The Zac Cupples Show
A show where we discuss all things rehabilitation, training, performance, health, nutrition, sleep, stress management, learning, and many more.
info_outline Troubleshooting the Stack 06/07/2021
Troubleshooting the Stack Can't talk to me? Then fine-tune your stack, fam! The stack is one of the foundational components needed for A TON of movements and for restoring movement, but what if you are struggle bus with this concept? What if you can't get a full exhale or get the expansion you need? Or maybe you don't even know where in the ribcage we should even see movement! Don't worry fam, ya boy big Z has you covered. If you want to beef up your stack, and your conversation with Zac, then check out Movement Debrief Episode 153 below! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video . are some testimonials for the class. Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! Want to sign up? Click on the following locations below: (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (Early bird ends October 22nd at 11:55 pm) (Early bird ends November 5th at 11:55 pm) a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This video goes through a simple way to help you get more out of your prone hamstring curls. - This post outlines how to differentiate moving the spine as one unit vs creating relative motion at the pelvis. Ribcage expansion vs rib flare Question: With normal breathing appears should get expansion of all ribs, but yet With the stack it appears as though you should not allow ribs to flare out. So in a sense no expansion of ribs? https://youtu.be/H4JS3IK0JnM Answer: Oh fam, don't you worry. I want them ribs to get #expandedAF. The key point here is we want to differentiate where the expansion is coming from. Ideally, during the stack, we should see multidirectional expansion in the ribcage when we take a breath of air. In fact, the following areas should expand: Buckethandle - Ribs will move outward and upward (predominantly lower ribcage) Pumphandle - Front ribs should move forward and upward Posterior expansion - Back ribs should move backward and upward Slight elevation - The ribcage will lift upward slightly as a unit, as the scalenes are a primary muscle of inspiration Slight depression - The ribcage will stretch downward slightly as a unit because of the pull from the abs. As you can see, the ribs move just about everywhere! This movement, however, is different from the ribs moving forward (aka the rib flare). Ribs flared AF :) With the movements listed above, you get relative motions occurring among the ribs. So the ribs will separate to make room for the increased air in the lungs. With a rib flare, we don't see this as much. Instead, the ribcage migrates forward and upward as a unit. Imagine the thorax translating forward. That is the rib flare, and it is often accompanied with increased tension in the accessory muscles. Compensations during the exhale Question: As a narrow infrasternal angle, I am going to be taking a long relaxed exaggerated sigh. However, I get to a point where nothing is happening or I actually feel like my sternum is collapsing inward causing almost an out of breath sensation. Any idea what this might be? We want to be seeing the lower ribs dropping down correct? What if upon an exhale they don’t move? https://youtu.be/O9bYviWlk4Y Answer: You think you have a full exhale, but you have no idea. This is the diary of someone who needs help getting a full exhale. (gah I'm old) But don't worry, fam, it's totally common. Ideally, the deeper abdominal muscles compress the lower ribcage in all directions, assisting the diaphragm in full ascension. There are two big tells that let you know you have this position: The ab wall will get smaller, especially the lower abdomen region. The lower ribcage will drop downward and inward. If you don't have these two points, then a full exhale is not attained. The sternal collapse is a compensatory strategy to attempt to get this full exhale. Here, the rectus (damn near killed us) abdominis contracts, pulling the sternum downward. This can help create a pseudo domed position of the diaphragm, but you do not get changes in the lateral ab wall. You also can't get the complete air evacuation out that you normally would, as this altered shape change pushes air posteriorly and inferiorly, limiting posterior diaphragm ascension. Rectus damn near killed us. The worst! (Photo credit: ; ) To mitigate these compensatory strategies, we need to emphasize the ab wall getting smaller and the ribcage dropping. To get the ab wall smaller, the best way I've found this is to just utilize a self-manual cue. Put your hands right below your belly button, and do your darndest to get the abs to get smaller. The second point is the get the lower ribcage to drop. If you get the abs moving but the ribs don't, then you need some help. The Beatles got a little help from their friends, but you, my fine fam, are going to get a LOT of help from your arms. That is, you are reaching. Reaching is like icing on the stack cake, as it can promote the ribcage shape change desired by affecting the upper components of the ribcage. Depending on your archetype, you have one of two options to start with. For narrow ISAs, you'll want to reach forward, as this action will bend the ribs by generating anterior and posterior compression. I like doing these unilaterally, with a move like a hooklying tilt with a one arm reach: https://youtu.be/-GwHrk0zmc8 For wide ISAs, an upward reach (around 100-120° shoulder flexion) can be quite useful. A move like this supine hip extension move can be a great choice: https://youtu.be/NIt5Ass84VQ Reaching during the stack Question: What if the medial borders of the scaps were NOT flush with the ribcage, could then a reach at 90º be useful for posterior expansion, ribcage retraction, and getting those medials borders to find their nice cozy home along the ribs? https://youtu.be/jJAZp-NeZoY Answer: The big thing to watch on this lack of flushness on the ribcage is that it often accompanies the thorax migrating forward. If the thorax goes too far forward and you have lost the stack (and subsequently, the inability to talk to me), then you will not get posterior expansion. However, I've been known to manually pull the medial border off of the ribcage to encourage posterior thorax expansion, and it can be quite useful. Yet, it's really fricken hard to perform this action actively. UNLESS.... you create a relative motion between the scapula and humerus, aka scapular internal rotation. How do you do this? I'M GLAD YOU ASKED! If you can externally rotate the humerus without moving the scapula, this creates a relative internal rotation at the scapula. If you have internal rotation at the scapula, the scapular external rotators (which cover the dorsal rostral area) will be eccentrically oriented, which can allow for posterior expansion. A great way to achieve this action is by performing armbars with screwdrivers: https://youtu.be/EbgUI2jjN-4 Making prone and supine more comfortable during the stack Question: I find it uncomfortable in the prone and supine position for the stack. Any tips? Answer: If these positions are hurting, then there is an inability to express movement options, hence the increased pressure in respective areas. In the prone position, gravity is pushing downward, which can drive more anterior orientation. If your backside is concentric AF, then it may be that this position pushes you even more forward. Problems ensue. The prone solution? Take yourself out of the anterior orientation. This action can be done by either putting a few airex pads underneath your stomach, or even lying over a swiss ball. An airex pad underneath the stomach is s quick way to restore the anterior orientation. The same issue can cause problems in supine. If you can't reverse the posterior concentric bias, then there may be increased pressure in the sacroiliac joint and upper back. The solution could be the same. Placing a pad or wedge underneath the pelvis can help encourage the posterior orientation that you OH SO DESIRE! Side planks for the deconditioned? Question: When working with wide ISAs who are deconditioned and older, will you give them side planks right away? I worry about the shoulder. Answer: Side planks can be great for creating the lateral compression needed to make wide infrasternal angle presentations dynamic. The issue, however, is that you need to be able to produce enough force to get yourself into position. Otherwise, you are going to overload the shoulder. That said, you can still get the benefits of "side planks," you just need to regress them. Simply not lifting the body up in the air, instead pushing through the arm, can create a lot of benefits without as much load. https://youtu.be/b-m54cWG95s If that's too much, then you can bear weight through your hand like so: https://youtu.be/fHkQJ_IdwH8 If even that is too much, you can simply lie over a swiss ball to create some lateral compression: https://youtu.be/1j_9eJZRkDA Neutral pelvis or posterior tilt? Question: Neutral pelvis vs posterior tilt stack. Which/when? https://youtu.be/5PxboQFisRg Answer: While we cannot say what true "position" the pelvis is in, there are some indicators that can let us know if we have a good orientation during stack coaching. The key is to orient the pelvis in a manner that allows the viscera to bob up and down as we breathe; restoring sacral dynamics. Your key indicator that you are in a good spot is perception of the glutes and hamstrings contracting WHILE keep the pelvis and thorax stacked atop one another. If you have that, you are in a great spot :) Too much rectus abdominis during exhales Question: What kind of cues would use for someone who keeps kicking in rectus abdominis? Answer: The rectus (damn-near killed us) abdonimis kicks in when we can't get a full exhale. You'll see that when the following stuff happens: the sternum depresses the belly gets bigger the pelvis translates forward If you see these things, you can bet your bottom dollar that your stack is whack! Here are the keys to focus on to derectusify (technical term) the stack: Keep the exhale slow and drawn out Feel the lower belly get smaller Drive upper cervical extension Choose good positions that minimize rectus activity (e.g. sidelying for wide ISAs) Stacking during rotation Question: How do you ensure that you have a stack during rotation? Answer: The most important piece is to ensure that you aren't bending as a unit when you reach. Winging during front planks Question: If I try a front plank and the scaps are winging, what is going on there? Answer: If the scapulae are winging, the thorax is falling WAY too forward, which creates space between the thorax and the scapula. To create space, you need to push the ribcage backward while achieving a full exhale. Less air in the front, more air in the back. Too much lower back during the exhale Question: I have a client who uses erectors to complete the exhale. Any tips? Answer: You need to put the back muscles into an eccentric orientation so they don't create the exhale. Choosing some of the positions mentioned during the prone and supine portion of this debrief can be useful. Cueing out of overtucking Question: Any tips on client who overtuck during the stack? Answer: I usually start with this person arching their back excessively, then slowly unarching out of that position. This helps them isolate the movement to the pelvis. Sum up The ribcage should expand in all directions during the stack, not migrate forward as a unit. A full exhale should entail the ab wall getting smaller and the lower ribcage dropping downward. A reach can help facilitate a fuller exhale. Scapular internal rotation can promote posterior expansion. Prone and supine can be more comfortable by positioning passively into a posteriorly expanded position. To reduce rectus abdominis overactivity, keep exhales slow, ab wall small, and chin away from neck. To reduce overtucking, arch then unarch
info_outline Split Squat Biomechanics 05/10/2021
Split Squat Biomechanics A complete guide to split squat biomechanics The split squat is incredibly versatile, but how can I most effectively use it to drive the range of motions I need. Or why in the heck is my person compensating in that way when they do the split squat? We will answer that with this post, as the split squat can vary its rotational qualities depending on factors such as depth, arm positioning, and more! If you are ready to absolutely crush all things split squat, then check out Movement Debrief Episode 152 below to find out! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends May 7th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (Early bird ends October 22nd at 11:55 pm) Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - The bible for all things elbow and wrist - This post goes over many of the common foot compensations we may see and what to do about it. - If you want to understand hip biomechanics, getting your hands on this paper is a must. - This article outlines how altering trunk position can influence muscle activity as the split squat occurs. Pelvic and femoral split squat mechanics Question: During Split squat which mechanics can be observed? Nutation on the front leg? Counternutation back leg? Watch the answer Answer: It depends on what we are talking about respective to the point in the split squat. So, fam, let’s dive into the various aspects of the split squat. For all positions, let’s assume we are talking about a split squat with the left leg in front. [caption id="attachment_14459" align="aligncenter" width="810"] No asses outta me or you fam![/caption] Split squat start position At the start, the sacrum is right facing, but beginning to turn to the left. Based on the relative rotation that occurs throughout the movement of flexion, the front leg will have a relative external rotation bias. This bias is due to the top leg being at around 20-30 degrees of hip flexion. [caption id="attachment_14460" align="aligncenter" width="515"] Sacrum turns left, front leg ER'd, back leg IR'd.[/caption] The back leg will have a relative internal rotation bias due to being at around 0 degrees of hip extension. Split squat descent As I descend through the squat, the sacrum will progressively turn more and more left, kinda like that one song by Joe but less seductive. In order for this turn to occur, there will be progressive counternutation on the left side of the sacrum and nutation on the right. As we move downward, we start to see a shift in the rotational influences of the femurs. On the front, once the femur passes around 60 degrees of hip flexion, there is a progressive move towards internal rotation. The back femur, staying at roughly 0 degrees of hip flexion, maintains slight internal rotation bias throughout the course of the movement. Bottom of the split squat Once we are at the bottom of the split squat, we’ve officially reached internal rotation city. Congratulations, you are the mayor. The influence of 90 degrees of hip flexion on the front leg and maintenance of 0 degrees of hip flexion on the right both lends towards internal rotation occurring at the femurs. Although the sacrum is continually turning to the left, this rotational influence causes the sacrum to perform the act of nutation. That doesn’t mean that the sacrum is nutated, but this is the direction it is moving. Split Squat ascent As I push out of the bottom of the split squat, the sacrum rotates back to the “start” position via external rotation of the front leg and maintenance of back leg internal rotation. [caption id="attachment_14462" align="alignnone" width="810"] The rotational difference on the way up creates the turn back to the start[/caption] How do offset loads influence mechanics? All of the above points assume that there is no change with load distribution, but what if I hold a weight in one hand. How does that change things? I’M GLAD YOU ASKED!!!!!! Think of whatever arm I hold the weight in as creating a reach. Whatever arm I reach with will aid in driving rotation in the opposite direction: Ipsilateral load: rotate away from the front leg Contralateral load: rotate towards the front leg [caption id="attachment_14463" align="alignnone" width="810"] Think of the weight distribution as reaching[/caption] Therefore, an ipsilateral load will limit the sacral rotation towards the front leg, and a contralateral load will increase the sacral rotation towards the front leg. Femoral, tibial, and foot split squat mechanics Question: I watched the video of the Front Foot Elevate Split Squat Shift for driving supination/calcaneal inversion. Does this happen as a result of femoral internal rotation --> tibial external rotation -->supination--> calcaneal inversion. Would this line of thinking be correct? If so, I am having a tough time wrapping my head around the fact that femoral IR (an exhalation measure) would bias supination (an inhalation measure) further down the chain, would it be possible to clarify? Watch the answer Answer: Your line of thinking is tots mcgoats correct. The reason why we have alternating actions occurring with the femur, tibia, and foot has to do with the relative motion occurring between the bones as I bend the knee. There is this concept at the knee joint called the screwhome mechanism. As the knee extends fully, the tibia externally rotates to glide along the condylar grooves. This creates a relative femoral internal rotation. As the knee unlocks from extension, we see the reverse of this mechanism. The tibia internally rotates, and the femur externally rotates. These actions roughly "cancel" each other out to create what appears to us as a purely sagittal movement at the knee (but it's not, folks). According to these two studies ( and ), we actually see these rotational differences throughout the range of knee flexion: Knee hyperextension: tibial external rotation & femoral internal rotation 0-30 knee flexion: tibial internal rotation & femoral external rotation 30-90 knee flexion: tibial external rotation & femoral internal rotation 90 to full knee flexion: tibial internal rotation & femoral external rotation Taking into consideration what is happening as I drop into the bottom of the split squat, we hit roughly Taking into consideration what is happening as I drop into the bottom of the split squat, we hit roughly 90 degrees of hip flexion and knee flexion. Therefore, we can see that we will be moving toward a tibial external rotation and femoral internal rotation orientation. Given that tibial external rotation is paired with calcaneal inversion and subsequent supination, we now have a way to link a pairing of inhalation and exhalation orientations. What doesn't necessarily change in this orientation is what is going on at the pelvis. There will still be the turn towards the front leg occurring. One thing we have to be clear on is that although we have biases of specific movements, there are likely inhalation and exhalation actions happening simultaneously everywhere. So too with internal and external rotation. The combination of these movements working together is what provides us several movement options to put our bodies where we need to. Deep hip flexion in a split squat Question: Would mechanics change if I can dip below 90 degrees of hip flexion in a split squat? Watch the answer Answer: As we pass 100 degrees of hip flexion, the femur begins to externally rotate again, and the sacral will turn even further towards the front leg, which will alter the mechanics at the bottom of the split squat to reflect in this fashion. Peep to learn more! Hip shifting in the split squat Question: Do you consider hip shifting in the lead leg of the split squat more external or internal rotation? Watch the answer Answer: The rotation driven will depend on the range at which the shift occurs. Heuristic: Hip shifting will increase the relative rotation in a given direction Given that higher ranges of hip flexion have more external rotation bias, shifting here will increase external rotation. If I shift towards the bottom of the split squat, more internal rotation will be driven in the motion. What direction should the knee move in a split squat? Question: In the descent of the split squat, do we want to cue the knee to go toward the big toe? Watch the answer Answer: The midline of the foot is the second toe, so I generally want the knee to go over this position. To keep it simple, I just cue my supreme clientele to keep the knee centered over the foot. Lumbopelvic compensation during a split squat Question: What happens on a split squat if someone throws the front hip in front of the thorax and the pelvis is overtucked? Watch the answer Answer: The split squat requires relative motions to occur at the various joints of the pelvis to create the motion. If you can't create these motions, body regions will begin to move as one unit, and definitely not the cool G-Unit. A common one you might say is the back hip flexed forward as opposed to going straight down. When this happens, the pelvis and lumbar spine posteriorly orient as a unit, which flexes both hips forward. This allows me to attain depth while minimizing the sacral turn towards the front leg. You could also see shifting backwards of the hip, which is essentially the sacrum turning away from the front leg. What's more, you could also see a long stance that anteriorly orients the pelvis to create intenral rotation and depth. In each of these instances, the major key is to keep the stance length shorter, stack, push the front knee forward and the back knee down. One can use a foam roller as a target can help with this latter cue. Front foot elevated split squats can be good starting points for this: Watch the answer Split squats for powerlifting? Question: Split squats for powerlifting? Answer: Since powerlifting involves restricting motion and increasing tension to some degree, the rotational nature of splits squats can be useful to restore any lost range of motion to reduce the risk of tissue overload. The difference between front heel elevated and front foot elevated split squats Question: What are the differences in mechanics between front heel and front foot elevation in a split squat? Watch the answer Answer: The front foot elevation helps shift weight backwards to reduce front leg loading. A front heel elevation biases calcaneal inversion, which will drive further external rotation through the leg and sacral counternutation. Lateral split squat vs regular split squat Question: What biomechanically changes in a lateral split squat versus a regular split squat? Watch the answer Answer: A lateral split squat induces more pelvic lateral tilt, whereas a regular split squat provides more pelvic rotation. A lateral tilt will drive even greater internal rotation bias than your traditional split squats. Dorsiflexion loss in a split squat Question: Would a heels elevated split squat be better than squatting for a dorsiflexion loss? Answer: Anytime you can use rotation and do it savagely well, you. can drive both anterior and posterior expansion. This will generate WAY more motion than bilateral stuff, whcih is why it's easier for peeps to generate more motion. Back leg position in a rear-foot elevated split squat Question: What position do I like for the back foot in a rear foot elevated split squat? Watch the answer Answer: As I lower into the squat, the back knee is going to be in a relative tibial external rotation and femoral internal rotation position, which will bias calcaneal inversion. Inversion is associated with plantarflexion, which is a good reason to keep the back foot plantarflexed when. you are using this modality. Sum up The split squat starts with an external rotation bias, but progresses towards an internal rotation as we hit the bottom; the sacrum progressively turns towards the front leg Ipsilateral loads decrease rotation towards the front leg. Contralateral load increases rotation towards the front leg With progressive knee flexion, femoral and tibial movements rotate in opposing directions. The deeper the hip flexion in a split squat, the more the sacrum turns towards the front leg. Hip shifting magnifies the sacral turning depending on the depth at which it occurs. The knee should be centered over the second toe in a split squat. Loss of "ideal" motion in the split squat often results in the lumbopelvic complex moving as one unit. Lateral split squats create lateral pelvic tilts; regular split squats create pelvic rotation Front foot elevation shifts bodyweight posteriorly; heel elevation increases leg external rotation The back foot in a rear-foot elevated split squat should be plantarflexed, as this promotes the foot, tibial, and hip position needed throughout the range of motion.
