• Improving Thoracic Mobility
• Money Moves

Unfortunately, they may not work for everyone. If this is the case, or if you are simply looking for another tool to add to your arsenal, take a shot at performing the “Wall Slide”. This is one of those exercises that aims to improve both your thoracic posture and scapular positioning. It’s not an easy exercise…but it sure is effective.

Performing the following exercise:

• The individual starts in a seated position on the floor with the buttocks and back flush against a wall.
• The knees and hips are flexed as much as possible, paying attention that the buttocks do not round away from the wall.
• The neck is in a neutral position
• The shoulders and elbows are in a 90 / 90 position with the elbows and hands in constant contact with the wall at all times.
• The individual is asked to press his/ her chest lower back as close to the wall as possible to “lock out” the lumbar spine and minimize arching throughout the movement. This is especially important when one reaches the top of the exercise.
• The individual is asked to slide his / her arms up the wall, ensuring that they are not shrugging their shoulders.
• Upon reaching the top of the movement (this is where they feel that they cannot go any further), they are asked to take one diaphragmatic breath, both inhaling and exhaling with minimal tension. Note: this breath was not included in the video below but is highly recommended.
• The arms are brought back down following the full breath and the movement is repeated.

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Performing the following exercise:

• The arms are at 90 degrees to the side with both palms facing upward
• The hips are flexed to greater than 90 degrees and depending on your level of ability, the knees can either be flexed or extended.
• The legs are then rotated to one side and while doing so, the same side palm turns downward to face the floor.
• While doing so, the opposite shoulder blade should actively be retracting (pulling) toward the ground.
• Repeat to the opposite side.

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This is a fantastic issue with topics such as Thoracic Outlet Syndrome, Neurodynamic testing for Carpal Tunnel Syndrome, and Reciprocal Inhibition (stretching), among others. I highly recommend anyone and everyone in manual therapy and rehabilitation to check it out.

On another note, I just received word that my case study on “costochondritis” has been accepted for publication. That makes two papers in press…AWESOME!

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Part 2: The research behind the technique

Part 3: What is P.A.I.L’s™ and how is it used in this system?

Part 4: Assessment techniques, and how the system sets itself apart

For more information on Functional Range Release and any of Dr. Spina’s other seminars, please visit Functional Anatomic Palpations Systems.

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Also make sure to check out the following posts as scapular dyskinesia may play a role in both:

• Neurovascular Problems in the Athlete’s Shoulder
• Rotator Cuff Tears: Predictive Factors for Management

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DO YOU SWIM?

If you answered “yes” to the above, please proceed to the next question. If not, thanks for visiting!

Question # 2:

DO YOU PREPARE YOURSELF TO SWIM?

If you answered “no” to the above, please view the following videos to help you prepare for your next run using the GRID by Trigger Point Performance Therapy.

Quadriceps – 60 seconds each leg (Total = 2 min)

Tensor Fascia Lata – 30 seconds each hip (Total = 1 min)

Mid – Latissimus Dorsi – 30 seconds each side (Total = 1 min)

Thoracic Spine Rotation – 30 seconds each side (Total = 1 min)

Quadruped Reach & Roll – 60 seconds

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What we need:

• Dorsiflexion mobility

Why we need it:

• Minimize stress on knee

How we can get it:

KNEE:
What we need:

• We need to realize that the knee is often an innocent bystander

Why we need it:

• We need to realize this because the research says so

How we can get it

• We can achieve optimal knee mechanics by looking both above (the hip) and below (the ankle) this joint.

