Tag Archives: injury prevention

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Re-balancing the Body: Addressing the Hip (Flexors), Groin (Adductors) and Knee

Intentionally moving more throughout the day or implementing a stand-up work station is one of the most proactively potent things you can do to potentiate better overall health; but especially to the neuro-musculo-skeletal system.

We see patients do this all the time and then rave about the difference it has made; only regretting not doing it sooner.

If for whatever reason, movement modifications like the stand up desk is an obstacle, mobilization techniques like the one demonstrated below (a personal favorite & go-to) can work wonders towards opening up those hip flexors & lengthening those shortened adductors.

Movement Monday: AP Lunge

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Mastering the Air Squat: Mastering Strong, Pain Free, Functional Movement

For demonstration and additional explanation, click the link:

Movement Monday: Air Squat

Stand with feet approx. shoulder width apart.

Stand up straight with ears lined up above shoulder, lined up above hips, lined up above knees and ankles.

Brace the core by inhaling through the nose, breathing diaphragmatically (with your belly, not your chest), and upon exhalation create approx. 20% tension in the area between your ribs and pelvis (360 degrees, your core).  You are now braced. This does not mean to hold your breath, but a little bit of tightness and tone in the abdominal region.  For some bracing and being able to breathe while bracing may be the starting point.  This should be the staring point for all subsequent movement; the air squat and beyond.

Begin the movement by hinging at the hips, with the hip being the fulcrum and lever arms being your femur (thighs) and torso (abdomen and chest). Both of the lever arms should remain as straight as possible throughout the movement.  The hip hinge is executed by sticking out your backside and pushing it posterior.  You can counter balance by increasing your hinge and keeping your arms out in front of you (as seen in the demo above).

Ideally we want to work on maintaining the braced core, maintaining a straight torso (if not slight extension) and lowering your backside down to the point where the hamstrings are parallel to the floor and the shins are perpendicular to the floor.  Once you reach your personal depth, you should be able to pause, and then in a controlled fashion, rise back up while maintaining balance, and the straight spine.

That would be ideal.  However, we all have our personal baselines and starting points.  Find yours and work at improving it.  It may just be getting comfortable with bracing the core and beginning the hinge.  That is fine, that is the start of proper movement which, with practice will protect you and provide power as we move through life each day.

If you notice that the knees translate forward as you descend, to the point where they are becoming even with or moving anterior to the toes below, you have an anterior dominant squat which can wreak havoc on the knees and neglects relying on the optimal intended core and glute strength.  Do not proceed to drop deeper into the squat until you can do so without knees staying behind the toes.  Once you have improved balance, core stability, and activation of the glutes, you will be able to continue your decent correctly.

The “Chair of Death” exercise shown above can be implemented as a means to keep you in check as you practice mastering this essential, functional movement.

Get moving.

 

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TRUE Core Strengthening: Creating Functional Stability

The following is a blend of two oft performed exercise techniques.

Step 1 is being able to simply execute a side plank to awaken, activate and engage the other non-AB 360 degrees of your true core.  This will create a more stable state to perform our movement throughout the day.

More stability.  More balance.  More strength.  Less chance of injury.

Step 2 is to add this variation of the old school “clam,” WHILE keeping the core engaged.  Marrying the two will translate to enhanced movement patterns throughout your daily routine; whether that be during training or just general movement as you navigate the day to day activities.

If you expect that body to continue to perform without a hitch (ESPECIALLY as we age), pay it some well deserved attention and watch it pay dividends on a performance and enjoyment basis.

Get after it.  You know how it goes…use it or lose it.  DON’t LOSE IT!

Movement Mondy: Side Planked Core Clams

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Do You Lunge? You Should. Make Sure You Do It Right.

To stretch or not to stretch?

Static stretch PRE-workout is somewhat antiquated as more has been learned about the physiological effects of the stretch and hold technique.  (Check out our article from way back on further insight into what happens to the body when we do stretch.)  It is more of a routine or habit based practice at this point; something that was done for years, so it is now fitness gospel.

However, we need to remember to continue to question everything.  Even something as arbitrary as stretching.  Be open to unlearning in order to experience relearning and a functional evolution.

The “dynamic stretch” or “warm-up” is the better suited pre-performance activity.  But try to resist the temptation to mindlessly go through the motion here as well.  This activity can be performed as a barometer to your starting point and potential short comings (and thus an area to work on); as well as a solid hip-flexor elongating, glute engaging & cerebellum (balance & muscle coordination) activating “dynamic stretch” to implement.

