to learn even more about how I optimize movement?  Eric Cressey and I have teamed up on Functional Stability Training: Optimizing Movement, to show you exactly how we both assess, coach, and build programs designed to optimize movement.

Click the button below for more information and to sign up now!

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What Exactly is Optimal Movement Quality?

What exactly does optimal movement quality mean?

Have you ever thought of that?  How do you define “optimal” movement?”  I would argue optimal movement is slightly different for everyone as we are all unique.

However, I usually think of optimal movement as simply two things:

  1. Do the right joints move (and the wrong ones don’t)?
  2. Do the right muscles work (and the wrong ones don’t)?

Simple.

Watch this video below, which is a clip from my product Functional Stability Training: Optimizing Movement, to learn more about what I mean.

 

What is Optimal Movement Quality?

 

Learn Exactly How I Optimize Movement

Want to learn even more about how I optimize movement?  Eric Cressey and I have teamed up on Functional Stability Training: Optimizing Movement, to show you exactly how we both assess, coach, and build programs designed to optimize movement.

Click the button below for more information and to sign up now!

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Is GIRD Really the Reason Why Baseball Pitchers Get Hurt?

Today’s guest post comes from Lenny Macrina, my good friend and co-owner of Champion PT and Performance.  We work with a lot of baseball players at Champion, which makes us really understand one thing – baseball pitchers are unique!  Many of our athletes come to us after going elsewhere for care but not making the progress they want.  I don’t think we are special, we just see a lot of baseball injuries, so we know what to look for in these athletes.  

Lenny does a great job here discussing a very common misconception about pitching injuries and GIRD.  Honestly, GIRD is kind of outdated.  

Lenny has conducted a ton of research on this topic and wanted to share his results.  You MUST understand the science and not get caught up in all the hype on the internet!  Read below and learn more!


 

Baseball pitchers tend to have unique amounts of mobility of their shoulders. Because of this, throwing generates tremendous forces on the shoulder.  This is important to consider when evaluating and treating baseball injuries.

All of this fancy talk basically says that throwing a baseball is technically bad for your body, and many times we see baseball pitchers with hurt shoulders and elbows.

But why?

We believe there are many reasons, but as physical therapists who have to assess and treat these baseball players, we must be aware of their unique presentation and act accordingly.

It has been well established in the literature that pitchers exhibit adaptations to their shoulder mobility from the act of throwing.   Generally, the thrower’s shoulder exhibits less internal rotation but greater external rotation compared to non-throwing side. There are many proposed reasons for these shoulder mobility changes, including bony adaptations, muscular tightness, shoulder blade position, and capsular restrictions.

This loss of internal rotation has received a lot of attention and has even been referred to as glenohumeral joint internal rotation deficit (GIRD).

 

Is GIRD really the reason why baseball pitchers get hurt?

Several authors have stated that GIRD may increase the risk of shoulder injuries in baseball pitchers. This has caused everyone to assume this and treat accordingly.

Our initial research, that we published in 2011, showed pitchers with GIRD had a 1.8 times increased risk of shoulder injury. But it was NOT statistically significant. Since then, we have published more data that shows similar trends, specifically in our paper looking at 8 consecutive seasons of injury data.

While pitchers with measured GIRD had a slightly higher rate of shoulder injury during that season, the relationship was not statistically significant and GIRD did not correlate with shoulder injuries.

Essentially, we have not shown that GIRD correlates to pitching injuries.

 

Total Motion May Be More of the Issue

Perhaps the issue really isn’t GIRD?  A more important measurement to consider in the overhead thrower is total rotational range of motion. Total rotation is defined as the sum of external rotation and internal rotation.

 

Total Rotational Range of Motion

Rather than look at internal rotation by itself, it may be more valuable to look at the combined total rotational motion of both external and internal rotation together.

In fact, we showed that pitchers with greater than a 5 degree deficit in total rotational range of motion displayed a greater risk of injury. In one study, this was a statistically significant 2.6 times increased risk of shoulder injury.