HIP:

What we need:

• Saggittal plane mobility
• Extension strength

Why we need it:

• Minimize stress on lumbar spine

How we can get it:

• Glute Bridge
• Glute Bridge – Marching
• Glute Bridge – 1 Leg

What we need:

• Frontal & Transverse plane dynamic stability

Why we need it:

• Minimize dynamic valgus at knee and dynamic internal rotation at knee

How we can get it

• Side Lying Abduction
• Clam Shells (Hip – External Rotation)
• Mini Band – External Rotation
• Airplane (I’ll get a video of this up soon)

LOW BACK / CORE:

What we need:

• Antirotation, Antiextension, Antilateral flexion STABILITY

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Antirotation: “Pig on a Spit” Roll
• Antiextension: Front Plank series including the Body Saw
• Antilateral flexion: Farmer walk / Suitcase carry

What we need:

• Lumbar intersegmental stability

Why we need it:

• To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

• Effective “core activation” methods

THORACIC SPINE:

What we need:

• Rotation & Extension mobility

Why we need it:

• Lumbar relief & Shoulder mobility

How we can get it:

SHOULDER:

What we need:

• Scapular stability

Why we need it:

• Shoulder mobility

How we can get it:

For those of you who are unfamiliar with this approach of looking at the body, please have a look at Coach Boyle’s The Joint by Joint approach and FITS Toronto’s 5-site Integrity

Anatomical photos courtesy of Primal Pictures

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I am really looking forward to what Mike Reinold and Eric Cressey have to offer since I visit their websites on multiple occasions each week. In my opinion, they bring together what drives my passion in everyday practice: a blend of evidence-based sport medicine and athletic performance.

Mike Reinold

Eric Cressey

Unfortunately, I have come to a realization that my continuing education budget is much higher than what my entire tuition was.

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But is this the most effective way to apply strain to the posterior capsule?

Using a cadaver-based study, Izumi et al examined and measured posterior capsule strain of 8 different shoulder positions.

What you need to know:

• 3 male and 5 female fresh cadavers were included (74 – 96 years of age)
• Bodies were disected and prepared so that only the posterior capsule was preserved and exposed.
• A displacement sensor (Pulse Coder, Levex, Kyoto, Japan) was used to measure posterior capsule strain
• For specific strain measurements, the posterior capsule was sectioned into 3 parts (upper, middle, and lower)
• Passive internal rotation was used as the primary motion for strain measurement.

Measurement positions:

• Internal rotation + 0 deg. elevation in scapular plane
• Internal rotation + 30 deg. elevation in scapular plane
• Internal rotation + 60 deg. elevation in scapular plane
• Internal rotation + 90 deg. elevation in scapular plane

• Internal rotation + 60 deg. flexion (IR in 60 deg. elevation + 60 deg. horizontal ADDuction)
• Internal rotation + 60 deg. ABDuction (IR in 60 deg. elevation + 30 deg. horizontal ABDuction)
• Internal rotation + 30 deg. extension (IR in 30 deg. elevation + 120 deg. horizontal ABDuction)
• Internal rotation + 60 deg. flexion + horizontal adduction (IR at 60 deg. flexion + 30 deg. horizontal adduction)

More information pertaining to this study’s methodology:

• A reference length (R0) was first established and indicated the point at which the stress-strain curve first indicated a sudden decrease in strain
• Strain of the capsule was measured at the terminal range of passive IR. This was determined by grade III mobilization after Kaltenborn procedure.
• Beyond this point, a stretch was applied to the joint for 10+ seconds until no further strain was observed
• To determine the Glenohumeral joint positions that demonstrated significant increases in strain from R0, a one-way repeated measures ANOVA was used.
• The differences in strain among the positions were assessed via paired t-test.

Glenohumeral positions that significantly stretched the posterior capsule:

• Internal rotation + 30 deg. elevation in scapular plane: significantly stretched the UPPER and MIDDLE sections of the posterior capsule

Self stretch

Rotater – assisted

• Internal rotation + 30 deg. extension: significantly stretched the UPPER and LOWER sections of the posterior capsule

Rotater – assisted

Caution:

It should be noted that joint capsule strain seen in aged cadavers may not be similar to that seen in younger adults. In fact, strain rates in younger populations may indeed by larger.

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• A device that can be used in physical and manual therapy settings, as well as in the sporting arena.

What is it used for?