Check it out:

https://onebody.live/2018/03/19/movement-monday-ap-lunge/

Functional Training: Identifying and Rectifying the Basics

A belated Happy New Year to all.  I hope that 2017 is off to your desired start, and if not, you’d better hop to it as we’re already one down and eleven to go.  No pressure though.

Being someone who gratefully works with a steady diet of athletes on a daily basis, this post is all about placing emphasis on stepping up your performance on activities like running by intelligently going beyond exclusive upright, uniplanar, cross-crawl repeats; aka running.  It is quite common for a seasoned runner to present with an issue, along with a lack the strength, stability, and/or mobility to correctly perform basic movements.  This can translate into the inability to move efficiently and pain free while navigating the obstacles of the day, but is exponentially put on display when those everyday tasks like walking, are altered in intensity and duration in the form of running.  Unsteady stabilizers, shortened tissues and insufficient or incorrect neurological firing patterns and muscle recruitment can all spell disaster and frustration for any athlete, but especially us runners.

Below, we’re going to go through a few tests and potential, subsequent remedies to work at, and then retest.  These are all designed to serve as self-help to hopefully identify and rectify a possible impedance to optimal performance.  

(It should be noted that the handful of tests and remedies shared in this article serve as a general assessment and are based on some of the most common issues seen in daily practice.  If you are truly having an issue or any question, your best bet is to work with myself or any of the other trusted and skilled practitioner.  There are a good variety of us, and each can provide their unique approach that may be right for you.)

Let’s dive right in:

Hip Hinge Test:

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This is a good test to assess posterior chain mobility, mainly in your glutes and hamstring.

Test:

Maintain a braced and neutral spine, drive your hamstrings back and tilt your torso forward, allowing your arms to hang.  Hinge from the hips and try to keep your legs straight and shins vertical.  If you are unable to flex your hips to 90 degrees while keeping the shins vertical, actively mobilizing the hamstrings is a good place to work and then retest.

How to Fix It:

The banded hamstring floss is my personal preferred, do it yourself, hamstring mobilization technique.  Wrap a band around your upper thigh, just inferior to the hip and create tension by walking forward. Optimal positioning would be to also have both hands in front of you, on the ground, without rounding the back.  If this is not possible, use a chair as shown in the picture.  Keeping the back as flat as possible, create a flossing motion by repeatedly straightening and bending the banded leg and driving the hips back.

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Bi-Lateral Squat:

This test is used to identify the commonly seen hip flexor and quadriceps dominance that most are plagued with for a variety of reasons, including prolonged, uninterrupted sitting. 

Test:

Stand with feet about shoulder width apart and perform a squat.  Ideally you should be able to lower to the point that your hamstrings are close to parallel to the ground, while keeping your tibias (shins) perpendicular to the ground.  If you find that your knees translate forward past your toes, it can be a contributor to a longer stride, leading to an unsteady lever arm that can lend itself to issues anywhere from the hips to the feet.  Ideally you want your squat and stride to be more posterior dominant, mostly in the form of gluteus maximus recruitment.

CORRECT

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INCORRECT

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How to Fix It:

To work on this, stand with your knees about an inch from a chair and practice initiating your squat by hinging at the hips, sticking out your rear, and working on sustaining your balance as you lower your hamstrings towards a level parallel with the floor.  To return to the starting position, keep the knees and hip back and concentrate on firing and sticking out your rear.  Repeat until this becomes your default firing pattern when performing a squat.  The key things being worked on here are true core stabilizing balance and optimal recruitment of your glutes.

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The flip side to reversing the anterior dominance, is training that gluteus maximus to fire.  When asked to, many aren’t even sure how to do this.  A good way to begin to reacquaint yourself with the designed ambulatory and running workhorse is by performing a knee to chest bridge.

dscn4509Pull in your right knee, and hold it against your chest.  While keeping the shoulder blades and head on the ground, push up with the left leg, getting into a bridge position while keeping your right leg against you.  Practice this for 12 to 15 reps on each side, concentrating on what it feels like to contract and relax the gluteus maximus that is responsible for pushing into the bridge, and propelling your forward efficiently when you run. Once this is mastered, not only in execution, but the ability to fire and feel the glute, appropriate progression in conditioning can be made.