 

What About External Rotation and Shoulder Injuries?

Does GIRD Cause Baseball Pitching InjuriesCuriously enough, we also have shown a relationship between loss of external rotation mobility and shoulder injuries.  Pitchers with external rotation insufficiency were more likely to undergo surgery, 2.2 times more likely be placed on the DL for a shoulder injury, and 4.0 times more likely to undergo shoulder surgery.

Wow!  At first you would think, let’s stretch these guys out and gain external rotation. But hold on one second and let’s get a grip!

If you remember our study from 2011, we showed a high preponderance for shoulder injuries especially in the pitchers whose total motion was greater than 187 degrees.  You don’t want too little or too much motion!

So, as I always tell my students, athletes and fellow clinicians: We’re always walking a fine line between too much and not enough mobility.

 

What About Shoulder Flexion?

While internal and external rotation get all the exposure, shoulder flexion may actually be an area we see tight the most.

I think one interesting finding of our recent research has been the relationship between the shoulder flexion deficit and injury.  Pitchers with a deficit of greater than or equal to 5° in shoulder flexion of the throwing shoulder had a 2.8 times greater risk for elbow injury.

The correlation between shoulder flexion deficit and elbow injury may represent a lack of tissue mobility and overall flexibility (possibly to the latissimus dorsi) in injury-prone subjects.

The baseball pitcher has a unique mobility of the arm.  We need to be careful assuming that these abnormalities and asymmetries correlate to injury.  They often do not.

The challenge is figuring this out and keeping up with the research…as it is always evolving!  The more you work with baseball pitchers the more you appreciate these subtleties.  These are the subtleties that make them unique, and effective as athletes.

 

So, what does all of this mean?

  • Assess motion
  • GIRD not necessarily bad (actually pretty normal)
  • Lacking ER may increase risk of injury
  • Total range of motion deficits increase risk of injury
  • Shoulder flexion deficits increased elbow injury risks
  • Assess and never assume!

GIRD is not as evil as everyone makes it out to be.  Treating them unnecessarily and trying to gain internal rotation may actually make them worse.  Don’t treat without thoroughly assessing, and don’t assume GIRD is the reason why baseball pitchers get injured.

 

 

Does Strength Prevent Injuries?

Evan OsarToday’s guest post comes from Evan Osar.  Evan is doing a great job sharing his views and systems for corrective exercise.  He has a new program teaching you his complete assessment and corrective exercise system that he has produced with our friends from Fitness Revolution.  They have been gracious enough to offer a special $100 off discount for my readers this week.  More info after the article, but you can learn more here: The Integrated Corrective Exercise Approach.

 

Does Strength Prevent Injuries?

The goal of corrective exercise is to help our clients develop a more ideal postural and movement strategy. We strive to teach the nervous system to hold a more optimal alignment, to breathe better, and to control the body better so our clients can hold proper posture and move with greater efficiency and without so much compensation, which is a key factor in many of our clients’ problems and loss of performance.

As strength conditioning specialists, we like to believe that strength prevents injuries because we think the stronger somebody is, the better they are, and the fewer injuries they’ll have.

I’ve been working with clients and patients for the last 17 years, and some of the most dysfunctional individuals whom I assess and work on are the strongest individuals.

 

Strength by Itself Does Not Prevent Injuries

How, then, do we prevent injuries?

What really prevents injuries is helping your client develop an improved strategy for posture and movement. What, then, are the key components to developing an improved strategy for posture and movement?

To improve your clients’ posture and movement, you must get them to understand and incorporate the fundamental ABC’s—the fundamental principles of the Integrated Movement System™.

 

A = Alignment

Evan Osar Corrective ExerciseYou have to teach your clients how to develop the optimal alignment, so when they load the joint, the joint is loaded in the right direction and position.