info_outline How to Program Chops and Lifts 04/19/2021
How to Program Chops and Lifts Why are you doing chops and lifts? Chops and lifts; a staple of “functional” training, but do you ever ask yourself why you program them? Do you program these moves because: They help with rotation? They help with anti-rotation? Cuz PNF? Cuz Gray Cook said so? I say this to not poo-poo these moves. I actually think that chops and lifts are AWESOME. But critically thinking through why we’d program these moves can help so much with knowing when to program what. I’ve found these moves to be useful for many reasons: Promoting thorax expansion Increasing hip range of motion Making infrasternal angles dynamic And so much more! Want the when, how, and why to take your chops and lift game up a notch? Check out Movement Debrief Episode 151 below to find out! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video . are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (Early bird ends October 22nd at 11:55 pm) Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This article outlines the different hip and muscular actions that we see at various ranges of motion. - Daddy-O Pops. My mentor. Thought leader on propulsion arc concept and more! Using Chops to Increase Range of Motion Question: How can you use chops to bias expansion and compression to restore shoulder range of motion? Answer: I'll do you one better. Let's dive into how chops and lifts can be used to improve BOTH hip AND shoulder range of motion! Generally, chops and lifts are driving rotation about the ventral cavity. So if I chop to the right, the effects of expansion within the ventral cavity will be shown left anterior and right posterior: [caption id="attachment_14181" align="aligncenter" width="600"] Blue areas are where expansion occurs to create the turn.[/caption] But now how does this change when we go into each respective area? Lower body component of chops and lifts Generally, there are two ways to use these movements: Increase rotation into a given area (chops) Maintain position into a given area (lifts) Let's take a half-kneeling cable chop for an example. [caption id="attachment_14367" align="alignnone" width="600"] Just call me a worldwide chopper![/caption] Both legs are in a relatively internally rotated bias, with slight sacral rotation towards the left [caption id="attachment_14368" align="alignnone" width="600"] There is an IR bias at each respective femur[/caption] If I chop towards the down leg, I'm going to rotate the sacrum towards down leg, from a leftward facing position. This will increase external rotation occurring on the left side, and further internal rotation on the right. Conversely, if I chop towards the up leg, I will drive further sacral rotation towards the front leg, increasing front leg internal rotation and reducing the amount on the right. [caption id="attachment_14370" align="alignnone" width="600"] More IR on the left, less IR on the right[/caption] This is generally how I incorporate chops. Chops help increase rotation towards a given area. The way I utilize lifts is slightly different. Because I am reaching more overhead, there is more extension occurring throughout the axial skeleton, which limits rotation. Therefore, a lift can be useful to focus on maintaining lower extremity position. Lifts help maintain position in a given area If I perform a half-kneeling lift towards the front leg, I would be challenging my ability to maintain the position. There won't be as much rotational increase. [caption id="attachment_14371" align="alignnone" width="600"] I keep the rough amount of IR I started with in the beginning.[/caption] Upper body components of chops and lifts You can bias airflow even further depending on what type of diagonal movement you perform. Let's again, assume I am performing a rotational action to the right. In this case, I will be driving left anterior expansion and right posterior expansion. [caption id="attachment_14181" align="alignnone" width="810"] Blue areas are where expansion occurs to create the turn.[/caption] From there, you can manipulate airflow with various reaching directions. We can utilize the flexion arc model made popular by to illustrate this concept: Chop (60°): Posterior expansion (T6-8 level) Horizontal chop (90°): Anterior expansion Lift (120°): Anterior expansion Again, you have to look at the above ventral cavity orientation to appreciate that this is the starting point that we go from. We then superimpose the reach performed to alter airflow gradients. Since rotation is still occurring, you will have the above differential in airflow, but you'll notice different airflow biases occurring in each. With a chop, there will be more posterior expansion occurring on the left, but it'll be less so than on the right. I still need that gradient to drive the rotation. [caption id="attachment_14184" align="aligncenter" width="425"] Dotted lines indicate less relative airflow compared to straight lines. so you can see, there will still be rightward rotation, even with the posterior expansion bias.[/caption] Conversely, a lift is going to drive a BOATLOAD of anterior expansion, with more occurring on the left to drive the rotation. [caption id="attachment_14183" align="aligncenter" width="390"] Dotted lines indicate less relative airflow compared to straight lines. so you can see, there will still be rightward rotation even with the anterior expansion bias.[/caption] Horizontal chops simply magnify the original rotation. Head motion during chops and lifts Question: With chops/lifts in particular, what is the ideal motion of the head? Are there circumstances where you might coach it differently? For example, instead of turning the head with the rest of the axial skeleton towards the direction of the chop/lift, is there a circumstance you might coach it where the shoulders are moving around a non-moving head? Would this be incorrect? If not, how would you explain the difference between the two in terms of axial skeleton mechanics and expansion/compression? And what would be the implications for when to coach it one way or the other? Answer: The ideal head position depends on what you are trying to drive. If the eyes follow the rope, you will be orienting the entire spine in the direction you are rotating. Again, if we use right rotation as an example, turning the head can magnify the rotation. But what if you are an ABSOLUTE REBEL and want to keep the head fixed forward as you chop or lift... I'm Glad You Asked! Remember from our cervical rotation debrief, turning the head will create movement all the way down to T5-6. So if you keep your head pointing forward, you would bias expansion in the uppermost segments of the thorax. Let's take our classic half-kneeling cable chop to the right. Only this time, let's fix the head forward. As we recall, the thorax will be rotating right, creating left anterior and right posterior expansion. [caption id="attachment_14186" align="alignnone" width="768"] Dotted lines indicate relative rotation from a given starting position. In this case, the upper thoracic segments would be rotating left from a rightward orientation[/caption] If we look forward, the spine will rotate in the opposite direction from T5 on up. Crazy right?!?!? [caption id="attachment_14185" align="alignnone" width="810"] I might make this an NFT[/caption] To be clear, that doesn't mean you are getting this crazy torque of the spine going from one extreme range to another. T2-5 would be turning left from a relative rightward state. The spine could still have a rightward orientation in this example, but you'd have better uppermost expansion in the places you desired. In the above example, someone with such as decreased left horizontal abduction and flexion and right horizontal adduction and extension, this chop variation could be money in the bank! Sum up Chops are useful to bias posterior expansion and increase lower body rotation. Lifts are useful to bias anterior expansion and hold lower body positioning. Fixing the head forward will help drive contralateral rotation in the opposing direction.
info_outline Core Training 04/12/2021
Core Training Core training...it’s not what you think it is. Core training is often recommended for getting those pesky rib flares to go away, and MOS DEF going to eliminate that anterior pelvic tilt… Right? RIGHT??!!? Uh, no fam. There are tons of misconceptions surrounding core training, the stack, and all that mess. Believe it or not: Rib flares and anterior pelvic tilt have NOTHING to do with a weak core A posterior tilt doesn’t always equate with a counternutated sacrum You don’t have to maintain a particular “core” position with every activity ever!!!!!! So then what does core training entail? Check out Movement Debrief Episode 150 to find out! If you want to watch these live, add me on . Show notes Check out promo video . are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - A great study outlining what positions the sacrum is in within various postures. - The spot that I work at in Las Vegas. - A great debrief that will help you refine and get the most out of your posterior pelvic tilt. - Daddy-O Pops. He has been my biggest mentor. - Here, I debunk the supposed unsafe spinal flexion that we do. - An absolute must in your cooking repertoire. Does a rib flare mean my core is weak? Question: I have anterior pelvic tilt as well, and one thing that I often hear about treating anterior pelvic tilt and rib flare is to strengthen your core. I guess I'm wondering how to go about core exercises with my narrow ISA. Often times when I exercise my core, my upper obliques want to do all the work, which squeezes my ribs together and makes my ISA narrower. Do you think that as of right now, I should just stop doing all core exercises to prevent this, or should I continue to do the more standard types of core exercises like planks and dead-bugs? Watch the answer Answer: Before we go through what to do for my main man Bob, we need to clear the air on a few different pieces: Anterior pelvic tilt is normal to see when you are standing upright. According to the sacrum is nutated during standing. The key is to restore any loss of movement that may be occurring versus static posture. Anterior pelvic tilt and rib flare does not occur because of a lack of core strength. We don't have any evidence to point to a specific or series of causes for the body assuming the aforementioned positions. If I had to hedge my bets, my thought would be these orientations occur because of and attempting to to maintain being upright against gravity. This position doesn't weaken the abdominal muscles but eccentrically orients the abdominal wall, more so the lower portions. This orientation would reduce force production at the abs to alter the position. A similar situation to the abs would be trying to do a bicep curl from an extended elbow as opposed to 90 degrees of elbow flexion. We can all agree that it's much harder to perform the bicep curl when the arm is fully straight compared to when the elbow is bent 90 degrees. [caption id="attachment_13955" align="alignnone" width="785"] Trust me, I've done extensive research on bicep curls, how else would these gains exist???).[/caption] However, we don't say that it's harder because the bicep is weak. The curl is more difficult because of the starting position. So too with the abs when you see a rib flare and anterior pelvic tilt. In this orientation, the diaphragm is descended far (concentric), which places the lower abs in an eccentric orientation, as these muscles act in opposing fashion during respiration. This position is especially the case with a , as the diaphragm is descended further in comparison to a wide infrasternal angle. This narrower angle will give the upper abs a bit more leverage than the lower, hence why when Bob does his core exercises it's all upper obliques all...day...every...day. The "fix" isn't to stop all core training, but to perform activities that act in opposition to this current movement behavior. The first step is to Watch how to stack What the stack aims to do is the exact opposite movement strategy that our caller refers to: Posteriorly tilt the pelvis instead of anteriorly tilt Restore relative sacral motion by breathing Fully exhale to reduce rib flare and make infrasternal angle dynamic You might start with a move that helps drive each of these positions without compensatory strategies. might be a great starting point. From here, it's just a matter of being able to demonstrate a wide variety of movements without falling into these compensatory strategies. That would include lower body work like squats, split squats, hinges; and upper body stuff like pushes and pulls. This training could even extend to higher-speed activities or other terminal tasks. All traditional "core training" serves for in my opinion is a lower level drill to teach your body to move while expressing desirable movement options. Take a for example. Instead of thinking this move is great for them oblique gains. Think that I am teaching my body to rotate in a split stance position. I can use these activities to aid in shifting into the downside hip, which is important to loading a cut if we related this to a terminal task. If you think of core exercises as a build-up to a greater purpose or task, then NO ONE will mess with you :) Why do we drive a posterior tilt? Question: I am very confused about core training. Why do we maintain posterior tilt throughout the range, when in real life the sacrum would nutate with hip extension? Watch the answer Answer: The reason is that most of us wonderful fam have a bias towards anterior pelvic tilt that we struggle to overcome. We would know that this orientation would be struggle bus because of the range of motion loss in the hip joint. What the does is it helps teach the individual to be able to move the pelvis in the opposite direction of their current bias. The hope would be that this helps restore some movement loss in the lower extremities. Now, Mohamed is correct. The sacrum ought to relatively nutate when in hip extension, and counternutate with the hip flexed. However, there is an important nuance to know that we are leaving out of the equation: The tuck does NOT counternutate the sacrum There is only about 2 degrees of available motion in the sacroiliac joint. So to think that we can isolate nutation and counternutation by a posterior tilt is highly unlikely. We aren't that precise of movers. Yet restoring these motions is important when creating a dynamic pelvis. So how in the heck do we nutate and counternutate like bosses? What drives these sacroiliac movements? The answer: breathing. Nutation and counternutation occur by tension changes in the pelvic floor. The relative tension and shape of the pelvic floor os determined by the natural visceral movement that occurs with breathing. That's why you cannot tuck alone and hope for the best. Ensuring you have the breathing portion down pat, the top part of the stack, is key to driving this motion. That said, I don't expect peeps to make sure that the pelvis is just so and the ribcage must be in the perfect position before doing any movement or else they'll die! That's unrealistic, unnecessary, and counterproductive when it comes to dynamic and explosive movements. [caption id="attachment_13956" align="alignnone" width="810"] Just ain't gonna cut it! (Image by from )[/caption] What's important is the body is moving in the directions necessary to maximize force production for a given task. If you are trying to jump as high as possible with little ground contact, you want vertical pelvis displacement, not bending over at the waist and knocking the knees together. If you are cutting and changing direction, your body needs to change levels and lower in position, again, not drastically anteriorly tilt the pelvis and staying too high into the cut. If you are explosively rotating as in a golf swing, restricts range at the hips and will limit your ability to rotate fully. All of these examples can be improved with technical coaching and appropriate drill selection that produces the desired outcome. This could be using resistance to assist to slow down people in specific directions. limiting motion with boxes, and many other things. Slow speed exercises, however, are the prime time to focus on stacking and breathing, as technique can be better emphasized. The hope would be that this strategy increases movement options and helps build context to be used in terminal tasks. Personally, I've found by emphasizing stacking and such in slow speed and with appropriate fast speed drill selection, you can marry both worlds effectively. Ab contractions during gait Question: Thoughts on abdominal activity during gait. Answer: The abs should be active during the gait cycle, as your obliques are your big trunk rotators. HOWEVER! Gait should be a fairly automatic activity, so you shouldn't have to actively tense them during gait. This may impact your movement capabilities. The most that I'll do is encourage someone to swing their arms or develop awareness of heel contact when they step. Breathing exercises with hypertension? Question: Are the breathing exercises I do safe for people with high blood pressure? Watch the answer Answer: HELL TO THE YES. The breathing activity that we have to be most careful of is the valsalva maneuver, where you take a big breath of air in and exhale against a closed glottis. Essentially, this strategy creates a high pressure environment in the body, which is useful when lifting heavy ass weights. The problem, however, is that this action increases blood pressure considerably. So for those with hypertension and heart disease, it is often avoided. The easy breathing exercises that I encourage, whether gentle nasal breathing (which can reduce blood pressure), or even exhaling with a controlled pause, are safe. And the reason why they are safe is because you are not creating a high pressure environment within the body during these activities, and blood pressure doesn't raise up (#joshgroban). Are crunches and situps useful? Question: Do crunches even have a purpose? Is it better to do planks, glute-focused core training, and dead bugs? Watch the answer Answer: First off, spinal flexion is totally safe. The in vivo evidence seems to suggest very much so. Though safety is there, are crunches, situps, and the like useful? In certain instances, yes. What a crunch or a situp can do is encourage segmental flexion within the spine; aka posterior expansion. This maneuver, however, can be quite difficult for someone who has TONS of anterior expansion. They may not be able to push their stuff posteriorly, which can limit situp efficacy. In a similar vein, they may end up just bending at the sternum to complete the action. No bueno. I start first with things that would drive posterior expansion a bit more easily. Moves like are a good starting point. Propulsion arc and core training? Question: Is using the propulsion arc a great way to choose core exercises? Answer: Absolutely. You can select exercises to drive particular movements depending on how you place the body within these arcs. If you have someone who needs external rotation to improve, you may choose exercises that involve: hip flexion at 0-60 or 100+ degrees Shoulder flexion at 0-60 or 120-180 degrees A fits really well here. If you need internal rotation, you could go with: hip flexion at 60-100 or at 0 degrees Shoulder flexion at 60-120 degrees A might be an option for this. And if you are feeling REAL frisky and need frontside and backside expansion, then any rotational activity can be useful. To get rotation through the sacrum and thorax, the is a wonderful choice. Sum up Though we don't know why compensations occur, we want to select activities that place one in the exact opposite orientation; restoring the full spectrum of movement options Tucking doesn't driver counternutation, but places the pelvis in an orientation to drive sacral dynamics We don't assume the stack in explosive activities. Coach position during slow-speed work, then choose drills with constraints that force desired positions. Breathwork is safe for those with hypertension as long as the valsava maneuver is minimized Situps, where there is some posterior expansion available, can be useful for further driving this adaptation. Image by from Song Credit:
info_outline Foot Compensation Patterns 04/05/2021