• The Rotator can be used for increasing both shoulder mobility and strength in clinically indicated situations.

When does Dr. Jeff like to use it?

• Aside from those situations listed on the Rotator website, I personally find it most useful with larger athletes and patients. The reason for this is essentially to make my life easier when performing manual therapy techniques. For example, when performing soft tissue therapy on structures in the region of the posterior shoulder girdle (i.e. posterior capsule, glenohumeral external rotators, etc), the Rotator allows the patient to use his/her opposite arm to assist the necessary motion that might not otherwise be possible in those with “larger” chest sizes.

How can the Rotator be improved?

• While I have yet to find a “be all – end all” product, the Rotator IS a useful device. However, a few patients have noted to me that the velcro strap isn’t the most comfortable and that a softer, cloth-type strap, may be more user friendly.

Here is a clip of the Rotator in action:

Photo source

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Let me tell you why:

• POSTURE: In order to jump rope efficiently and for long periods of time, it is important that one maintain an ideal posture throughout the exercise. As such, improving ones posture will effectively facilitate a neutral spine position in each of the Cervical (neck), Thoracic (mid/upper back), and Lumbar (low back) regions, thereby promoting proper function of each of the active, passive, and neural components of spinal stability. Perfect posture promotes movement efficiency (see MovementU) and therefore, training to maintain ones posture may translate into increased efficiency during running.

• BILATERAL SHOULDER EXTERNAL ROTATION: In general, the glenohumeral joint is isometrically held in a bilateral external rotation position throughout the jump rope exercise. Reinold et al. recently demonstrated that the concentric bilateral external rotation exercise facilitated scapular control without the need for arm elevation, while simultaneously utilizing a good lower trapezius to upper trapezius activation ratio. While isometric contractions certainly differ from concentric contractions, one may hypothesize that isometrically maintaining the shoulder girdle complex in this position may facilitate optimal patterning of the thoraco-scapulo-humeral joints…especially  since isometric contraction of the glenohumeral external rotators play an important role in force coupling with the powerful pectoralis major during the early pull phase of swimming (this force coupling helps keep the head of the humerus centered within the glenoid fossa: aka dynamic stability). Similarly, bilateral external rotation may  also play a rehabilitative role in those athletes presenting with signs of Type 1 “SICK” scapulae (inferior prominence of the medial border) for the same reasons noted above.

• ECCENTRIC HIP ABDUCTION: During the stance phase of running, the hip plays a contributing role in absorbing ground reaction forces sustained by the body upon impact. This is so via eccentric contraction and control of the abductors of the hip (i.e. Gluteus Medius). Each “foot contact” of single and alternating leg rope jumping is not dissimilar to the stance phase of running as the hip abductors are called into action with every repetition. As such, incorporating rope jumping in the off season may result in preventing dynamic valgus (aka “buckling in”) of the knee, thereby minimizing energy leakage while running. The end result: A more efficient, powerful running gait.

• Low Intensity Stretch Shortening: Plyometric exercise has been scientifically demonstrated to be effective in improving performance and economy in certain distance runners. Since, jumping rope can be viewed as a lower intensity form of plyometric exercise, improving the stretch shortening capabilities of the deep flexors of the foot and ankle may translate into similar effects. At the very least, since mid- and forefoot runners tend to have a single and greater peak force upon impact (as opposed to the double peak seen in rearfoot strikers), performing low intensity stretch shortening exercise may strengthen the ability of the lower leg musculature to act as shock absorbers, subsequently minimizing chances of dynamic instability (i.e. overpronation) and/or tendinopathy (i.e. of the achilles).

Unless I am mistaken, the efficacy of jumping rope for triathlon performance has yet to undergo scientific investigation. Therefore, definitive conclusions from the above statements must certainly not be made. However, as with many currently performed exercises, the theoretical rationale for rope jumping as an off season exercise in triathletes may seem plausible and thus, may enable this exercise to be performed without much scrutiny.

So…JUMP AWAY!

Photo source

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