One way to visualize this principle is to point your finger straight up. If you place the palm of your other hand on the tip of that finger (similar to a “timeout” gesture) and apply force down through the finger, you could hold your finger like this for a long time and not have any issues because you’re loading the joint in the most optimal position.

Now, bend your finger back so it is no longer straight up but is pointing as far away from its palm as it can go. If you try to make the same “timeout” gesture with your other hand and apply force down through the finger, you can’t do that for very long before your finger would be very uncomfortable because it is being bent even further back.

This same concept applies to all the joints in your body: There are maximally optimal positions for loading, and there are suboptimal positions for loading. Our goal is to help our clients align better so that they can put less wear and tear on their joint structures.

 

B = Breathing

We must breathe three dimensionally, or have access to our entire thoracopelvic canister, from top to bottom and from the top of our lung field to our pelvic floor.

We must be able to breathe laterally, or side to side. We must be able to breathe front to back so that we can access the entire diaphragm; all the intercostal muscles between the ribs; the deep myofascial system; and muscles like the psoas, transverse abdominis, and multifidi.

All these muscles coordinate with one another in the process of breathing, which also enables us to stabilize. The primary stabilization of our core should come from internal regulation of pressure—intrathoracic and intra-abdominal pressure. That’s what core stability is really all about.

It’s not about bracing or squeezing muscles—that’s a part of core stabilization, but it’s not the primary component of core stabilization. Therefore, it’s not strength that prevents injuries; it’s the ability to align and breathe.

 

C = Control

Once we align the body in the right position, and once we have proper three-dimensional breathing, we must be able to control our body positions. So whether we’re in a static position, performing a dynamic movement, or moving through the fundamental movement patterns (squatting, lunging, pushing, pulling, bending, rotating in gait), we must be able to use the right muscles at the right time in the right manner to control the joint for the activity that you are trying to do.

The “right muscles” and “right manner” will both change depending upon the different activities we need to do. For example, your clients’ resting postural strategy should be different than what they would do if they were squatting 300 pounds. Certainly, we should have alignment of the thoracopelvic canister both in quiet standing and during a deadlift or squat pattern. What changes however, is the level of activation.

When we’re quietly standing in posture, we should have very little activity of the core muscles; they shouldn’t be off, but there should be very little activity: Our glutes, abdominals, and erectors should be soft. This is similar to how you wouldn’t walk around with your biceps contracted all day long, your abs gripped up all day long, your low back tightened all day long, or your glutes gripped up all day long.

As an exercise, stand up if you are sitting right now. Feel your glutes. They should be soft. Feel around your abdomen, and feel around your lower back. They should all be soft while at rest. This doesn’t mean they’re not toned—in fact, they should be soft, just like how your biceps should be soft at rest.

When we need them to activate to lift a heavy weight, lift a child, lift a bag of groceries, do a sled push, etc., we need a higher level of activity. The key is to use the right strategy at the right time so that we have the control we need for, in this example, thoracopelvic canister.

So when I’m squatting 300 pounds, I have a nice controlled thoracopelvic canister where I’m braced up and able to use intra-abdominal and intrathoracic pressure, and I’m able to layer my abdominal muscles, my low back muscles, and my hip muscles. But when I’m done with that squat pattern, I leave the gym, and I’m living my life, those muscles should release and become soft. What we see with our general population clients specifically is they are not stopping their gripping/bracing strategy when they leave their exercise session, and that’s what starts to put wear and tear upon the joints, overuses the muscles, and creates a lot of compensation.

 

So what prevents injuries? It’s not about strength.

All things being equal, strength will help you prevent injuries, but all things are not equal with our clients. Most of our clients do not have an ideal or optimal postural and movement strategy.

They don’t have great alignment, they don’t have great breathing, and they don’t have great control. They default to gripping, bracing, and doing very accessory dominant breathing as their strategy, and that leads to compensation.

So what helps prevent injuries?

The fundamental ABC’s: alignment, breathing, and control, which should be 3 primary areas of focus in corrective exercise.