Foot Compensation Patterns A deep dive into possible foot compensations They say when the foot hits the ground, everything changes, but what if your feet hit the ground in all types of wonky ways? There seems like a bazillion different foot presentations: Flat feet High arches Bunions Plantarflexed first rays Oh my! We haven’t even talked about how the rest of the body can influence these strategies. YIKES. Is there a way to make the feet ridiculously simple? I think so! Really, all you have to do is restore the two “normal” strategies of the feet, and that can lead to profound effects on any weird foot stuff you may see. What are they? Check out Movement Debrief Episode 149 below to find out! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class Want to sign up? Click on the following locations below: (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( Here is a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Daddy-O Pops, my mentor and one of the top people I go to for all things biomechanics - These are the wedges I'll put in shoes to drive calcaneal position - A great study that shows the link between the ankle and the hip - This post goes into how to attack movement compensations in the most efficient manner possible. - This article outlines the biomechanics involved with bunions - Here is where I talk about cramping and some potential reasons Foot compensatory strategies Question: Can you talk about different foot presentations as compensatory strategies? Watch the answer Answer: Well before we talk about foot compensations, why don't we first talk about foot...normalsations? Ooh, I like that. Could be the word of 2021! There are three different foot orientations that correspond with the three different phases of gait: Initial contact Midstance Propulsion Here are the characteristics of each foot position in each phase: Joint Initial Contact Midstance Propulsion Talocrural Plantarflexing Dorsiflexing Dorsiflexed Subtalar Inversion Eversion Inversion Midtarsal Supinated Pronated Supinated First Ray Slight plantarflexed Dorsiflexed Plantarflexed Big Toe Dorsiflexed Plantarflexed Dorsiflexed What we want to ensure is that our fellow fam can express all of these available movement options both passively and with their desired terminal task. On the low end, this could be walking. On the high end, this could be a cut. How would you know what to look for?...Wait for it.... I'M GLAD YOU ASKED!!!! We'd simply first test to see what range of motions are available. You'll want to peep the following areas: Ankle range of motion Big toe range of motion Midfoot flexibility standing posture Dynamic activities (gait and relevant activities) Although I'm typically not the biggest fan of using static postures as an assessment piece, feet are the one exception to the rule. Seeing how the foot can organize on the ground can be quite telling as to what compensatory strategies one may be biased to. However, they cannot tell the whole story, and that's why range of motion testing is so useful. For example, it's not uncommon for the calcaneus to appear as though it's everted in the standing position. However, there have been many times that I've tested these fine fam on the table, only to find out their eversion range of motion is LOL status. In fact, I would argue that this compensatory strategy is one of the most commonly seen (and missed). More on that later ;) If you only looked at standing foot posture, you wouldn't be able to appreciate the subtle difference, and your fam would trick the snot outta you. Those pesky supreme clientele :) Common foot compensations Most foot compensations basically involve a person having a bias towards one extreme of a given range, and a subsequent inability to hit the opposing range. Although there are many foot compensations that we can see, I'll go into the three most common variations that I run into: The supinated foot [caption id="attachment_13903" align="alignnone" width="810"] Notice the high arch, the space between the toes, and how "centered" the heel is.[/caption] This is a situation where the foot is in that initial contact position/propulsion phase, so you'll see the following things: Inverted calcaneus (with a loss of passive eversion) Supinated midtarsal joint (high arch) plantarflexed first ray (there is often a space between the first and second toe) In terms of differences between initial contact and propulsive feet positions, Daddy-O Pops Bill Hartman does a great job explaining the difference the pronated foot [caption id="attachment_13904" align="alignnone" width="810"] Look at the everted calcaneus, flatness of the arch, and how close together the toes are.[/caption] This is essentially a foot in midstance orientation, with the following findings: Everted calcaneus Pronated midtarsal joint (low arch/flat feet) Dorsiflexed first ray (first and second to are often bunched together) Secondary foot compensations In the previous two compensatory strategies, you basically have the same general movement happening throughout the foot complex: either pronation or supination. Any other compensatory strategy typically involves a counterrotation in the opposing direction. So if the calcaneus is inverted, you may see pronation-based compensations in the remaining parts of the foot: mid-tarsal joint, first ray, big toe, etc. Vice versa with the everted calcaneus: supinatory-based movements. These actions could occur at one joint or multiple. The most common compensation that I see/worry about: The inverted calcaneus with a pronated mid-tarsal joint [caption id="attachment_13905" align="alignnone" width="810"] You can see how the calcaneus looks everted, and the toes are a bit closer together compared to our supinated foot model.[/caption] This one will trick the F out of you, fam. Because it will appear that the calcaneus is everted, but it's not. What's happening instead is the midfoot pronates, which drags the calcaneus towards eversion, but it never really gets there. How do I know this? This foot type has a loss of passive calcaneal eversion. If I can't evert the calcaneus, then the calcaneus cannot be everted. Instead, it gets dragged towards eversion, creating a twist between the subtalar joint and midtarsal joint; problems potentially ensue. Here are the common findings with this presentation: Externally rotated tibia Internally rotated femur at the knee joint Decreased calcaneal eversion Loss of big toe extension The most important component of restoring foot dynamics So there can be several different compensatory strategies that happen at the feet that can make assessment be TOTALLY HARD. But you know me, fam, I want to make the foot RIDICULULOSULY SIMPLE for you. What is the most important foot movement to address when it comes to restoring movement options? Priority #1: Restore calcaneus dynamics Yes folks. Getting the calcaneus to invert and evert can restore most of the foot/ankle movement options you see limited. If you see an inverted calcaneus, drive calcaneal eversion. You do this by cueing inside heel contact. The is a great starting point for this movement if you are working with a narrow infrasternal angle. If you have someone with a wide infrasternal angle, you can use the If you see an everted calcaneus, drive calcaneal inversion. You do this by cueing outside heel contact. One of my go-to moves is to either perform to drive this position. Or a How to increase foot and ankle range of motion Question: I would like to know what drives more supination, pronation, dorsiflexion, and plantarflexion of the ankles? because I have high arches but externally rotated feet, and more exhalation seems to increase even more the height of the arches so that the bones and veins protrude at the top side. Watch the answer Answer: Alright alright. Your foot and ankle dynamics are whack, how do I make that better, Zac? Well fam, we need to dive into what corresponding lower extremity movement occur with each of the respective foot and ankle actions discussed. Because if you move your foot into various positions, and you keep going...and going...and going...a relative motion will occur at the femur, pelvis, etc. Conversely, you can drive particular motions up the chain to place the foot where you need it. Let’s make life easy for you. Here is a super simple table that illustrates what movements are associated with various foot actions (like the store, but better prices ;) Foot/ankle movement Corresponding relative hip motion Dorsiflexion Flexion Plantarflexion Extension Inversion/supination adduction Eversion/pronation abduction **This table assumes primary compensations, no secondary compensations. More on that later Now that you’ve seen my table, let’s apply the F out of it and look at some moves that apply this concept: Dorsiflexion are my de facto move to increase ankle dorsiflexion. Plantarflexion Although plantarflexion restrictions are a bit rare, getting hip extension is the major key to increasing this. You want to try and get towards end-range hip extension while keeping the stack if you can. The supine cross-connect mentioned above is actually a great choice for this, but if you aren’t there yet, start with the Supination Adduction for the win. Doing a can be money for this. Pronation Driving abduction with lateral squat variations are my go-to. I’d start with the Then work toward a Untwisting the legs Question: So midstance favors internal rotation, pronation, hamstrings, and anterior gluteus medius. However, it's common that the left foot is already pronated, so why do we often focus on driving internal rotation on the left side? Watch the answer Answer: The reason for this is because we are a bunch of twisted sisters (80’s hair included). AND WE AREN’T GONNA TAKE IT! What I mean by that is it’s quite common to have a “twist” occurring between the femur and the tibia. That means that the femur will be rotating in one direction, and the tibial will rotate in the opposite direction. This situation causes a mismatch in the common rotational action that this fam is referring to. The most common compensatory pattern in this sense is: Left femoral external rotation with tibial internal rotation and foot pronation Right femoral internal rotation with tibial external rotation and foot supination This presentation will usually see a loss of left internal rotation measures and right external rotation measures. It’s this specific presentation where you work on “untwisting” the lower extremities. Basically, you reverse the aforementioned positions: Left: Drive slight foot supination and femoral internal rotation Right: Drive slight foot pronation and femoral external rotation My go-to move, if you can build up to it, is the It’ll humble you if you get it right. Big toe contraction Question: Should the big toe dig into the ground with any exercise? Answer: Big toe flexion occurs during first ray dorsiflexion, which is a part of midstance. Thus, if you need pronation, you might need a spot of big toe flexion. Foot and ankle movement tests Question: What movement tests do you use to test feet for compensations? Answer: Basically, you want to look at all the physiological motions of the foot-ankle complex, which include: Ankle dorsiflexion Ankle plantarflexion Ankle inversion Ankle eversion Big toe extension Big toe extension in dorsiflexion Midtarsal pronation and supination Static foot posture Dynamic foot posture Sum up Loss of foot and ankle dynamics occurs when an individual cannot place the body into a “phase of gait” position. Restoring calcaneal dynamics is the most important factor in restoring foot and ankle movement options. Relative motions at the hips can be used to drive ankle position If there are twists present in the legs, you must drive counterrotation to restore lower extremity dynamics
info_outline The Darkside of the Movement Profession | Tim Richardt 03/28/2021
The Darkside of the Movement Profession | Tim Richardt Improving movement options is legit, but at what cost? We know that this breathing stuff works, but are there drawbacks to this approach? Can we really make the changes “stick?” These are a few of the many problems that Dr. Tim Richardt and I sift through, in a podcast where the script is flipped and Tim interviews me. In this podcast, you’ll learn: How I structure my own training What's better, time management or energy management? Forget following your passion, focus on this instead What my biggest failure was and what it taught me? The dichotomy of the type A personality Movement behaviors: How do we get them to "stick" The dark side of internal cueing The best way to communicate effectively to clients and more! Is there a darkside to all this movement stuff? Is there a better way? Look to watch the interview, listen to the podcast, get the show notes, and read the modified transcripts. Learn more about Tim Tim Richardt is a Doctor of Physical Therapy, Strength and Conditioning Coach, and Owner of Richardt Performance and Rehabilitation located in Denver, CO. He specializes in the treatment and preparation of humans that like to run, lift, or play in the mountains. He currently offers personal training, physical therapy, and professional mentorship services. – Tim's podcast that is specifically designed around engineering the adaptable athlete. Instagram: Show notes Here are links to things mentioned in the interview: - Where ya boi works - An excellent coach who works with me at Elevate. - One of my favorite books. This book taught me to emphasize systems over goals - This book completely flipped all that I know about business upside down. - This book will keep you pushing forward in all things business - A book that helped me take ownership of all my own problems. - If you are going through a tough time, this read is essential. - This book will help squash any ego issues you may have - Basically modern Buddhism. A must-read - Why hope is BS and how to start a religion. It's an awesome book. - One of the best PTs in the Denver area. - My incredible nutrition coach. A master at behavior change - One of the best pain researchers in existence. - An excellent physio - All things foot, he's the guy - One of the best at all things trauma-related from a movement perspective. I reviewed his course - Coach Bo. One of the best coaches in da game. I reviewed her course - This podcast made me appreciate intensity and its importance - The OG book on interacting with others. - An awesome read on elicitation and interaction with others. - Daddy-O Pops himself. My mentor. Modified Transcripts How I structure training Tim: So, my man, I thought we could start with your own training. And I'm wondering if you could describe the last workout that you personally did? Zac: Well, that would have been yesterday. I train mostly at night after work. Yesterday, it was chin-up day. I start with vision exercises because I did some vision therapy, so I'm just trying to maintain the visual skills that I currently struggle with, which is the ability to diverge. So, divergence is the eyes moving apart. You basically stretch them out, which is kind of like external rotation of the eyes, if you can think about that way, which is expansion. And guess who doesn't have that? Ya boy, same thing with everyone else. So, I do some moves to work on divergence, but then focusing within the divergence, which is accommodation. I spent a few minutes doing that. And then my warmup, I kind of do the same thing. I just roll around on the ground for a while, do just a few moves to - yes, I just literally - they were finishing class at Elevate and Francis is like, "Don't worry about the Ninja who works here in the background." Which was funny. So, just warm-up and then... Tim: Just some spinning flying kicks? Zac: Yes. Something like that. Tim: Yes. Like three sets of five...? Zac: Nunchucks. Tim: Sure. Zac: Yes. Tim: Yes, of course. I saw those in your office. Zac: Yes. Tim: I was going to ask about that. Zac: Once I do that, then I do my main move for the day, which yesterday involved post-activation potentiation combo. So, I'll do med ball throws up against the wall, rotational-style, and then chin-ups with some weight. I did these in the 3-6 rep range until I can't do that anymore. And then I ended up doing a trap bar squat and overhead press. https://youtu.be/CJgcqP_X8jM And then I usually do like a circuit of some - like something single leg. I did like a single-leg squat off a box. I do pushups. I do one-arm dumbbell row. And then, like the body saw. I did a circuit of that with just, you know, whatever reps I need. https://youtu.be/uBRYEyebmAY And then sometimes I'll follow with conditioning. But I did my favorite conditioning yesterday, which is kicking my man Francis ass and spike ball. Boom! You heard it internet. We usually play spike ball once a week and we have some good competition. We both have gotten pretty good. We did this thing where we were just playing Spikeball one on one for months because we both sucked. Tim: Sure? Zac: We didn't tell anyone. Tim: One on one spike ball? Zac: Yes. It's weird, but it's fun. And so, Francis was killing me and I can't have that happen because I hate losing in all things. So, I'm like consuming YouTube videos and figuring out how to serve. And so, now I can serve with both hands... Tim: Walking around with the spike balk all the time and go for it? Zac: Yes. And so, now we have some great games and we're just like hitting it way good. And we finally played two on two, not together, but it was way more competitive than we ever did. So, that was the skill that I learned. And that was my training session. Tim: How do you think kind of in the macro about structuring your own training? Like, do you have short, medium long-term training goals, and you kind of period eyes to accomplish those? Or are you more like a fly by the seat of your pants kind of guy? Zac: I have my main moves that I alternate between. So, what stays the same, and I got this, it's the mass effect program from Daddy-o Pops himself, , just with some slight modifications. It looks like this: Lift one: 4-6 reps Lift 2: 6-8 reps Lift3: 10-12 You do each of these until you fatigue out of those rep ranges. And then I just do, you know, two to three rounds of whatever else I feel like I need, which can be like eight to 12 reps. And if there's a day I need to condition, I'll do that. If I want to do some extra arm farm, I do that. So, the three mains are there. I keep trying to get better at them. But the other stuff just varies depending on what I'm feeling. Because my main goal training-wise is just to look good naked. Tim: Okay. Zac: And maintain decent body comp. Tim: No, more fat Zac? Zac: Yes. Fat Zac is done. Tim: Fat Zac's not coming back? Zac: He's done. Tim: That guy was fun though. Zac: He was fun. Yes. He had the beard. He is like a young Santa. Tim: Couldn't touch his toes. Zac: Yes. Definitely couldn't squat. I still can't touch my toes, but I can squat now. So yes. And then like, you mentioned like periodization, I need to train enough that someone can take me seriously from a movement standpoint. It's kind of like looking the part when you're being a PT because I do think that that matters to some extent. https://youtu.be/UEZZEWyBN78 Tim: Yes. Zac: But right now, the highest priority is work, teaching, all that stuff, learning the craft. And so, that's always going to be the A1 for right now. Tim: The A1 of life. Yes. A2 is fitness. Time management vs energy management Tim: You gifted me a book about five or six months ago. In it, he talks a lot about this myth of time management and argues that time isn't necessarily the resource that we should be seeking to manage, but it's instead energy. And that in managing your own energy and taking on projects that seem to give you energy rather than drain them or tackling endeavors that seem to increase energy, you can get a lot more done versus just trying to very efficiently kind of micromanage your own time. So, you're one of the most kind of efficient, effective, prolific people that I personally know within our field. What do you think about this energy management concept? Is that something that kind of lets you do the amount of work that you do? Zac: It's very easy to waste time on frivolous things and I try to do my best to minimize that now. But I think because I have a little bit more freedom to do that now. I can, I think, for example, a couple of years ago I had the shackles of student loans, so it's like, I'll take on anything I can do to try to manage that. But I do think about that when I'm thinking about things that don't bring joy into my life, like social media, for example. Tim: Sure. Zac: I try to stay off that as much as humanly possible. Because it does take energy, even answering texts. Like I'm horrendous about getting back to people via text message or phone calls because I eliminated notifications on that. Because even that takes energy out. Tim: Yes. Zac: Even being around certain people who suck the life out of you... Tim: Exactly the black hole type of thing? Zac: Yes. But at the same time, I do think time management to some extent is important as well because, sometimes you might have to do things that are energy-draining, but they help move the needle forward. Does he talk about following your passion as well and how that's BS? Tim: Yes. Zac: Okay. Tim: And I've probably had that conversation with like 10 people over the past week that like passion is fleeting. It's, you know, rocket fuel, but it's not actually going to sustain you over the longer. It opposes a lot of advice that you conventionally hear. Zac: Yes. Well, what you have to do and there's another good guy you should read it. I might have an extra book. I'll give it to you. MJ DeMarco. He wrote and He talks about that as well in the sense that you don't want to do things that you're passionate about. You want to do things that are going to have a positive impact on the world and change things forever. And then if you do that and you make enough money from that, you eventually will become passionate about it becauseyou're making an impact. Tim: Yes. Zac: I love video games, but I'm not going to be making money, playing video games unless I started... Tim: I was thinking about Twitch and Onlyfans. And I'm like, is there a way to combine those concepts and maybe have people pay you to watch you play video games in a reduced amount of clothing? Zac: Haha right? But even with that, sure, you can make money, but Twitch is not going to change the world. Tim: Sure. Zac: And I want to try to make the little world that I'm in, that we're in, a better place in that sense. And that's really the crux of what I do. That's why I try to take complex things and simplify them so most people can carry it out. I have a lot of good friends who are really smart, but they might not be able to devote the time and energy to diving deep into topics because maybe they got kids to worry about and all this stuff and well, they still patients to take care of. Tim: Yes. Zac: And so, if I can help that person get better a little bit faster, then I think we all win. Tim: I mean, and is doing that something that you find gives you more energy than it drains or drains kind of a minimal amount of energy? Zac: Yes, absolutely. I could teach, talk all the time. I love that. Even doing these podcasts. It's so much fun and then it's just time flies by. Because then it's also, you're just interacting with people and... Tim: Also real-life people. Zac: I know. Right? The failure that changed everything Tim: That's useful. I think along the same lines of that book, it's in the title that he's amassed a massive amount of failures and yet still is an extraordinary success. Thinking about kind of your own life professionally in the past five or 10 years, what are some of your favorite failures? Zac: Professional basketball. The thing that I had going into that was getting to pro basketball kind of a big deal. And I probably let that get to my head a little bit. I think I had a little bit of a Dunning-Kruger effect kicking in. Even though like I still would say back then, I was a pretty good practitioner. I'm much better now. But I think I let that get the best of me that I was in that setting. I can't say that that's why I was fired, but after that happened, it completely flipped everything. I did a lot of soulsearching during that time period. And there were four books that I read that just like changed everything. Tim: I bet I know one of them. Zac: Which one? Tim: Zac: That was definitely one of them. That was one, "," both by Ryan Holiday and then by Mark Manson. I read those four and that's when I realized my behaviors, my issues were the problem. And I was able to do things to flip that and just be more humble, reacquire the beginner's mindset, interact better with peers and people who I'm working with. And it really made a big difference. And I'm grateful for that. I'm grateful that I was out of that situation. It pushed me towards more of what I really like, which is this. And the fact that now I have a bit more freedom flexibility than I did in the league, was huge. That's probably the biggest failure that has flipped things for me. [caption id="attachment_13675" align="aligncenter" width="375"] the failure that led to this[/caption] Tim: Going back to something that we discussed, like removing things in your life that are not really serving you. The hard truth is those are people and probably people that you've known a really long time. And you know, If you can't kind of reflect back on your own life and make a decision about which people you're spending time with, you're liable to get trapped in a lot of, and trap is probably a strong word, but waste the resource of energy on relationships that aren't getting you to where you want to go. Zac: Is that something that you ever struggled with? When you knew you had to move on from a situation or a person? Tim: Yes. The job I took right out of school being a director of rehab in rural Colorado. That was so nice because it was lucrative. It was flexible. I think I could still do a lot of the things that I wanted to, because it was a three-day work week. In a lot of ways, it was the perfect situation, but it didn't have any upward trajectory to it. I started at the ceiling. I'm immensely grateful that I had that opportunity. And I think it changed me for the better, in many ways. But after my three years and change out there, I knew it was time to do something else. Something that had a little bit more of an avenue for growth. Zac: Yes. It's hard when you get comfortable like that because the chance of getting stagnant is significantly higher. And so, you always got to put yourself in slightly uncomfortable positions, I think, to really grow. Tim: Yes. It's a really interesting juxtaposition. I mean, that's something I think about all the time that type A people, kind of people like you and I, a lot of what drives us is we're not happy with the way things are. But if you let that mindset pervade everything, then you never really enjoy what you have. So, it's a really interesting tight rope to balance kind of, as physical therapists, as athletes, as human beings, how do we hold these two seemingly opposing ideas in our head simultaneously and not kind of fall apart? Zac: Yes. That's hard. Tim: Yes. Zac: I definitely let that bleed into areas that it shouldn't bleed into. Tim: Yes. Some things in life are just fine and they're okay the way they are. They don't need to be optimized. Zac: Yes. There are some things too that you got to just keep pushing. Tim: Absolutely. I mean, that's how people do great things. You're not going to just get this great opportunity kind of plopped in your lab. Zac: How do you find the balance? You probably are better than me. Tim: I don't know. I don't think I have a really good answer. I was talking to a mutual friend that we have, . She was mentioning this friend that she has an incredibly high-powered tech broker of some type, makes boatloads of money. But he's a really, really good chef. And he says that the second he no longer has time to cook each day, that's the line in the sand that he draws between. That means he's striving too much. That means he's packing so much into his day that he can't just enjoy what he already has, which is quality time doing something good for himself, for his family, for his children. That really hit home. I love to cook as well. I also like to play Frisbee with my dog, Molly. If I can't take 10 or 15 minutes to do that like that's another - like I just want that to be built into my day-to-day. And then if I can maintain these things and then continue to strive and see certain life, key performance indicators trending in the right direction, I am doing an okay job. Zac: That's something I probably struggle with because I'm thinking about like, as you were saying that I'm like, "That's brilliant. Like everyone needs to find their cooking." And I don't know what mine is. Tim: I think for a lot of people it's working out. Zac: Yes. Tim: Probably not in our industry, because I think we are the people that will probably sacrifice in order to train and train at very inconvenient times. But I think for 99% of the American population, that's one of the early things to go. Zac: Yes. That's very reasonable. See, I can't fathom not having that. It's so automatic at this point that - there was one time where maybe I didn't work out and I'm like, I'll notice that one day, if I had a plan to workout, I can't do it. But I've never gotten to the point where I've worked so much that I've had to cut that out. Tim: And you do, and it's like a super power. But you go about the rest of your day supercharged, you know that you've done something that's probably more difficult than 90% of the people that you're going to interact with have completed that day. Especially for people like I'm a big morning trainer. Zac: Really? Tim: Yes. I'd love to train at like 6:00 AM or 7:00 AM. And that's recent. That's as I've gotten older, but in terms of the Scott Adams concept of adding energy to your life, it's like, that is something that so acutely drains you of energy and yet so quickly fills you right back up. Zac: Yes. It is interesting how that works. Isn't it? Can we get postural changes to stick? Tim: You and I, both physical therapists, we commonly see people that present with particular movement behaviors or positions. And I think one of the most pervasive ideas in our industry is that there's a bad posture or a bad position. Right? Like extension, anterior, pelvic tilt, rotation. What have you? Zac: Oh sure. Tim: There's this idea that there are these bad postures and people have bad postures and well just swap it out for a good posture and they're going to be good to go. Something you and I have talked about before is these postures positions, movement behaviors emerge in order to solve a particular problem? To manage gravity, to breathe, to better prepare you for a training stressor that you've experienced before. So, I guess how do you think about replacing a less than ideal movement behavior or pattern with a better one, because that's kind of what we do with these resets, with these drills to regain mobility? And how do you think about making that intervention like quote-unquote, "sticky" enough so that a person doesn't revert back as quickly as possible? Zac: I don't think it's replacing one for another. I think the key is giving more options. So, for example, if we go with like the forward head, I'm sitting at the chair for an extended period of time, you do that long enough, something might get cranky just because of tissue ischemia or whatever. At the same time, if you sit perched...
info_outline All About Myofunctional Therapy | Melissa Mugno 03/21/2021
All About Myofunctional Therapy | Melissa Mugno If you mouth breathe, struggle sleeping, snore, or have eustachian tube issues, then check this out! Mouth breathing is linked to sleep disorders, tooth decay, eustachian tube issues, and so much more, what do you do about it? Could the answer be myofunctional therapy? That’s what I sift through with Myofunctional therapist Melissa Mugno. In this podcast, you’ll learn: Why Steph Curry chews on his mouthguard the way he does Why do we clench and grind our teeth? The importance of breastfeeding on orofacial development What myofunctional therapy is and where it belongs in the healthcare system The two causes of the mouth breathing epidemic and how to tackle this problem How behavior change plays a crucial role in a successful outcome The intersection of physical and myofunctional therapy Why belly breathing is totally overrated The myofunctional therapy intervention process The link between swallowing and eustachian tube dysfunction and TONS more If you are ready to make your upper airway healthy as can be, then definitely check this podcast out. Look to watch the interview, listen to the podcast, get the show notes, and read the modified transcripts. Learn more about Melissa Since becoming an Orofacial Myofunctional Therapist in 2014, Melissa has improved the lives of hundreds of patients and lectured around the country. Melissa treats patients of all ages suffering from a wide range of conditions stemming from adverse myofunctional habits. Her background as a Dental Hygienist and experience in the fields of Orthodontics and Pedodontics contributes to her success. Melissa works in Las Vegas, NV, and is a Breathe Associate at The Breathe Institute in Los Angles, CA. Show notes Here are links to things mentioned in the interview: - One of the foundational people in the field of myofunctional therapy. - Another foundational person in myofunctional therapy. - A possible way to improve teeth position. - A great dentist in Las Vegas - My dentist who is doing my - She is my go-to optometrist in Las Vegas - Where I got my tongue-tie release done. - The doctor who did my - That's who I took my myofunctional therapy course through. You can peep the review - Daddy-O Pops himself. My mentor. - A great article that goes into how maladaptive beliefs can manifest. Modified Transcripts Why Steph Curry chews on his mouthguard Zac Cupples: So, Steph Curry walks into your office, and he asks you, hey, Melissa, why is it that I like to chew on my mouth guard so much? Melissa Mugno: So, the chewing is because of his airway. Zac: Mm-hmm. Do tell. Tell me more. Melissa: So, in sleep dentistry or airway, we've really come full circle to understand that like chewing and clenching, has a lot more to do with a deficiency in the airway than it does anything else. So, there are habits that are created, that actually kind of stimulate the jaw to come forward, and there's a feeling that feels good. It gives us more air, more serotonin overall, and it actually will give you a lot more clarity. Get some good oxygen, you feel better. So that's actually what's happening. So, the chewing couple times you do it, you're like, it feels good, right? Most humans continue to do things that feel good, stop doing things that feel bad. So, please stop doing that. But the thing was, Steph Curry that's quite interesting is he doesn't just chew on it. He doesn't even - more interesting, he flips it out of his mouth and holds it. And what I was saying to you before was, again, I have not worked on Steph Curry so I do not know. This is just me looking at it, I was intrigued by it. My husband brought it up and said, ‘’Hey, this guy's really known for doing this’’ and I was interested. I've always thought there was a big sports connection. I started looking at how thick his mouth guard was and I'm like, "oh, it's at least two millimeters, two and a half." One of the things we do, the dentist will do or to help patients that have sleep issues, is they'll actually open up their bite, open up the jaw, so they can't close all the way, which naturally will allow their jaw to come forward, and that does is it opens up the airway and allows for the air to flow easier. So, he's holding it, and he's protruding his own bite and you can see it's literally bringing his jaw forward. I started looking and then I watched some YouTube video and I saw that Forbes I think it was? It might be off one of the bigger publications that did an actual survey or did some type of research of how many free throws that he made when the mouthguard was out versus when it wasn't. He shot significantly better with it in! It was a no-brainer to me. he's breathing better. Oxygen will absolutely get you focused and therefore he is more comfortable. So why wouldn't you keep doing it? Yeah, so now it's become this whole thing. Now, I guess like, tons of athletes do it and I was like, yeah, of course, yes, it protects your teeth, but there's a lot more to it. Zac: But when you're clenching as well, how does that open up the airway then? Because I would think... Melissa: Clenching and grinding are not opening up the airway. It's a side effect of having a reduced airway. I love my analogies. So, I call it the body's fire alarm. And so, it triggers something and what's happening is the body knows it's getting a reduced amount of air, so it acts to check that. It's going to create some type of function, some type of habit to make sure everything's good down there. So, this, the grinding, and I have this little theory that we grind when we're kids because we're carefree and we clench when we're older because we're trying to control it. [caption id="attachment_13634" align="alignnone" width="810"] Grinding, but not like the Clipse :( (Photo credit: )[/caption] Zac: Gotcha. Melissa: It seems that way more adults clench than kids and I realized some of my, I mean, it's not absolutely proven, but my adults that grind are usually my cool cats. They just grind it out, let that jaw flow. The adults are like they're trying to control, they don't want that feeling. It's they're trying to control that bite. They don't know why their jaw wants to move. So, I believe the clenching has a lot to do with trying to contro Zac: Prevent it. Melissa: Exactly. It's also connected to the mind--anxiety and all like so much more mental health and stuff like that. I think it's a natural thing that happens as we become adults that we just want to control. Zac: Yeah. Melissa: That control leads to me building some type of subconscious behavior, to take it out on, and activating the buccinators and we're straining out all in here. No nasal breathing. Breastfeeding Melissa: That's one reason why breastfeeding is so important. Yes, it has a lot of cool nutrition value, but one of the coolest things is that happens is it actually teaches you how to breathe and eat at the same time. The tongues pushes the nipple up, and then be able to help extract the milk, and then the baby's actually letting the mom's body know, hey, you got to keep producing. When moms don't produce milk, they automatically assume it's their fault because they have mom guilt. So, then it's like, I just got to make my baby free to be able to eat and stuff. And they think that the formula is doing the trick but what's not happening is that then the bottle goes in, and now the tongue goes down. Zac: Then you can't control the rate at which the liquid is coming in when it’s a bottle versus when you're breastfeeding. Melissa: Then nipple companies make it go quicker, the older you get, make it easier, it just flow it in there, no work needed. Then we don't learn how to breathe nasally really young, then problems ensue. Teeth clenching and grinding Zac: From my standpoint, when we see someone clenching or grinding on the PT side of things, usually that's done to restrict available movement. So, you almost make the system more rigid. And to your point when you're talking about who is this it's those type-A people and a lot of times, I forget what book it was where they talked about the chairs in the waiting room of a cardiologist. Melissa: Oh, yes in the armrests. Yeah, because like they're gripping way hard; fight or flight. Zac: Yeah, and maybe it's just to change the pressurization that's going on in the airway. The importance of breathing Melissa: I laugh a little bit, when people will be like, airway dentistry, PT, speech, what has that have to do with it? "I'm like, Oh, yeah. Who needs air?" Oh, we don't have enough research and I just want to be silly and be like, so we don't have enough research on how important oxygen is? Or seeing the interconnectivity of the body? We all heard that elbow bone is connected to the wrist bone song as a kid, right? Zac: Yeah. Melissa: I just paid you to tell me to breathe? I am breathing! Well, I mean, that's left to be decided, right? [caption id="attachment_12187" align="aligncenter" width="250"] Then you end up looking like this guy #gross[/caption] Myofunctional therapy Zac: Well, and I think most people don't even know that your specialty exists; myofunctional therapy. Melissa: I don't know if I'm the best representation of myofunctional therapists. Zac: You're just my favorite. Melissa: Because it's been more about connecting the dots for me and I think myofunctional therapy happened to be a vehicle that I could I drive that allowed me to go to all these places and I don't think that would maybe be the same for most. I think most love the skill and the passion of myofunctional therapy and what it is day in and day on and how to make the exercises better and that one on one with the patient. I love my patients, don't get me wrong but it's more of this bigger thing for me. I like looking at the teeth, tongue, and more. It opens the door to another place. It's probably my ADHD. The beginning of my journey was untraditional. I was an orthodontic assistant for a long time, hygiene, whatever but I ended up not really even practicing all. My real calling was running a business, selling dental stuff, and making sure the patient and being that liaison to connect everything but at the end of the day, what does that mean? It means making sure the numbers and production and collection were good and I was good at that. We had this really amazing pediatric dental program, but we had this hole in our practice. We would get these referrals for kids who we couldn't start because they didn't have all their molars in yet. How do I make that work? So long story short, I'm from New Jersey, we don't have a very long summer there. And the doctor comes in and he’s like hand me this thing and he's like, we're going to go to this course, I'm like, in August in New Jersey, no, thank you, and ended up being a Myobrace course. There was this patient with a class III bite (where maxilla is behind the mandible). These presentations can occur either genetically or because the tongue sits low, pushing the jaw forward instead of the maxilla. The only real way to fix it is to do surgery (or so I thought). Zac: Yeah, a lot of times they'll break the jaw and pull it back. Melissa: Yes. That's a whole other thing. Zac: I had a friend who did that and I didn't know him at the time. He was a coworker and I told him ahead of time, my buddy was like, don't do this. If anything, you got to bring the jaw forward. Melissa: Did you know that? This was before you started doing? Zac: Yeah. Melissa: so, you were already? Zac: Yeah. I knew like a little bit of airway stuff and like some of my earlier things, it was more about using splints to change occlusion. I started with a gelb splint. [caption id="attachment_13637" align="aligncenter" width="375"] Ah, the classic[/caption] Melissa: Really? Zac: Yeah, because my wisdom teeth were still in and I had no truce of movements in the jaw and so we use the gelb to try to get me a little bit extra just for moving perspective but then the fix was to get the wisdom teeth taken out. So, then we went that route. I wasn't really having sleep issues, then but as I got older, it was - Melissa: Well, you did your sleep study show sleep apnea? Zac: No, I got upper airway resistance syndrome. Melissa: I wonder because of your athleticism and all those things that because you – elongation in the sense you did, it would look like you might be more of a sleep apnea patient, but really, you’re UARS? Apparently, you and I are in the same club. Zac: I know right? Melissa: So we had this mom who all three of her boys had an underbite. She challenged us and asked if there was really nothing I can do besides surgery? We ended up implementing myobrace and started to notice some decent changes, but the execution was rough; we didn't know what to look for and how to progress. So, the journey then, long story short, kind of went in that I really started to crave the need of like, okay, who created these exercises? Where did they come from and that actually kind of brought me full circle to Sandra Colson and realizing she was a huge part of working with them. Her husband was an orthodontist, she was a speech therapist, and they were getting amazing results. Learning from her made sense to the cases we had that relapsed. And it was important. I didn't hear tonsils and adenoids so much like we weren't bringing like was sort of doctors doing an orthodontist is doing his you know console, he's usually rattling off stuff, that type of by you know, class one class two, upper post for your class or whatever, convex all the different profiles have any they might say, you know, within normal limits, but I noticed we started seeing WAY more enlarged tonsils. [caption id="attachment_12197" align="aligncenter" width="500"] Tonsils are the bottom read and white spot thingy. Looks like a solid "3" there, Bob. (Photo credit: [/caption] My real aha moment was working with this amazing orthodontist who produced incredible smiles. It was my first job assisting, so I didn't know any different, but he used removable appliances, nothing cemented. Zac: Really? Melissa: And we always were doing early expansion, twin blocks maras, we would use anything, everything was removable, prop that bite up, pull it forward, and expand the heck out of it. Zac: Wow. Melissa: Now he - how do I say this a nice way? He had, I guess back then I probably would have called an arrogance. He commanded the room. Right? Like you didn't question. He just carried himself in a way. There was no option but the one he gave. Like if Bobby didn't wear it. Like that's your problem, then you shouldn't make him wear like, so that level of expectation. So why that's important to understand. So, I go through and I remember one day we're in the office and I know nothing, right? Like, I'm just figuring out how to do this. He walks by, and the patients are humble, we do and he's like God, somebody should cut that kid's tongue out of his mouth. It's messing up my teeth. It sounds dramatic but now I totally understand but I didn’t. I was like, wow, what a jerk. Right? Like, he doesn't care. So, come all the way full circle, I'm now inMyobrace class, I'm doing it, and it was like this light went off, I was like, oh my gosh, this is what he was talking about. The kid was tongue-thrusting. No matter what he did to that bite, he couldn't close it. Zac: Because the tongue kept pushing on the teeth. Melissa: Yes, that's what he meant. He's like God, that tongue is going to destroy everything. So, he knew it. But the crazy thing is if you go back into his story, he was originally an engineer. He was a mechanical engineer prior. Then after had gotten married, went back in dentistry and became an orthodontist. Essentially, orthodontics is engineering. It's all about force and movement and I think that's what makes most orthodontists very specialized is because they can see things in a different way. With Myobrace, we could take it to another level. Years go by and I go back to school and all those things. And I noticed, almost every orthodontist just cements everything in and they just, I didn't even know you cemented it. It allowed me to basically see all aspects of dentistry, and I needed this whole journey to see it. That myofunctional was the most powerful thing. Oh, that's why the teeth keep relapsing because we didn't address the tongue thrust or we didn't retrain the tongue, we would maybe tell the kid hey, Bobby, try to put your tongue up or we put a habit in there or something. Well, anyone that's ever had a real habit, thought was very easy to overcome, right? Especially if you don't even know why you're doing it. And mouth breathing and tongue posture, I mean, if you're drinking all the time, you kind of know what you're doing is wrong, right? Well, you know what the culprit might be, like this is what's causing this? But if you don't even know that it's wrong to mouth breathe and have a low tongue posture, now I tell you, oh, you have a breathing issue. It's because of your tongue. What? Like how do you do that? How do you fix that? Zac: Especially considering how common mouth breathing is. Melissa: Well look at how it's changed. So, you look in Disney movies, so if you go back to like Snow White, the older ones, all of the characters are lips closed. Zac: Really? Melissa: And now you go to Frozen, she's drooling with her mouth open. Zac: Wow. I never even noticed that but that totally make sense. Like sleeping beauty, was she snoring? Melissa: No, no, lips closed, breathing through. Zac: If you have this epidemic of mouth breathing, and maybe this is where you are realizing the limitations of myofunctional therapy. Just like I have limitations as a PT that's why I talk to you and work with a ton of other people who have skills that I don't. Where myofunctional therapy starts Melissa: In a perfect world, you'd start with breastfeeding. Every baby that's born would address whether or not the baby has a tongue-tie, and has a tongue tie to the new protocols and standards. Unfortunately, the system makes that hard. So now we go out longer and longer. Now, time starts dwindling. So that's in the perfect world, that becomes the standard and protocol. Zac: Interesting. Melissa: Just like, when you have a baby, they come and they check hearing and they've checked all the other stuff, like, we'd want to have the tongue checked as well. I also think we could put protocols in and say what we should all do but I think maybe just the real simple of somebody when they come in and they talk, the lactations will come and I know when I had my first daughter, and they talk about why it was important to breastfeed, they definitely talked about how important it was for connection and they talked about the nutrition value but they didn't tell me that hey, by the way, she might have some breathing issues, she might not be able to latch, she might not be able to really eat, could change the way her diet is, it could change her airway positioning. There is some research out there now that shows that unchecked could send somebody down the road of having sleep issues. Possibly, we know that there's a correlation in connection to ADHD with kids that snore. I wish I would've gotten that information because I did not breastfeed my first daughter. I mean, I have lots of my own reasons, but I don't know I had made my decision but I didn't feel like I was given all the information, right. So, don't we have the right to know everything? So, if we don't educate the parents, how can they make an educated decision? I don't know so I think education is probably the first thing that would make the biggest difference. [caption id="attachment_13638" align="aligncenter" width="600"] Get your knowledge up, yo! (Image by from )[/caption] It's all about building these programs, implementations, having standards and I mean, listen, when I first started and it’s been...