Deep Squat:

This test is utilized to identify a variety of mobility issues necessary for proper movement as it can shed light on limited hip range of motion.

Test:

dscn4521Again, stand with feet slightly wider than shoulder width apart, but no narrower. Keep your toes pointed directly forward and attempt to lower downward into a deep squat, with your hamstrings resting on your calves, your spine neutral, and your knees slightly outside of your feet.  The photograph paints a better picture of what we are shooting for here.

A variety of dysfunctional movement patterns and restrictions can be identified through this test, but the most common are the inability to keep the spine neutral (back straight) or the backside from rotating underneath you, indicating a lack of hip flexion.  Another commonly seen issue is the inability to externally rotate the hips and get the knees outside of the feet.

How To Fix It:

If you noticed an inability to keep the spine neutral or the backside rotating underneath you, and we are zoning in on limited hip flexion as the culprit, we often see this as a product of a femur that sits anterior in the hip joint.  Again, not to be a dead horse (horrible saying), but this can be an additional product of long uninterrupted sitting, as the femur head gets pushed forward in the joint space.

dscn4562We can begin rectifying this issue by working on resetting the hips to their biomechanically optimal orientation.  Begin by kneeling on the ground and extending one leg out behind you. dscn4566Follow this by shifting the majority of your weight onto the grounded knee (mat or some sort of padding highly recommended for grounded knee) by aligning that knee directly underneath the hip.  Keeping that weight on the knee, sit the hips back in the direction of the grounded leg, which, when done correctly, creates a posterior, lateral pressure in the hip joint. 

dscn4571This can be further amplified by taking the foot of the grounded knee and placing it in front of the knee of the extended leg, and then sitting back again. (see picture)  Working on getting in and out of this position for 2 minutes on each side can assist in encouraging that femur into a more optimal position within the hip joint, allowing for improved range of motion in the hip, necessary for running.

If you noticed an inability to, or you struggled with getting the knees outside of the feet (while keeping the feet flat and facing forward), you can work on improving your external rotation in the hip.  Often times we see a lack of external rotation in runners who notice their knees knocking together, an inward pointing foot, or chronic, tender adductors (muscles along the medial thigh).

dscn4576To begin to rectify this issue, start with getting down on your hands and knees, and step one leg forward, keeping your shin perpendicular to the ground.  Keep the back flat, hips square dscn4580and lead foot facing forward.  Keeping the lead foot flat on the ground, drop the lead knee to the outside of you, while actively driving your hips into the ground.  Encourage this movement further by placing one hand on the knee and pushing the outward (see picture).  This movement, when done correctly, simultaneously mobilizes the hip into external rotation, while actively stretching the adductors.

A common theme seen here is generally reversing the anterior dominance, improving range of motion and mobility, and become better well acquainted with recruiting, firing, and utilizing your gluteus maximus and other posterior chain musculature for optimal hip extension and propulsion forward.  

These serve as just a sampling of the functional tests we implement with all of our athletes, but especially the runners, as part of an initial and ongoing assessment in order to identify, and correct any imbalances and asymmetries that may be contributing to that painful issue up or down the kinematic chain.  If you have any questions on how to perform these tests, feel free to reach out. If it “just doesn’t feel right,” or causes pain, definitely refrain and save it for working with your trusted healthcare practitioner or trainer.  These tests are designed to identify problematic issues, and the subsequent remedies are provided as potential ways to begin to fix the problem, contingent upon the fact that they are performed correctly.  Proper supervision and advisement from a trained professional is always well advised.

Happy training my friends, and good luck to you as we steamroll forward into another year.  Enjoy yourself out there and our beautiful Florida winter.  As always, if you ever have any questions pertaining to any musculoskeletal issues, the content above, or an overall natural and holistic approach to your health, feel free to reach out. (321-848-0987; dr.rclarke@gmail.com; clarkechiropracticwellness.com)

Be well and continue to STRIVE to THRIVE.

REFERENCES:

Starrett, Dr. Kelly. (2016) Deskbound; Standing Up to a Sitting World.  Las Vegas, Nevada: Victory Belt Publishing

Dicharry Jay. (2012) Anatomy For Runners; Unlock Your Athletic Potential For Health, Speed, and Injury Prevention.  New York, New York: Skyhorse Publishing