 

Learn Evan Osar’s Corrective Exercise System

Corrective exercise systemI am really excited to share that Evan and our friends at Fitness Revolution have offered my readers a special $100 off Evan’s new program, The Integrative Corrective Exercise Approach.  In this great program, Evan shares his proven system to help you assess postural and movement problems and develop a corrective exercise strategy.

The program is $100 off for my readers this week only!  The offer ends Friday March 18th at midnight!

Assessing for Lat and Teres Tightness with Overhead Shoulder Mobility

Limitations in overhead shoulder mobility are common and often a frequent source of nagging shoulder pain and decreased performance.  Any loss of shoulder elevation mobility can be an issue with both fitness enthusiasts and athletes.  Just look at all the exercises that require a good amount of shoulder mobility in the fitness, Crossfit, and sports performance worlds.  Overhead press, thrusters, overhead squats, and snatches are some of the most obvious, put even exercises like pullups, handstands, wall balls, and hanging knee and toe ups can be problematic, especially when combined with speed and force such as during a kipping pull up.

Assessing for Lat and Teres Tightness with Overhead Shoulder MobilityWhen assessing for limitations in overhead shoulder elevation, there are several things you need to evaluate.  I’ve discussed many of these in several past blog posts and Inner Circle webinars on How to Assess Overhead Shoulder Mobility.

I am worried about what I am seeing on the internet right now.

I feel like the mobility trends I am seeing are focused on torquing the shoulder joint to try to improve overhead mobility.  Remember, the shoulder is a VERY mobile joint that tends to run into trouble from a lack of stability.  Trying to stretch out the joint or shoulder capsule should never be the first thing you attempt with self mobilization techniques.  In fact, I have found it causes way more problems than it solves.

Think about it for a second…

If your shoulder can’t fully elevate, jamming it into more elevation is only going to cause more issues. Find the cause. [Click to Tweet]

In my experience, the focus should be on the soft tissue around the joint, not the shoulder joint itself.  The muscles tend to be more of the mobility issue from my experience than the joint.  Just think about all the chronic adaptations that occur from out postures and habits throughout the date.

Two of the most muscles that I see causing limitations in overhead shoulder mobility at the latissimus dorsi and the teres major.

Here’s a quick and easy way to assess the lat and teres during arm elevation.

 

Assessing and Improving Overhead Shoulder Mobility

For those interested in learning more, I have a few Inner Circle webinars on how to assess and improve overhead shoulder mobility:

 

 

How to Assess for a Tight Posterior Capsule of the Shoulder

Over the years, the idea of posterior capsular tightness and glenohumeral internal rotation deficit (GIRD) in baseball pitchers has grown in popularity despite not much evidence.

I routinely see baseball players ranging from kids to MLB pitchers that have been told they have GIRD and need to aggressively stretch their posterior capsule and into shoulder internal rotation.  One of the first recommendations I make is essentially addition by subtraction – stop focusing on these areas!  I’ve discussed at length my feelings on why I don’t use the sleeper stretch, which is something I haven’t used in over a decade and none of my athletes have a loss of internal rotation.

Many people assume that GIRD is caused my posterior capsular tightness, without assessing the posterior capsule itself.  Blindly applying treatments without completely assessing the person is always a bad idea, especially considering GIRD may be normal and not even an issue.

Assessing the posterior capsule can be tricky and most text books continue to demonstrate the technique poorly.  I wanted to share a quick video showing how to assess the posterior capsule of the shoulder.

 

 

Perform your assessment of the posterior capsule this way and you’ll realize most people can actually sublux posteriorly and that mobilizing the posterior capsule isn’t what they need for GIRD!  Keep in mind this is applicable for athletes, you can certainly get a tight posterior capsule for many reasons, I just don’t think this is the primary cause of GIRD so shouldn’t be the primary treatment.