info_outline Military Head Posture 03/14/2021
Military Head Posture Got double chins for days and can’t open the neck up? Check this out While there is no perfect static posture, it is not uncommon for someone who has a military head posture to have limited cervical extension. Maybe you’ve tried a bunch of traditional moves to get it back, yet it still persists. Oh, if only getting neck range of motion was so easy. We have to ask in this specific presentation, why is cervical extension limited? It turns out, there are three key areas that are interrelated AF that we need to hone in on to improve motion here we have to hone in on: Anterior thorax Hyoid Tongue How are these three areas related to neck movement? Check out Movement Debrief Episode 148 below to find out! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video . are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Daddy-O Pops himself. Originator of the hyoid position test. - This is my go-to resource for all things myofunctional therapy. I did a of the one I attended. Military head posture Question: I've been enjoying the cervical extension test to help determine hyoid position. However, I had an issue last week where it didn't work. This client had a military posture. We did this assessment, but as they opened the mouth, they got no additional cervical extension at all. Usually, additional cervical extension is expected with military neck posture. The result threw me off, however, the person did have zero IR of the shoulder and I'm wondering if that had any influence on the cervical extension test. Thanks, Homie! Answer: The hyoid position test was created by , as a way to assess hyoid position, which is essentially the infrasternal angle equivalent in the cervical spine. In noncompensatory mechanics, the hyoid should be able to depress and elevate without restriction. Functionally, the hyoid normally elevates with swallowing, which you do like a BAZILLION times a day. Loss of dynamics in this area could impact swallowing, neck motion, and a whole lot more. The hyoid position test is a way to assess the concentric bias of either supra or infrahyoid musculature. If you notice a restriction within cervical extension, opening your mouth can oftentimes lead to an increase in motion by eccentrically orienting these frontside muscles, which has to happen as I tip the head back. So then what should happen in the case of a military head posture? [caption id="attachment_13580" align="aligncenter" width="376"] Aka chin on chin on chin[/caption] In this particular posture, the hyoid is elevated, which means that suprahyoid musculature is concentrically biased. You will also see lower cervical extension and upper cervical flexion. Subsequentially, the infrahyoid musculature should be eccentrically biased. In theory, when the mouth opens during this particular test, the upper cervical spine should tip further backward, enabling more range of motion. But what happens when hyoid testing goes wrong?!?! In the case that David mentions, we don't see this happen. Why is that? I'M GLAD YOU ASKED! If the infrahyoid musculature is eccentrically oriented, the sternum should theoretically be in an "up" orientation. Anterior thorax expansion ought to be available, thus shoulder extension, adduction, and internal rotation should be free. However, David's tricky client doesn't present in this fashion. If there is a shoulder internal rotation loss, then the infrahyoid musculature will be concentrically oriented. [caption id="attachment_13582" align="aligncenter" width="376"] Aka not a lot of motion going on[/caption] So what my boi David has is a double concentric. With this situation, there is no position that the hyoid can eccentrically move into, thus, no change in motion. You'll likely either see restricted extension OR the thorax tilting posteriorly as the client extends, giving pseudo full extension. What are you to do in this case? The solution would be to create an eccentric orientation somewhere so you can induce some movement in the hyoid. Following the filling to airway dynamic restoration, you ought to start with getting the infrahyoid muscles to chill. This can be achieved by putting air into the front of that chest. For a presentation, you may choose a quadruped activity, like the lazy bear. https://youtu.be/WZtO_Gty2rU For a wide infrasternal angle, you may reach about 110 degrees of shoulder flexion. https://youtu.be/IEWg_sC8G2E You then may have to drive manubrial expansion, which can be achieved with shoulder extension-based activities. Tricep extension exercises can work wonders here: https://youtu.be/Xi3dfPp53OM Okay, let's suppose that your anterior thorax is now dynamic AF, how in the heck do you get the suprahyoid musculature to chill? This process is twofold. At the cervical spine, we have to drive OA extension without inducing a forward head posture. The cranium moves, not the neck [caption id="attachment_13584" align="alignnone" width="810"] We want the position on the right[/caption] Simply cueing "undouble chin" during many moves can be helpful. You can kill two birds with one stone by choosing an activity where you are both driving air into the front of the chest and OA extension. A front plank can be a great choice: https://youtu.be/xLN_bueVBv0 Now I've played with the hyoid position test and altering dynamics in that area, but I think measuring what the tongue is doing might provide more information. I want you to consider this. When we are measuring things like the infrasternal angle, proxy measures for the infrapubic angle, and the hyoid, what are we really looking at? The answer, folks, is how well we can manage the internal anatomy: Viscera The airway This issue with proxy measures is that we are looking at a proxy. An estimate. The further removed we are from the actual thing we are measuring, the more prone we are to inaccuracy with testing. In my experience, the hyoid orientation is often prone to this, as many can achieve full cervical extension in a variety of compensatory ways. You may get some false negatives. What if we could directly measure the internal anatomy that the hyoid test is looking at? It turns out, folks, we can. How can we do that you might ask? The answer: The tongue Tongue range of motion, posture, and dynamics are the rate-limiting step when it comes to hyoid orientation. Simply put, the hyoid cannot be dynamic if you cannot manage tongue placement. Here are the factors that go into tongue management: Range of motion: Can you have roughly the same range of motion with a tongue tip open and a cave? Here is what a "normal" amount of these measures looks like (I had a tongue tie release, so I cheated a bit): [caption id="attachment_12201" align="aligncenter" width="500"] Great for catching flies[/caption] Compare that with the limitations noted in this client: [caption id="attachment_12202" align="aligncenter" width="500"] You can see here how with each position the available opening becomes less and less. There is likely a posterior tongue restriction with this person.[/caption] 2. Posture: Can the tongue be fully placed on the roof of the mouth, lips closed, face relaxed, and breathe through the nose? If the tongue sits low, it will encroach on the back of the throat, decreasing the space in the pharyngeal wall. This position will restrict the airway dimensions. And get this shit, fam. OA flexion will cause the mandible to protrude more, which aids in opening the airway. Consequently, movement options will be reduced. Here, we see a compensatory strategy to keep the airway open. 3. Dynamics: Do you possess all the movement options the tongue should be able to perform? There are TONS of different positions the tongue can assume, all requisites to practicing swallowing without compensatory strategies. If you want to learn all the positions you need to practice, you can peep that Sum up Military head posture involves lower cervical extension, upper cervical flexion, and concentric orientation of the suprahyoid musculature. If shoulder internal rotation is lost, the infrahyoid musculature will also be concentrically oriented. To restore movement options in this position, you must drive anterior thorax expansion, OA extension, and tongue position. Photo credits:
info_outline The Evolution of My Treatment Process 03/07/2021
The Evolution of My Treatment Process What has changed in my treatment model? If you aren’t getting better, you are getting worse, so how has your thought process and model changed? I was asked this question recently, and I think over the last several years many things have changed. There has been a bigger focus towards: The basics Sleep Building power And more! What changes have been made? Check out Movement Debrief Episode 147 below to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Daddy-O Pops himself. One of the biggest influences to my treatment model - This is the best book I've found on biomechanics of the elbow, wrist, and hand. - This is my go-to resource for all things myofunctional therapy. I did a of the one I attended. - My current myofunctional therapist. She's incredible. - A great journal article on sleep and pain. - Where I work at in Las Vegas - If you want to know why intensity is important, this is the podcast to check out - My go-to guy for all things upper airway - He's my dentist who is doing my palatal expansion. You can check out when I interviewed him - He's the ENT who did my . How my treatment strategy has changed over the years Question: How your strategy/perspective evolved over the last couple of years? Fam recognize fam! Answer: There have been two pieces that have led to a major impact and alteration in the way I treat in the last couple of years: model Bill's model has simultaneously simplified and expanded the way I look at movement and most importantly provided principles that have helped me figure out areas within the model that were less clear for me. Simply put, Bill helped me be less protocol-driven and more principle-driven. For example, the elbow, wrist, and hand are still areas that the mechanics are a bit fuzzy and incomplete, yet thinking and studying this topic with his framework in mind have helped me develop a better understanding of what is biomechanically going on. To him, I'm grateful. Myofunctional therapy has provided much of the biomechanical cleanup that I think was missing within my movement model. We had all these great ways to improve movement capabilities below the neck, but once we got above C5...YIKES! I think the missing piece here was appreciating just how influential tongue position can be. Most of the movement stuff we discuss here focuses on managing and within the ventral cavity. The tongue is the visceral equivalent in the upper airway. Tongue = guts Being able to place the tongue fully up onto the roof of the mouth can influence neck orientation, upper airways dynamics, and your ability to nasal breathe. These pieces are important for a wide variety of reasons, but improving sleep might be the most important. Especially considering that Exploring this path has led me down a personal rabbit hole of getting a , messing with , and a whole lot more. It's also showed me just how much farther I need to go to help my supreme clientele become healthy human beings. It's one reason why I recommend my peeps get sleep studies quite often, something I'd never thought I'd be into. What does my current treatment strategy look like Basically, the name of the gave is to demonstrate movement competency and options across a wide variety of tasks. This involves breaking down tasks all the way to the basic constituents. If we take a movement such as a vertical jump, demonstrating movement competency across a spectrum for this task might look like: Vertical jump Front squat rowing machine (a conditioning option that explores the same range of motion) In each of these examples, I'm demonstrating the biomechanics needed to complete the terminal task, which is a jump. In order to jump, I need , which involves femoral external rotation and sacral counternuation. You get each of these with every listed move. Doing each action well helps you demonstrate the movement with power (jump), force production (front squat), dynamically (drunken turtle), statically (lewitt tilt), and for long periods of time (rower). The above concept forms the basis of . If I evaluate a client, I look at how many different ways I can push their movement options and design an according program. if someone needs to drive counternutation, I may opt to squat the snot out of them and abandon hinging for the time being. Whatever it takes to expand their movement options across a variety of intensities, which ought to help performance. All that said, the above points are moot if your client has a that is whack. https://youtu.be/7SQQeEuTPo0 A bulk of my process involves teaching clients this concept, as it provides the basis for exploring all of the aforementioned areas. In cases of pain, hammering this first is essential. Though since I've begun to work at , my more fit and active population has forced me to get fancier by re-incorporating shifting and such into the program. Following that, demonstrating movement competency with plyometrics and the like has really been tripping my trigger for my peeps. has inspired me to push quite far in this domain, and is a reason why I've been programming many drop catches and such to keep intensity in my client's lives. https://youtu.be/7TAEVNwgZ6E By keeping some form of intensity occurring at all times, I've noticed smoother transitions back to full force as my clients rehab from given injuries. Where will my treatment strategy evolve to next The next however long will continue to focus on refining the biomechanics and finding better and simpler treatment strategies. Although I feel the movement model I subscribe to is dope as all hell, it's not perfect. It's incomplete. Moreover, I fall victim to making exercises WAY TOO COMPLICATED at times. If I can make this model ridiculously simple to execute, you and my supreme clientele will win. Aside from refining, the areas I wish to dive into more are sleep medicine and pushing breathing physiology. [caption id="attachment_13550" align="alignnone" width="810"] Sleep. It's a big deal, fam (photo credit - Image by from )[/caption] Sleep is uber important. I've caught so many people in the last year who've had obstructive sleep apnea, and I think leaving these sleep disorders unchecked is hingering many of my client's wellbeing. I want to do all that I can to help them. Lastly, learning more about expanding breathing physiology intrigues me quite a bit. Of course, my focus has majorly been on breathing biomechanics, but once you have the biomecahnics improved, where do you go next? Just like once someone moves well you ought to expand work capacity, so to with breathing. Once someone "breathes well," we need to expand work capacity. That's where I'd like to learn more surrounding controlled pauses, resonant frequency breathing, and whatever else is out there. Sum up The major changes in my model involve Bill Hartman's model and myofunctional therapy Movement competency must be demonstrated in as many different scenarios as possible Simplifying the movement model, learning more about plyometrics, breathing physiology, and sleep are the next frontier.
info_outline Difficulty with Rotational Athletes 02/28/2021
Difficulty with Rotational Athletes How rotational athletes can fool you and your measures Sports such as golf, baseball, tennis, and more involve TONS of rotation, yet are certain athletes better predisposed to rotate well based on ribcage structure? Can tests be thrown off because of particular sport adaptations? We dive into these questions today. Here, you’ll learn: Which infrasternal angle presentation has easier rotational capabilities If ribcage structure predisposes someone to be “GREAT” at their craft What shoulder external rotation really means in this population Be prepared, folks, to better help your supreme rotational clientele. Check out Movement Debrief Episode 146 below to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends September 26th at 11:55pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Daddy-O Pops himself. He is THE GUY for all things biomechanics - One of the best Yoga Teacher Training systems out there, and the one I choose to teach through. - An excellent yoga instructor and biomechanical BOSS. - One of the best articles that goes into ribcage shape and more! Which infrasternal angle is better for rotation? Question: I have noticed that roughly 75-80% of my baseball players are narrow infrasternal angles (ISA). Do you feel this is representative of a normal population? I'm wondering if this is a case of selection bias where narrow ISA's, being more eccentrically oriented, have an easier time rotating, and therefore would be more likely to advance in a rotational sport like baseball or golf. Whereas a more concentrically oriented wide ISA may have a more difficult time and as a result would more bias towards sports requiring less rotation. Watch the answer Answer: Terry, you are spot on in the differences between narrow and wide infrasternal angles and the subsequent ability to rotate within the lower thorax. Leverage in the lower thorax is the name of the game, and the obliques are the major players (folks, don't hate the playa tho). Your obliques are some of the largest rotators within the lower thorax. The better these puppies have leverage, the more your rotational chops will be on point. Now the next question should be which obliques have more leverage with each respective infrasternal angle (ISA). AND YOU KNOW I'M GLAD YOU ASKED, FAM! According to this study, drawing a lot from Shirley Sahrmann concepts: the internal oblique has more leverage with wide infrasternal angles. The external oblique has more leverage with narrow infrasternal angles. Now, you need both obliques to perform rotation, so rotational function alone doesn't tell the whole story. What does tell a larger portion of the story is the compressive action on the abdomen. If you compare the attachment points of the external and internal obliques, the external oblique lies more superficial to the ribcage in comparison to the internal oblique. [caption id="attachment_13522" align="aligncenter" width="399"] The big dog, external oblique itself! (Photo credit: )[/caption] External oblique proximal attachment: Outer surface of ribs 5-12 [caption id="attachment_13521" align="aligncenter" width="403"] The good ole' internal oblique (photo credit: )[/caption] Internal oblique proximal attachment: Deep layer of thoracolumbar fascia, iliac crest, ASIS (peep this anatomy textbook to learn more) These anatomical differences allow the external oblique to generate greater compressive forces in the lower ribcage, contributing to the narrowness of the infrasternal angle. When this muscle contracts, it assists in pushing the viscera downward. If we assume, based on compensatory mechanics, that the infrapubic angle is also in a narrow orientation (and ), the pelvic floor will be eccentrically oriented. This position will allow the viscera to migrate downward, allowing for rotation to occur! The simple reason why narrow ISAs can better rotate: The guts can get out of the way. Contrast this to the wide ISA folks. The internal obliques have worse leverage to compress the ribcage and push the guts downward. Moreover, the wider infrapubic angle begets a concentric pelvic floor, which pushes the viscera upward. There simply becomes too much visceral interference in the ability to rotate. Wide ISAs can't get guts out of the way. Does this difference mean that there will never be elite wide ISAs in rotational sports? FALSE! In fact, many of the top golfers that I work with at have a wide ISA presentations. How in the hell does that happen? Structural bias alone doesn't determine success in sport. One thing to consider is the when looking at infrasternal angles, we have only concerned ourselves with rotation at the lower thorax. HOWEVER, rotation occurs throughout the whole body. In sports such as baseball and golf, you have to be able to rotate in the upper thorax, pelvis, axial skeleton, basically everywhere. Each ISA presentation can have restrictions in the ability to rotate in these other areas, contributing to success or lack thereof in the ability to rotate. Moreover, we cannot ignore the skill component needed in these sports. Again, many of our top golfers are hella stiff wide ISAs. It blows my mind how well these guys do at their craft. Some people are so skilled that they find a way to work within their body structure to achieve the desired output. Lastly, considering the heavy narrow ISA bias within the population that Terry helps, I wonder what position many of his athletes play. Someone who has to move a lot within the game, such as an outfielder or shortstop, may be more biased to be narrow. Heavy hitters, first basemen, and catchers? Not so much, as playstyle changes for them, as wider ribcage have greater force production capabilities due to concentric bias within the pelvis. [caption id="attachment_13520" align="alignnone" width="810"] Yeah, definitely not narrow, flaxseed oil aside (photo credit: )[/caption] None of the greats in the steroid era of baseball were narrow ISAs. Pelvis movement during rotational sports Question: What are the Ilial and sacral movements during rotational movements like a golf or baseball swing? Watch the answer Answer: The mechanics during a swing are no different than what we see in . There is an initial contact, midstance, and propulsive phase in both gait and the swing: Backswing = initial contact Impact = midstance Follow-through = propulsion With these parallels, we can see what is going on with the pelvis at each component: Backswing: Counternutation and sacral rotation toward the back swing. Impact: Backswing-side sacrum begins nutating and rotating away from the back swing. Follow-through: Counternutation and full sacral rotation away from the backswing. Single-arm and leg exercises instead of shifting? Question: Are single-arm and single-leg exercises good forms of shifting without using resets to accomplish this? Watch the answer Answer: Short answer: YASSSS. Single-extremity moves are essentially a cheat code to drive anteroposterior expansion, as these movements rotate the axial skeleton. Plus, they are WAYYY easier to coach than most shifting-based work. Let's look at left rotation as an example. You can see how if I turn to the left, I can drive expansion into the left posterior and right anterior aspect of the thorax. These rules also apply to the pelvis regarding expansion. The above action happens when you reach with your right arm OR have your right leg forward ASSUMING that you can maintain . Stacking sets the foundation for rotational actions to occur. If you can't stack and you attempt to rotate, problems and a subsequent compensatory rotation could occur. In the thorax, you may see the following compensations: Crunching, which downs the pump handle and limits rotation Anterior thorax migration, which restricts the posterior thorax At the pelvis, you'll see an anterior pelvic tilt/orientation, which limits rotational capabilities in the pelvis. What skills do each infrasternal angle excel at? Question: What are some skills narrow infrasternal angles would be better at than wides and vice versa? Watch the answer Answer: The infrasternal angle changes the relative contractile bias of the ventral cavity. This has to do with how the pelvic floor orientation that each type possesses. Narrow ISA: eccentric bias Wide ISA: concentric bias Because of this, narrows generally have greater eccentric/flexibility capabilities in comparison to wides. Also, because narrower ribcages have a larger surface area in relationship to the volume of abdominal contents, they are generally better at heat dissipation, which can help with endurance activities. Wides, on the other hand, have a greater concentric bias, which is useful in terms of force production. To summarize, here is what each could potentially be biased towards doing well with, with obvious exceptions to the rule (as there are many other influences to movement competency): Narrow ISA: Flexibility-based activities, endurance sports Wide ISA: Power and strength activities Relative motion between femurs and pelvis Question: Will there be a relative motion between the femurs and the whole pelvis or do we lock the hip joint as a whole and only work relatively within the pelvis? What actions would be happening? Watch the answer Answer: Given that there is more relative motion available within the hip joint in comparison to the pelvis, the hips are most certainly going to move. The movement that the hips perform depending on what direction my legs need to move. For example, let's say I want to keep my femurs pointing straight forward in a golf swing. If we use the sequencing above in pelvic rotation portion of the debrief, you'd have the following motions occurring. Suppose we are swinging right to left: Backswing: Right hip external rotation, left hip internal rotation Impact: Right hip begins to internally rotate, left hip begins to externally rotate Follow-through: Right hip internally rotates, left hip externally rotates Excessive shoulder external rotation? Question: I work with 99% baseball players. You've talked about using shoulder external rotation at 90 degrees as a proxy for determining a need for expansion in the posterior lower thorax. The majority of my guys are hypermobile in that measurement. However, I still believe there could still be potential restrictions in the lower posterior thorax. Is there another way to assess this? Additionally, is an increase in external rotation for a baseball player still indicative of a posteriorly oriented thorax? Again, thank you for your time and the work you have done! Watch the answer Answer: As I have mentioned , shoulder external rotation can act as a proxy measure for the ability to expand the ribcage along T6-8 level. In some individuals, the thorax can tilt/orient posteriorly as a unit to compensate for a loss of posterior expansion. [caption id="attachment_12963" align="aligncenter" width="500"] Like this joker[/caption] When the thorax orients posteriorly, the scapula will also externally rotate, retroverting the glenoid and subsequently the humerus. Due to this orientation, someone may be able to pick up shoulder external rotation beyond physiological normal (aka 90°). This change would actually coincide with the . (If you want to check out a blog that goes into shoulder motion in baseball players, is awesome!). So okay Zac. We know that a baseball player should have a LOT more external rotation available. How do we know if this is a structural issue that we should let chill or if the we need more posterior thorax dynamics. The short answer: Shoulder flexion. If you look at the , you'll note the following ought to be present: Tons of humeral external rotation as I progress through the flexion arc (Yay for baseball players) The scapula progressively upwardly rotates (yeesh!) If I have a posteriorly orientated thorax, concentric bias of the posterior musculature is going to give the scapula a helluva time realizing full upward rotation. Thus, shoulder flexion will be limited in a posteriorly oriented thorax. Some folks may have enough eccentric bias in the anteroinferior shoulder capsule to give the appearance of full shoulder flexion. You could check as well to ensure you are actually getting posterior thorax expansion, as cervical rotation can cross-reference the T2-4 expansion that is also needed in maximal shoulder flexion. If you are limited in shoulder flexion, starting with can drive expansion in the lower regions of the thorax. Progress this to , and NO ONE should mess with you. Sum up Narrow ISAs have better rotational leverage than wide ISAs due to ability to move the viscera. Lower ribcage structure is only one component of rotational success. One must consider the ability to rotate in other areas of the body and sports skill. The pelvis rotates through the swing as it does in gait: counternutation, nutating, then counternutation. Single-arm and leg exercises can drive rotation, which acts as a cheat code to increase anteroposterior expansion in a given area. Narrow ISAs are better at eccentric strategies; wide ISAs are better at concentric strategies. The femurs rotate during the swing. Posterior thorax orientation can give the appearance of humeral external rotation beyond 90 degrees. Shoulder flexion and lower cervical rotation can be used as a test in these individuals, as they are often limited. Image by from
info_outline Can I Gain Muscle and Move Better? - Michelle Boland, Tim Richardt, Francis Hoare 02/21/2021
Can I Gain Muscle and Move Better? - Michelle Boland, Tim Richardt, Francis Hoare Are pursuing better movement and better physiology mutually exclusive? There appears to be a divide between performance and health. Many argue that you cannot get bigger, stronger, faster, while still moving like boss. Others fear pushing heavy weight, relegating their program to mostly ground-based breathing resets. But does it have to be this way? That’s the question that Michelle Boland, Tim Richardt, Francis Hoare, and I wrestle with, proving several examples of how this dichotomy is more often than not FALSE! In this podcast, you’ll learn: How Francis was able to put on 11 pounds in one year and have better range of motion throughout his body The false dichotomy between performance and health How to increase movement in those who already have lots of muscle mass, but seek to move better and have less pain How the general population can increase fitness, muscle growth, and movement all at once Getting a training effect to those who are in pain Key Performance Indicators (KPIs) for moving well Are basic resets necessary to maintain movement options? How to balance expansive vs compressive activities Pairing respiration with training How to balance client's wants and needs The big rocks to maximizing movement options How to decide what your body composition should be Ready to move better, get stronger, and become an absolute savage? Look below to watch the interview, listen to the podcast, get the show notes, and read the modified transcripts. Check the video Learn more about our guests - A podcast specifically designed around engineering the adaptable athlete. Michelle Boland Michelle is the owner of Michelle Boland Training which provides many services including, in-person 1:1 training sessions, coaching people remotely, writing training programs, and educational content for fellow trainers and fitness professionals who want to take complex training concepts and turn them into real outcomes for clients. Michelle has a bachelor’s degree in Nutrition, a master’s degree in Strength and Conditioning, and a doctorate in Exercise Physiology. Michelle was previously a strength and conditioning coach at a Division 1 institution and Director of Education at a private training facility. Instagram: Work with Michelle: Tim Richardt Tim Richardt is a Doctor of Physical Therapy, Strength and Conditioning Coach, and Owner of Richardt Performance and Rehabilitation located in Denver, CO. He specializes in the treatment and preparation of humans that like to run, lift, or play in the mountains. He currently offers personal training, physical therapy, and professional mentorship services. Instagram: Francs Hoare Francis Hoare is a Performance Coach and the Member Experience Director at He has helped hundreds of people of all ages and abilities improve their health, lives,l and athletic performance. Hitting the path to your goals efficiently requires being specific. Francis excels at creating programs tailored to your needs and goals. If you need someone to hold you accountable with high energy, Francis is one of the best in our industry. His motivational tactics ensure you both get challenged and succeed. When Francis is not coaching, he spends his time with his wife and two daughters, in the mountains or devouring a pint of Ben & Jerry's. Instagram: and Show notes Here are links to things mentioned in the interview: Here is Francis' before and after pic [caption id="attachment_13492" align="aligncenter" width="500"] More gains AND better movement? Sold![/caption] - A master of science and training - A bodybuilder with a unique approach to getting hyooge! - This is what we reference on the bro retreat, where we discuss hypertrophy and more Peep the video below to see how my getting fat took away my squat: https://www.youtube.com/watch?v=UEZZEWyBN78 The drunken turtle is a great move to improve backside expansion: https://www.youtube.com/watch?v=yjmjUihXtrs - An excellent coach who does a great job of pushing physiology while improving movement options. - Daddy-O Pops, the godfather of many of the movement concepts we discuss. - My nutrition coach, and a master of behavior change Modified Transcripts A hypertrophy and movement case study Zac Cupples: How can I get huge as all hell while still moving well? How can I preserve these two qualities? That’s why I wanted to bring my boy Francis here. He is a very effective case study of how we were able to do merge these two goals. Here’s his story: Francis Hoare: The last six years, five or six years or so, been doing a lot of running, 35, 40 miles mostly, mostly trail running. I competed in Spartan races, couple 24-hour races in there as well just for fun. I would spend quite a bit of my vacation time, go into places like Yosemite or Glacier National Park and either getting a cabin and going into the parks and doing a lot of hiking and running or backpacking. Because of my exercise choices, I had a fair bit of strength, but more biased toward rock climbing, American Ninja Warrior type stuff, a few lifting sessions per week, and about 8-10 hours of running each week. The issue was this style of training led to my like calves constantly hurting, hips constantly hurting, stuff like that. I was getting burnt out from the running. I decided to take a break, then quarantine it. It was the perfect time to put on some weight! I just met Dr. Zac and instantly, the stuff that he was talking about just captivated me. This stuff was hard. It would torture you, yet at the same time I’d feel good afterwards. I had a pump and felt more mobile. That’s where it started. Zac: We spent the first couple blocks testing you and trying a few different interventions just to see what would work. And then- Francis: There was a lot of learn by doing. Because we weren’t working with clients during the quarantine, I was able to wrap my head around all this stuff that Zac was talking about. It helped me troubleshoot what areas to improve movement-wise. If there were times where Zac was giving me some high-level stuff, and it just wasn't connecting with me, so we could pull the ropes back and build from the ground up. It was super beneficial as a strength coach. Once our gym, our facility was able to open up, I had a whole new set of tools to work with my members with. Zac: After you built that foundation, you took the concepts and ran with it for yourself. With more of a hypertrophy-focus. Francis: This all started in April. So, I did not rush this process at all, which, which helped me immensely. I knew I wanted to put on weight but didn’t have a specific number. I just wanted to feel better and move better. My first girl was learning the basics movement-wise; starting with squatting, tucking, etc. I paired all that with eating more. I was keeping things in the 8-12 rep range, and that’s how the process started. Zac: Yeah. And so, I'd say, correct me if I'm wrong, we probably spent a couple months building the movement foundation, and then you just kind of made it more hypertrophy volumes and and intensities for the last four or five months. Francis: No, I think I'm about eight weeks in to, you know, what on paper would look more like a hypertrophy phase, I was able to put on some weight again, just by hitting reps of 8 to 12 and doing new stuff and not running. Zac: Always good. Always good to know. Francis: Late October we really buckled down. Holidays are coming out and I'm going to eat a lot. So, let me take that guilt away from eating a lot by going into an official hypertrophy phase and yeah, all we did was we picked up the movements that we liked, assess how progress was going, and kept it simple over a 4–5-week span. I kept the load down and switched to what I call the 2020 workout—two seconds on the eccentric, two seconds on the concentric, no pausing in between, always staying under tension, never going all the way down or all the way up. You do that for 10 reps, obviously the time should work out to 40 seconds, doing four sets in a row with little rest. I’d do that for my big lift, then do 10 reps of three accessory moves with 30 second’s rest. Four more sets of that. So, I'm doing only one movement at a time, knocking out all the sets, then I move on to the next movement. It takes about 30 minutes, which is perfect for my busy work and life schedule. Zac: How much weight have you put on over the year? Francis: 11 pounds so, from 152 to 163. Zac: That’s a pretty good change in a year! On my on my end, at least with the movement testing, we had some great changes movement-wise: Hip flexion improved from (left/right) 110 bilaterally to 125/140. Hip internal rotation improved from (left/right) 35/15 to 30/40. Which I’m cool with as it’s more symmetrical. I think it was really cool to see because I think a lot of people see this false dichotomy between moving well and getting big. You can only gain muscle by using machines, back squatting, and deadlifting. Yet Francis didn’t do a single back squat. Francis: I haven’t squatted more than 100 pounds. Zac: But you're doing things well. You're getting tension where you need to get tension. You were able to pack on size without losing movement. In fact, across the board your table measures improved. There may be a path where movement and performance diverge, but not for the overwhelming majority of us. Most of us aren’t the elite bodybuilder who is debating whether or not to start using gear. Pursuing hypertrophy and better movement is absolutely doable for the general population. How those with substantial muscle mass can improve movement options Michelle Boland: Why I wanted to jump in this conversation is I want to talk about tearing down vs building up. How do you deal with less loading. I struggle with this personally because of the deep held traditional beliefs and expectations of not only my role as a strength conditioning coach and the years I’ve spent training. This started with a same as a Francis. Quarantine hit, and I had to think about what my training needed to look like. Evaluate the good and bad. My body shape is closer to a female cross-country runner, I enjoy running, but I went big into the bilateral lifts. Consequently, I’ve probably kept 12-15 pounds of muscle mass on my frame, past the point of probably where my body wants to be. I shifted to running a bit more and working out from home during the quarantine. Because I didn’t track too much, I dropped about 11-12 pounds pretty quickly, and probably all that was muscle mass. This led to feeling some fear of switching my training, but I recognized some mistakes that I've made. My question involves those who have a lot of muscle mass and are currently dealing with aches and pains. If you look at the long game, this may lead to major issues like joint replacements in the future. It’s a difficult perspective, but many leaders in the field have been ex-powerlifters who’ve had a shift in perspective. What are some strategies these people can employ? I’m sure some muscle mass will be lost in the process, but can they maintain some and move better? Zac: What does it take to grow muscles? The big hypertrophy keys are volume and mechanical tension. That’s really it. Kudos to for teaching me that. Not once did these two mention back squat or bench press being essential. Hell, even most elite bodybuilders are doing machine-based work. Volume and tension are the key, the modalities are likely irrelevant otherwise. Michelle: Yeah, 100%. Much of what we focus on is isolation exercise to alter position and shape change. One thing I definitely missed was something that Francis stated before, and that’s tempos. I think that is a huge factor, especially with pairing movements, simply phases of movements with phases of respiration, the tempo, kind of prescription of exercises is, I think, something that would have maintained kind of gains in something that I'm trying to do now. Francis: And I think stacking helps target the muscles you want better. Squats for example. If you can shift to sandbags and still torch your quads and glutes without back tension, that’s a win. Tim Richardt: Another thing that Francis mentioned with what you guys outlined earlier, which I thought was really interesting was just the skew towards higher rep ranges. People talk about getting big, getting strong. 