 

Learn Exactly How I Evaluate and Treat the Shoulder

If you are interested in mastering your understanding of the shoulder, I have my acclaiming online program teaching you exactly how I evaluate and treat the shoulder!

ShoulderSeminar.comThe online program at takes you through an 8-week program with new content added every week.  You can learn at your own pace in the comfort of your own home.  You’ll learn exactly how I approach:

  • The evaluation of the shoulder
  • Selecting exercises for the shoulder
  • Manual resistance and dynamic stabilization drills for the shoulder
  • Nonoperative and postoperative rehabilitation
  • Rotator cuff injuries
  • Shoulder instability
  • SLAP lesions
  • The stiff shoulder
  • Manual therapy for the shoulder

The program offers 21 CEU hours for the NATA and APTA of MA and 20 CEU hours through the NSCA.

Click below to learn more:

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A Simple and Easy Hip Mobility Drill for Low Back Pain

Low back pain continues to be one of the most common health complaints that limit people, especially as we age.  Rehabilitation of low back pain has transition from simply focusing on reducing the local pain to emphasizing a biomechanical approach of how other areas of the body, such as the hips, impact low back pain.

Essentially we have done a great job moving away from simply treating the symptoms and working towards finding the movement impairment leading to the low back pain.  Sure, using something like a TENS device may have a role to neuromodulate pain, but it is now common knowledge that the improvements seen are transient at best and not addressing the real dysfunction.

One area that has received a lot of attention, and rightfully so, is looking at limitations in hip mobility as a cause of low back pain.  Much of the research to date has focused on looking at the loss of hip external rotation and internal rotation mobility.  In fact, I have an older article on the correlation between hip mobility and low back pain.

I can say that my own ability to help people with low back pain has greatly improved as I’ve learned to focus on hip mobility over the years.

 

hip extension mobility low back painHip Mobility and Low Back Pain

A new study was recently published in the International Journal of Sports Physical Therapy that adds to our understanding of the influence of hip mobility on low back pain.  In the current study, the authors evaluated hip external rotation, internal rotation, and extension mobility in two groups of individuals, those with and without nonspecific low back pain.

While using a Thomas test to assess hip extension, the authors found the follow:

  • Hip extension in those with low back pain = -4.16 degrees
  • Hip extension in those without low back pain = 6.78 degrees

That’s a total loss of 10 degrees of hip extension in those with low back pain.

 

A Loss of Hip Extension Correlates to Low Back Pain

So now in addition to rotational loss of hip rotational mobility, it has been shown that a loss of hip extension correlates to low back pain.  To me, this has always been something I have focused on and makes perfect sense, especially as we age.

The vast majority of our society sits for the majority of the day and becomes less and less active as they age.  Among many things, this results in tight hip flexors and an anterior pelvic tilt posture.

Putting recreational activities like sports and running aside, this anterior pelvic tilt posture with tight hip flexors causes a loss of hip extension mobility and the low back tends to take the load but hyperextending.  This happens while simply walking and in a standing posture.

Think about the results above, people with low back pain have negative hip extension, meaning they can’t even extend to neutral!

As we all know, the human body is amazing and will compensate.  Hips don’t extend?  No problem, we’ll extend our spine more.

So a pretty easy step to take to reduce back pain is to work on hip extension mobility.

One drill that almost everyone that trains at Champion PT and Performance gets is what I named the “True Hip Flexor Stretch.”  I’ve talked about it at length in past articles, but I am a believer that most of our hip flexor stretches commonly performed in the fitness world are disadvantageous and not actually stretching what we want to stretch.

The True Hip Flexor Stretch is a great place to start to work on hip extension mobility:

As you can see (and feel), this gets a great stretch on your hip flexors without causing any compensatory low back extension.  And by focusing on posterior pelvic tilt, we gear this towards those with a lot of anterior pelvic tilt.