5x5 doesn’t quite produce as much of the volume and mechanical tension as the higher rep ranges do. Going after 10, 15, 20 rep maxes lets you maintain movement quality, maintain the stack, and get a lot more of a training stimulus with a lot less of those deleterious secondary consequences that we're trying to step around. Zac: If you don’t consider body position, then your only option to create tension is heavy loads. When I was in , I was teaching some bigger dudes the way I coach s. Admittedly, I wasn’t coaching the squat as well as I am now. I was overtucking and flexing, which led to some trepidation with them. Regardless, with very little weight, their quads were absolutely destroyed. The only other way that sensation could be recreated is through heavy weight. Conversely, we just don't have data to support it one way or another aside from anecdotes. Is the only reason that you got this tension is because it's a novel position that you're not normally in? Or is it we're actually targeting the quads more? That’s just something I don't know or have an answer to. What I have seen is those who do a lot of hinge-based work (I consider a back squat along this line) lose movement options. I think to preserve health of the tissues and joints, probably worthwhile to throw in at least some type of stuff that contrasts that. Francis: Depending on the person, I don't think you need to go all one way. If buy-in is limited, then give them a couple breathing resets at the beginning, for their warm up, give them one or two movements to do throughout their set. And take it from there, especially if there's someone who refuses to give up something like deadlifting or back squatting. Try to offset that with their accessory work. Michelle: I think the best thing you can do is every coach needs a coach. My current coach is Eric Huddleston. He’s done a great job putting programs together that feed into what I want to be doing and will do. I told him I'm not going to lie on the ground and do resets. Some clients will be that way. ] But he does an amazing, amazing job at creating exercises that just build those concepts in; using tempos paired with phases of respiration; almost like an active reset. With this, I’ve noticed muscles gains and better movement quality. And he only programs about six exercises per session. The false dichotomy between performance and health Tim: I just want to circle back to something Zac mentioned a couple minutes ago, we have two somewhat incomplete truths. On one hand, we have that being strong is absolutely badass and having some muscle and the ability to produce power is kind of the sign of a healthy human right? It's the strength training is good paradigm. And then there's a lot of people that just say, you know, strength training tightens up joints and muscles, and it leads to an achy, stiff human. And neither of those two statements is completely true nor completely false. It reminds of the interplay between bulking and cutting. For 99.99% of people, it’s probably not a thing. Most individuals tend to be so detrained that they don't need to worry about a specific bulking protocol or cutting protocol. You can do both with intelligent eating and intelligent training. And I think what you guys have outlined is sort of the intelligent eating, intelligent training approach to improving movement options and improving like muscle bulk strength power output concurrently, which is cool. Zac: Even this conversation to some degree is more focused on how coaches can get themselves as jacked as possible. For most of our clients, we are lucky to get them in the gym three times per week! Francis: You definitely have those less dedicated, but I also have people I've trained for years that I’m excited to implement some of this stuff. After the quarantine ended and our gym opened up, we started focusing on stacking; spending a few phases getting good at that. We built our initial phases on that, then were able to focus on more specific qualities. It's not necessarily the what? But the how? And why? And that's where you can get really deep in all this stuff. Tim: And Zac, I might respectfully disagree with the point that you made a couple minutes ago. I think that the people that come to see, you, Francis, Michelle, myself, they tend to be people that are either bad at exercise or just really beat up. If we take those people that have a limited movement option repertoire, and a lot of things are going to hurt, if we can get them a training effect while furthering their movement options, then they don't feel like they're bad at exercise anymore. As opposed to the typical gym where someone might be back squatting on the first day of their program, potentially experiencing pain associated with that. That’s not going to retain clients very effectively. So, I think this stuff really becomes paramount to ensuring a long-term positive client experience. Zac: I would agree with you. Back squats and similar moves have a much higher technical demand than say a goblet squat or a sandbag squat. Francis: You can hand someone a 50-pound sandbag on a ramp, and torch them. It makes your coaching job that much easier. Key performance indicators for better movement Tim: I think one big problem in our industry is not defining terms especially well, this is something that talks about all the time where we say things like we want to move well, we don't want to lose motion, but we don't really have a clear idea of what that means. Zac, Francis, what were some of the Key Performance Indicators (KPIs) that you tracked every few weeks as Francis was putting on muscle? And how would you recommend people approach that? Zac: Francis is so lucky because I can table test him on a fairly regular basis. The issue with Francis is many of the standing measures I normally recommend he was pretty good it. His toe touch and squat were full. But if you are limited in those moves, you can always pursue getting them better. They can also be a good gauge on if you are going in a good direction or not. Personally, if I get too fat, I lose my ability to squat and I got a really good video of that happening to me. In the video, I was 200 pounds. Fat as shit. It was a Herculean effort to squat below parallel, I just couldn't do it. But now that I'm leaner, I can squat fairly easily. The key KPI is you need to find stuff that you're limited in, and then just recheck that periodically to make sure that you still have that. That could be an Apley’s Scratch test where you check shoulder internal and external rotation. If you get bigger and lose motion, that doesn’t mean you need to stop pursuing hypertrophy. You just need to change something to restore some of that motion. It could be getting on the ground and doing a reset. Maybe it’s re-evaluating your exercise selection. It’s not a matter of maintaining certain movements at all times, but can you get into positions that you should be able to. For Francis in particular, we looked at hip and shoulder range of motion predominately. Francis: Trunk rotation was another thing we tracked. But I also didn’t have the toe touch down pat. Zac: You didn't? Francis: No, not at first. But an exercise like drunken turtle cleaned most things up fast. It’s easy as a coach to check range of motion, but don't be afraid to use your Coach's Eye too. It can be sometimes hard to describe or put KPIs to good movement, but you also kind of know when you see it. I think this better...
info_outline Limited Shoulder Motion, Where Should I Start? 02/14/2021
Limited Shoulder Motion, Where Should I Start? So many shoulder measures, so little time. Where should you start? If you have someone who has a mix of shoulder restrictions, you might wonder…. Eh, which one should I go after first? This gets equally troublesome when few people have exactly the same restrictions. What’s a fam to do?? You likely know how influential ribcage orientation can be, yet you can be laser-focused at which measures should be your target when you consider: Where each shoulder measure correlates to ribcage position Where to expand first pending infrasternal angle presentation If you want to make your exercise selection much more accurate, this is the debrief, folks! Check out Movement Debrief Episode 145 below to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class Want to sign up? Click on the following locations below: (Early bird ends January 31st at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This is my go-to study when understanding scapulohumeral rhythm. - The spot in Las Vegas where ya boi works. Prioritizing shoulder restrictions Question: If shoulder extension and horizontal abduction are both limited, which do you chase first? We could probably also add internal rotation in there. Answer: Picture this, you have someone with measure XYZ limited on the right side, then ABC is limited on the other, where to start, fam? If you've been following this site for a hot minute, you probably have the belief that humeral measures are used to approximate movement restrictions within the thorax. Put another way, airflow is going to be reduced in a given area based on particular shoulder measures. Therefore, increasing shoulder mobility depends on where you have to put air and in what order you need to perform this. When you are looking to improve shoulder measures, there are a few different principles that I operate by to enhance decision-making. The lungs fill bottom-up If you have a glass and you fill it with water, how does the water fill the cup? [caption id="attachment_13466" align="aligncenter" width="500"] Preferably Topo Chico or Sedona Mineral Water[/caption] The bottom-most parts of the cup fill first, then eventually it fills to the brim. You can't fill the middle of the cup, then a little bit at the bottom, and a little bit at the top. Your lungs are like that cup of water (that's some philosophical sounding shit right?). When you take a breath of air in (assuming you are upright), the bottom parts of the lungs fill first, working up to the apex. And just like that cup of water, you can't expect to put a bit of air in the top, a smidge down low, etc. You gotta fill those lungs bottom-up Restriction in the thorax will generally lead to greater lung fill in the bottom portion of the lungs, with restricted ability to fill higher areas. Because the intercostals cannot expand the ribs, accessory breathing muscles will lift the ribcage as a unit, increasing bottom fill. We want to restore the ribcage's ability to expand in all directions. In order to make that happen, we have to restore this bottom-up fill that the lungs perform. In order to know how to "fill" the thorax bottom-up, we have to understand how different shoulder measures can let us know where airflow is restricted. The first heuristic that we operate from is breaking down how specific measures are related to thorax restrictions: Flexion, abduction, and external rotation restrictions indicate decreased posterior expansion Extension, adduction, and internal rotation restrictions indicate decreased anterior expansion The reason why these measures are related is because of how scapular position changes when the thorax cannot fill adequately. For example, if the anterior thorax cannot fill adequately, the shoulder blades will round forward, which leads to the humerus externally rotating to bring the arm back to center, causing an internal rotation loss. Flip this for posterior restrictions, you'll see a flatter upper back, which pulls the shoulders back, which leads the humeri to internally rotate back to center, causing an external rotation loss. You can have a mix of in-between pending what thorax levels are restricted, hence the wide variety of postures people assume. But how can you tell where the restrictions lie? I'M GLAD YOU ASKED! Each humeral measure corresponds to a different level of the thorax. It has to do with the fiber direction of tissue excursions you are testing and their location relative to spinal level. For example, the horizontal fibers of subscapularis run from around T2-4. Let's look at each of these measures and where they relate to on this fancy table. Only the finest for the fam! Test Tissue tested Spinal Levels Shoulder Flexion All posterior thorax tissues Entire posterior thorax with a slight bias towards T2-4 Shoulder External Rotation Oblique fibers of subscapularis Posterior thorax at T6-8 Shoulder Horizontal Abduction Transverse fibers of subscapularis Posterior thorax at T2-4 Shoulder Extension All anterior thorax tissues Entire anterior thorax with a slight bias towards manubrium Shoulder Internal Rotation Oblique fibers of posterior cuff Anterior thorax at sternal body (T6-8) Shoulder Horizontal Adduction Transverse fibers of posterior cuff Anterior thorax at manubrium (T2-4) Or if you are more the graphic kind of person, peep this: [caption id="attachment_12233" align="alignnone" width="810"] With flexion and extension being general proxies for posterior and anterior expansion, respectively.[/caption] So for example, if someone has a loss of internal rotation and horizontal abduction, internal rotation would be the first priority because it's a lower level on the thorax. of course, assuming you can , as that's what fills up the thorax period. Exercise options to improve thoracic expansion Now that we know how to assess each level of the thorax, let's look at some general ways of improving these measures. Before getting uber specific with each measure, the first priority is to coach the stack. The stack helps create the necessary piston effect between the thoracic and pelvic diaphragm to allow for the ribcage to expand in all directions. [caption id="attachment_12618" align="aligncenter" width="195"] And it's necessary for talking to me[/caption] If you lack the ability to stack (#bars), then there will be increased accessory muscle tone, the lower portions of the lung will receive the most fill, and you won't have a whole lotta movement in your arms. Now let's suppose that you stacked (even though trust me, you probably didn't), let's look at some strategies for improving humeral measures: Shoulder external rotation: Reaching between 0°-60° shoulder flexion https://youtu.be/pWKeFumljTY Shoulder internal rotation: Reaching between 60°-120° shoulder flexion https://youtu.be/WZtO_Gty2rU Shoulder horizontal abduction: Drive thorax rotation while keeping the head forward, or drive active humeral external rotation. Driving cervical rotation https://youtu.be/h_X9-yoEdlY Shoulder horizontal adduction: Drive humeral extension https://youtu.be/nAhp1If44p0 Shoulder flexion: Progressively go overhead, but restore external rotation and horizontal abduction first. You can also utilize rotation to make this happen https://youtu.be/rD1Ejw5KKMs Shoulder extension: Reach forward, then drive humeral extension https://youtu.be/-kVMyKi4aoc If you are in doubt, you can always , which is an excellent way to drive anteroposterior expansion. You can also use to get uppermost thorax expansion, as the lungs will fill top down in this case. Now that we have an idea of what each measure means and what to do about it, how do I prioritize these restrictions based on the bottoms-up approach? Simple (though not easy), you address the lowest most restrictions first, then work your way up: Achieve the stack (have the be dynamic) Restore shoulder internal and external rotation Restore shoulder horizontal abduction and adduction Restore shoulder flexion and extension How does the infrasternal angle impact order of addressing shoulder motion? So we have an idea of where we need to put air, but how does the infrasternal impact the order of priority? Different infrasternal angles and the accompanying skeletal structure predispose someone to . Based on the order that compensatory strategies occur with each archetype, you want to go after restrictions in the following order: Wide infrasternal angle Dynamic infrasternal angle Address secondary compensations (limited extension, adduction, and internal rotation) Address primary compensations (limited flexion, abduction, and external rotation) Based on the order of attack, as well as the filling bottom-up concept, you might approach the following wide ISA individual: Reduced shoulder internal rotation and horizontal abduction, and flexion They would go after improving movement options in the following order: Dynamic ISA Shoulder internal rotation Shoulder horizontal abduction Shoulder flexion Narrow infrasternal angle Dynamic infrasternal angle Address secondary compensations (limited flexion, abduction, and external rotation) Address primary compensations (limited extension, adduction, and internal rotation) Based on the order of attack, as well as the filling bottom-up concept, you might approach the following narrow ISA individual: Reduced shoulder internal rotation and external rotation, horizontal abduction, and flexion They would go after improving movement options in the following order: Dynamic ISA Shoulder external rotation Shoulder internal rotation Shoulder horizontal abduction Shoulder flexion Sum up Shoulder restrictions correspond with airflow into the thorax at various levels Addressing restrictions should occur with a bottom-up approach The infrasternal angle and the order of compensation should be taken into consideration when exploring frontside or backside expansion first
info_outline Treating Hypermobility 02/07/2021
Treating Hypermobility Assessing and treating those who are really flexible! Having full range of motion is a good thing, but what if you have too much mobility? Can you accurately assess someone who is hypermobile? And most importantly: “WAT CHU GON DO BOUT IT?” Those clients who are hypermobile can be quite challenging in many respects. Namely, because the following is true: Assessments are more difficult to interpret because of increased mobility Coaching can be challenging Spotting compensations can be tough But don’t worry, ya boi has got you covered. Here are some helpful assessments, treatment, and myth-busting when working with this population. Check out Movement Debrief Episode 143 below to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 31st at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. Hypermobility Question: How do you go about assessing and treating someone that has joint laxity and hypermobility; particularly if they don’t seem to have any limitations. Answer: Hypermobility can mean a wide variety of things to people, but let’s break this concept down to the nitty-gritty. There are established physiological normative values for what ranges of motion our joints should be able to express (e.g. the shoulder should have 90 degrees of external rotation, the knee should have around 5 degrees of hyperextension, etc). Range of motion beyond the established norms would be considered hypermobile. Just as range below the established norms would be considered hypomobile. Based on this definition, there can be a wide variety of individuals who possess hypermobility. Here are a few examples: A baseball pitcher with 120 degrees of shoulder external rotation One who can palm the floor on a toe touch A high , a hypermobility measure [caption id="attachment_13433" align="alignnone" width="810"] Elbow hyperextension in a patient with Ehlers Danlos[/caption] On one end, the baseball pitcher may have hypermobility in only one specific direction. On the other end, one with Ehlers Danlos has a systemic hypermobility disorder affecting multiple joints (though not necessarily all). Although these individuals are on different ends of the spectrum, they both have similar biomechanics occurring that are creating this situation. That is: eccentric orientation on one or multiple parts of the joint [caption id="attachment_13434" align="alignnone" width="810"] Increased space between the joint surface can place stretch on tissues, causes eccentric orientation and increased motion[/caption] The key components of this orientation manifesting are: Joint space in a given area increases Fluid position presses up against the tissues ALL relevant tissues (muscles, synovium, connective tissues, ligaments, etc) increase tissue viscosity and reduce stiffness, increasing eccentric orientation and subsequent available motion. To some extent, this process is NORMAL. The tissues in your body contain that allow them to be either stiffer (elastic, think fast folks) or less stiff (more viscous, aka flexible). Tissues have to be able to express both sides of this equation in order for movement to occur. Hypermobility occurs when there is a loss of this process. Where the tissues develop a larger bias towards viscosity or have difficulty producing stiffness. Now, most peeps hear hypermobility and think this is a bad thing. Hell, some people even say this is pathological. OMG I'M PATHO AF, I BETTER JUST CALL IT QUITS FALSE!!!!!!!!!!!!! The problem is that there isn't really any research stating that those who are hypermobile (except , NOT you have a bit more hip external rotation than normal, please reread that again) are more inclined to experience pain or injury compared to those without. In fact, being able to lock out joints may have some benefits: Locking out joints allows for energy conservation between reps of an activity Locking out joints can enhance needed stability in certain phases of activity (think gait, those who lack full knee extension have worse balance compared to those with full extension) That said, when looked at from a movement variability standpoint. People who have too many movement options cannot move joint fluids as efficiently, thus having more difficulty recovering from perturbations. That doesn't mean hypermobile folks are in a worse situation than stiff folks, they just may be more predisposed to other injury mechanisms. The latter population may hurt themselves from overloading specific areas due to the inability to offload structures. Each extreme can be problematic. The solution, regardless of presentation, is as follows: Restore all viscoelastic capabilities and contractile options Thus, we want to first assess for any deficits, restore those deficits, then teach these individuals to generate tension. The hard part though, fam, is that hypermobile folks may look like they move super well passively on the table. In fact, a large portion of people will lower extremity injuries have . AKA YOUR APPENDICULAR MEASURES CANNOT BE TRUSTED However, there is one area that is not predisposed to having excessive movement variability: . [caption id="attachment_13437" align="aligncenter" width="349"] Axial measures don't lie, fam! (credit: )[/caption] Thus, when testing these folks, you'll want to do the following to ensure reliable testing: Use axial skeleton measures (Infrasternal angle, spinal rotation, etc) Use loaded/dynamic measures, as they may rely more on compensatory strategies when challenged Watch for compensations by monitoring joint motion during testing Appreciate end-feel, some may be actually missing the last bit of range of motion Note any symptoms of pain, pinching, etc, and call those points the limitation If you pay attention, you'll still find that these peeps present with movement limitations that need to be addressed first. many times, restoring axial movement options can positively change sensations of excessive motion. I've had many clients in my day who have had what appeared to be "joint laxity" upon testing, ranging from excessive motion or even feeling aggressive/excessive joint glides as I moved them through range, that magically went away once they restored axial movement. If that's the case, was there really joint laxity to begin with? Or was it merely a position, viscoelastic, and nervous system-influenced problem? Once you've restored those movement options that were limited, you then want to focus on tasks that increase tissue stiffness. Surprisingly, these tactics are well researched, and can be improved via the following mechanisms: (20 seconds or more) Make sure all tasks are performed with sound technique, and you'll no doubt be a rockstar who can move well! Sum up Hypermobility occurs when eccentric orientation of tissues is present, allowing for motion beyond established normal values Rely on axial measure testing, closely monitor appendicular measures, and use loaded/dynamic actions to see where restrictive strategies are present Restore movement options in limited areas first, then apply interventions geared toward increasing tissue stiffness Image by from