 

I really believe that the “True Hip Flexor Stretch” is one of the most important stretches you should be performing.  [Click to Tweet]

 

Next, Focus on Reducing Anterior Pelvic Tilt in People with Low Back Pain

Updated Strategies on Anterior Pelvic TiltI’m not a big believer that static posture is the most important thing we should all be focusing on when outline our treatment and fitness programs, but it’s a start.  Someone in an anterior pelvic tilt static posture isn’t always evil, and can be the result of many things such as poor core control, poor mobility, and even excessive weight.  I tend to care more about how well people move.

But based on the current evidence, it’s a great place to start.

Once you’ve started to gain some hip mobility, there is a ton more work to do.  We also have to work on glute and core control, among other things.  If you’re interested in learning more, I have a hugely popular Inner Circle webinar on my treatment strategies for anterior pelvic tilt that goes into detail on what I recommend:

 

In summary, we now have a nice study that shows people with low back pain have 10 degrees less hip extension that those without.  This makes sense, and focusing on hip extension should be one of the key components of any low back pain program.

 

 

Do We Really Need Corrective Exercises?

This past weekend, I was speaking at the Elite Training Workshop that we hosted at Champion PT and Performance in Boston on the topic of Integrating Corrective Exercises with Performance Enhancement.  As I was going through my slides, I actually tweaked it a bit and added one new slide with a simple statement:

 

Stop Trying to Correct and Start Trying to Enhance

Do We Really Need Corrective ExercisesAt the beginning of the talk, I discussed what some people would use to define the term “corrective exercise.”  I even asked around the room.  In general most people refer to corrective exercises as an exercise designed to improve poor mobility, strength imbalances, and altered motor control.

But there are some people that still refer to corrective exercises as exercises designto “fix” someone or “reduce pain.”  I would argue, this is not what corrective exercises are supposed to be utilized for within a training program.  Fixing injuries uses rehabilitation exercises, not corrective exercises.  They are different.

This may be why you see people doing a squat on an unstable surface and calling it a “corrective exercise.”  What are you trying to correct with that exercise?

One of the major components of using corrective exercises is a thorough assessment.  Without an assessment you are just taking a stab at something.  Without a through assessment, you are looking at an incomplete picture.  This may be OK to try on some people, but will be ineffective with many people, and could actually be detrimental with people in pain.  I’ve talked about this before in what I call The Corrective Exercise Bell Curve.

corrective exercise bell curve

I would define corrective exercises more like this:

Corrective exercises are designed to enhance how well you move and perform.  [Click Here to Tweet This]

 

So Do We Really Need to Use Corrective Exercises in the Fitness and Performance World?

I still think we do, but perhaps we should really change our focus.  Corrective exercises shouldn’t be used to “fix” people.  That implies there is a problem.  Don’t think of it as taking someone that is below their baseline capacity and getting them back to baseline, think of it as enhancing someone’s baseline and raising their capacity.

“Corrective exercise” is probably not the best terminology, perhaps that is part of the problem.  Incorporate corrective exercises to help enhance people.   Again, I’ll go back to that original phrase from my new slide:

Stop trying to correct and start trying to enhance.  [Click Here to Tweet This]

Use corrective exercises to enhance someone’s mobility, or improve someone’s movement pattern, or to add a strength emphasis to an area that is weak.  In this last example, if someone is quad dominant, has poor glute strength, and overuses their low back instead of their hips to hips, a “corrective exercise” may be a deadlift variation!  That doesn’t seem like rehab to me, that seems like performance enhancement, doesn’t it?

 

Learn How I Integrate Corrective Exercises with Performance Enhancement

 

If you are interested in learning how I integrate corrective exercises into our performance enhancement programs at Champion, I have an Inner Circle webinar on the topic.  In the presentation, I discuss:

  • What corrective exercises really focus on
  • How to  classify corrective exercises into specific components
  • My system for determining which corrective exercises to perform
  • What you can do to maximize the effectiveness of your corrective exercises
  • How and when to integrate corrective exercises into your rehabilitation, fitness, or performance enhancement program

To access the presentation:

 

 

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