info_outline CPAPs and Septal Deviations 01/30/2021
CPAPs and Septal Deviations Keeping the upper airway open Breathing while you sleep….it’s kind of a big deal. So much so that things like a CPAP exist to save lives, open the airway, and get your body the oxygen it needs to survive. But is this the best option? What happens if you have a septal deviation? Are there any measures we can take to improve airway patency while we sleep, and even train!? To better understand what our options are, we have to look at what a CPAP actually does, and we need to have our bodies be able to do in its place if it’s something we want to cease using. So too with nasal breathing. What are the components needed to breathe effectively through our noses? You’ll get to find all this out today in this debrief. Check out Movement Debrief Episode 144 to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 31st at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - If you want to dive into myofunctional therapy and tongue posture, this is the post for you. If you want to peep some exercises for your tongue, check out the playlist - These are great cueing devices for tongue placement - Clean your nostrils with this one. CPAP Question: My question for you has to do with the CPAP machine and why it could be bad? I know it's a steady flow of air that can affect the pressure in the ribcage, but can you explain this further? Would an APAP machine that does not have a constant flow of air be better? Or are there still risks? Watch the answer Answer: CPAP and APAP are devices that alter the pressure of the air you breathe in, which helps prevent the airway from collapsing while you sleep. Normally, we breathe through negative pressure. This means that as we breathe in, the diaphragm pulls downward, which creates a force that makes the airway and surrounding structures want to collapse inward. Fortunately, air getting pulled in the lungs helps maintain the shape, and life is good. But what happens if this negative pressure is so great that the airway collapses too far and you do not get adequate airflow? Well, now you aren't getting enough oxygen, which causes major problems. Like uh....death. A way to "fix" this is through positive airway pressure, which essentially has the reverse effect of negative pressure—creating expansion. Now I have a situation where I still create negative pressure from the diaphragm, but I change the pressurization of air coming into my body in a manner that allows the airway to fill. Life is good. There are three categories of devices you could go with to utilize this mechanism: Continuous (CPAP): Blows a constant stream of air in under a single set of pressure Automatic (APAP): Samples your breathing and determines what pressure you need to be at Bi-level (BiPAP): The pressure changes depending on the breath cycle. These devices are essential and life-saving for someone who has sleep apnea. This is especially true for central sleep apnea, where the brain causes the apneic events to occur. These devices can also mitigate many of the symptoms felt from sleep deprivation. So if you are someone with apnea, you most likely want to get one of these devices ASAP. In terms of which device you choose, the BiPAP will most likely make a full respiratory cycle occur more easily, but it's also more expensive. Your best bet is to coordinate with your sleep doc. Now before you read onward, let me be clear: PSA - Do not perform the following recommendations without consulting a physician first. This is not medical advice and is for entertainment purposes only. There are a few issues with using these devices as a treatment: Compliance is SUPER low. 50% of users after 1 year will stop. Several side effects can happen such as dry throat, difficulty falling asleep, etc. The device may not be fixing the problem if sleep apnea is obstructive and not central. What I mean by point number 3 is that the problem of sleep apnea has to do with the airway collapsing at some location. The machine does not fix the structural collapse but creates an artificial breathing environment; acting like a stent for your airway. Stents open up the pipe, but don't fix the underlying issue. This could be why CPAPs You could still have many of the following issues: Restricted nasal airway Low resting tongue posture, whcih collapses the pharyngeal wall during sleep Low soft palate posture restricted airway size Limited cervical dynamics Limited thorax dynamics All of these factors could limit your ability to breathe effectively during sleep and life. I think they need to be addressed to really "fix" the problem. [caption id="attachment_13405" align="aligncenter" width="386"] Make that airway dynamic AF, fam![/caption] Consider if you cannot adequately breathe through your nose for whatever reason. You will not get nitric oxide production needed to dilate blood vessels, which has several cardioprotective effects by reducing blood pressure and such. The key is to restore this mechanism. How would you do that? That I cannot answer, as each individual's needs will be unique. You need data, imaging, and a physical examination to make decisions. Pursuing upper airway restoration involves working under a skilled physician (Dentist, sleep doctor, ENT). Treatments could include the following: Surgeries to impact airway at any level (maxillomandibular advancement, septoplasty or other nasal surgeries, surgical palate expansion, tongue-tie release, etc) Oral appliance and airway orthodontics Myofunctional therapy and physical therapy Maximizing sleep environment Eating foods that support a healthy sleep environment Whatever you need, please consult a physician skilled in this domain, but I do think going this route is essential for improving upper airway dynamics, and subsequently sleep. If you want to check out some of the stuff I've tried, you can see them below: Deviated septum Question: When dealing with a client with a deviated septum, that is a constant mouth breather. What is the best route to take with them in order for them to improve their breathing during training? Would the tongue drill help? Are there other drills? Watch the debrief Answer: The best route to "fix" a deviated septum would be consulting a practitioner who specializes in the upper airway. What will likely need to happen is some changes in mouth structure and position to improve the floor of the nose (aka roof of the mouth) and potentially a surgical procedure to correct the deviation pending the degree. There are likely no conservative measures that can alter a septal deviation, this is a structural issue. That said, many folks can still nasal breathe well despite this structural issue. In fact, I know someone right now who has an 80% blockage in one nostril who nasal breathes like a boss! Just like you can have osteoarthritis without pain and a high level of function, so too can you have a structural problem in your nose but still breathe well. The key is to have all the pieces in places needed to ensure a nasal breathing environment: Palatal tongue posture Ability to breathe through your nose Carbon dioxide tolerance Let's dive into each! Palatal tongue posture A palatal tongue posture is the ability to place your entire tongue on the roof of your mouth and keep it there. Notice how the tongue is right up against the roof of the mouth (photo credit: )The ability to get into this position requires adequate mobility and knowing how to get into position. If you want some good exercises to enhance tongue mobility, check out and my Youtube playlist If you want to better improve tongue placement, utilizing on your mouth can be a big help. Basically, you can put the elastics where you can't get your tongue up to as an external cue. Focus on pressing the elastic into the roof of the mouth. [caption id="attachment_13409" align="aligncenter" width="376"] Elastic on the tongue tip. A good starting point[/caption] Ability to breathe through your nose This is as it sounds. Can you breathe through your nose while keeping a palatal tongue posture? Think breathe quietly and slowly through your nose in this position. You can also use a through your nose to keep it open and clean. [caption id="attachment_13411" align="aligncenter" width="376"] Keep ya nose clean, fam![/caption] Carbon dioxide tolerance Mouth breathing is useful for keeping blood pH in a tight window during exercise. pH is governed by carbon dioxide, so the better you can tolerate carbon dioxide, the longer you can nasal breathe. This quality can be improved by working on a controlled pause. Here are the steps to this action: Attain palatal tongue posture Exhale a normal amount through your nose Pause and do not breathe. Hold to the point of first experiencing air hunger (where you feel the need to breathe in) Breathe in lightly through your nose, and exhale again; repeating step 3. Over time, your ability to tolerate air hunger should improve, and NO ONE will mess with you. Sum up CPAPs help keep the airway open and oxygen in your body, but improving airway dynamics and structure are key to "fixing" sleep apnea Nasal breathing requires a palatal tongue posture, regular nasal breathing, and carbon dioxide tolerance Image by https://www.myupchar.com/en
info_outline Mindful Movement with Lucy Hendricks 01/16/2021
Mindful Movement with Lucy Hendricks The trainer's guide to teaching clients the fundamentals of health What does it take to make clients healthy? Is it just movement, or is it more? And is there a way we can make pursuing health for our clients simpler? Make the coaching process simpler? That's why I'm juiced up to bring you for this week's talk. In this podcast, you’ll learn: What it really takes to keep your clients healthy How to create a gym culture that values health, sleep, nutrition, and more What are the pillars of health? Which three habits should brand new clients focus on in their first year of training How mindful movement can give you all the benefits of yoga without the drawbacks Why you should use the "rule of 3" with your exercise cueing The benefits of creating a consistent approach with your clients Why coaching the general population is important What is the future of healthcare? Check this interview out if you want your coaching to be simpler and all-encompassing! Click to watch the interview. Below you'll find the show notes and modified transcripts. Learn more about Lucy Hendricks Lucy's website can be found Enhancing Life Virtual Gym (get 2 weeks of mindful movement free!) Instagram: Bio Lucy Hendricks is a gym owner, coach, educator, and speaker who not only takes a holistic approach to personal training but is known for her ability to take complicated topics and making them digestible for fitness and rehab professionals. She helps coaches who have clients that have been hindered by movement limitations get back to what they love. Show notes Here are links to things mentioned in the interview: - He's an awesome PT who specializes in trauma work. You can check out a course review I did on him - An exercise commonly used in movement prep. - This is the appliance I have in my mouth for palatal expansion. Modified Transcripts Zac: When I say "Personal Trainer," what does that mean to you? Lucy: Just a joke of a career. Zac: Really? Why do you think it's a joke of a career? Lucy: Because I feel like it's based on a really faulty foundation of all this from the start of how we get people in the industry, how we train them, what expectations we give them, how we train them to do their job and the expectation of what they're able to accomplish with people's health. Zac: You know, when you reflect back on your career and how you got started in this industry, did you ever get hit with that like, I'm working with some people and it's like, "Whoa, this person needs a whole lot more than what I learned in my beginning phases of my career."? Lucy: I wouldn't say there was one time where it hit me. It was more of reflecting back on the first five years of my career. Always feeling like a fraud. Because right from the very beginning I started getting invited to podcasts, seminars and people always ask the question, "What do you do to get your clients results?" Which I always hated because I was really good at getting people to lift without pain. But when people say "Results," they insinuate that you got them, their fat loss results, sleep results, just got them healthy. And for the first five years, I always avoided that question or didn't really answer it, beat around the bush, and went to the strength training without pain. And then I realized that the expectation that personal trainers are able to get people to the end result, which is completely healthy, is really unrealistic because no one has the skillsets for that. Building a gym that appreciates holistic fitness Zac: What kind of things did you first shift to that were outside of strength training without pain? Lucy: I would say the functional medicine world and those concepts of working on your sleep, eating real food, at the time gluten-free, sugar-free, trying to go back to what your ancestors ate, and stress management, which I didn't really understand either other than promoting people need to chill out. Zac: Of course, take a chill pill. [caption id="attachment_13364" align="aligncenter" width="500"] Although I personally prefer red pill (Image by from )[/caption] Lucy: It should be less stressed. And telling people that meditation is important, but never actually getting them to do it. Maybe a handful of people tried it or tried other stress-relieving activities, but there was never a process. It was more trying to create the culture where we believed in all these other lifestyle factors that needed to be addressed, but never actually had a system for it. Zac: And I know you like to have a systematic and consistent approach you might say. So, once you ironed out the kinks, so to speak with somebody approaches, as opposed to just say, "Try and relax" when it comes to stress management or meditation's important, sleep's important, but not having those processes in place. What was your process like of making that more systematic in your community that you train? Lucy: I wouldn't take this as advice, but we first started out with workshops. So, I remember we did the first sleep workshop probably three years ago and no one had signed up. So I gave away eight semi-private or something crazy without thinking, just wanting them to come so bad to the sleep seminar, believing if they worked on their sleep, they'll get better results. And then they'll stay longer, which the money won't be an issue. And clients knew that that was a horrible business choice, so they ended up coming, but never picked up the sessions. People did buy blue-blocking glasses, the sunlight lamp, and started walking in the morning and started turning off their overhead lights at night. So, it did change a little bit and some people got results. What really went well was the following year. We did a sleep challenge and we didn't want to attach the winning to results just because everybody's so different. And that's one thing that makes it so hard is you can't really control the outcome in a group setting unless you had one on one coaching, but that takes so much attention and skill sets that most trainers don't have to control a bunch of other aspects that influence someone's ability to get results. So, what we ended up doing was we attached the outcome to participation. So, everybody had a checklist of, I think, 12 things that correlate to sleep hygiene or influence sleep hygiene. And you had the check, I forget so many each day posted on Facebook. And each time you posted a picture, you got your name and a chance to win an , which is like a $300 ring. And that worked really well. A lot of people got amazing results better than I thought they would. People who struggled to get up in the morning were able to get up in the morning with no problem. People started drinking less coffee. People started going to sleep faster. We had another client who started pushing herself harder with running. So, she felt that she was working out too hard, but really, she wasn't recovering enough. So, when she started sleeping better, she found herself being able to push harder in the gym. So that was really cool. Zac: I think it's cool that instead of focusing on the outcome, you focus on the process. Because with something like meditation, I know you did a meditation challenge as well. How do you define a successful meditation? Whereas you were able to get people to focus more so on just habits people need to do to be healthy. What constitutes healthy sleep? And it's these keys. And I mean, that's fascinating that you're able to get the buy-in on that. You had good retention rates with that as well? The whole challenge? Lucy: With the challenge? Yes. Zac: It seems like once you take the outcome, so to speak out of the process, it's like people still feel successful. And I think that's absolutely brilliant. Lucy: And people are competitive. So, the minimum was you have to do X amount, but then sure enough, the first person that filled out the entire sheet went on there and got a bunch of praise from us on Facebook. And then other people started going through the entire sheet as well. A lot of people kept up with some of the routines. But anything that pushes the needle in the right direction when it comes to health. And that's what we try to teach people is you can do just about anything and you will get results. So, what we try to do is at least establish the basics of all these other life factors. So that way, we can start pushing the needle in the direction of better health and more sustainable results. The pillars of health a beginner client should achieve Zac: What are some of the key habits you want a new client to exhibit within the first year? Lucy: If I were to pick three, I would say getting a movement routine, which can also mean exercise routine, where they're consistent and they enjoy it. Where it's no longer a struggle to attend the gym. So now you don't have to sit there and "Do I really want to go, or should I just skip this week?" So once going to the gym once or twice a week becomes an easy choice, that would be something that I would want in the first year. The next two would be finding a meditation practice and getting them to teach themselves to be present and train their body to pay attention to what's going on inside and with their thoughts. And the third thing I would say would probably be walking and spending time outside. So, if I were to pick three of those would be the three. Zac: Why in your eyes are those three the most important? I think the movement practice makes sense because that's where people are coming to you for. But as a trainer, that is our bread and butter. So, what about the other two? Why do you think walking is important and why do you think meditation is important and the first things that you put? Lucy: Movement and exercise part is our bread and butter. If that wasn't a priority, then we probably wouldn't have clients. We are really good at getting people to enjoy exercise. I think a reason why people can't stay consistent on a schedule is because they don't enjoy it. We focus on making training feel good. The second one is building a meditation practice, training themselves to pay attention because a lot of people have either maladaptive beliefs, catastrophic thinking, unhealthy behaviors that really are impacting their ability to get healthy. And if you can't sit there and the present moment and pay attention to your thoughts, or even recognize that you have the behaviors that you're doing or practicing in or the self-awareness. [caption id="attachment_13365" align="aligncenter" width="500"] And if you meditate just right, you too will become psychedelic! (Image by from )[/caption] Self-awareness is the first step to changing any type of behavior, thought, or lifestyle that you're wanting to work on. If people don't have that, it's so hard to even change anything. Our goal is sustainable results. Meditation helps build the foundation required to change all of these thoughts and behaviors that people are having. Walking is to get people moving throughout the day. And that helps with our number one goal, which is getting people consistent in the gym. What we find is if people can walk and move outside of the gym, they're able to recover faster from their workouts. That makes their workouts feel better, they progress a lot faster, which gets them excited. If they're not moving outside of the gym and they're only exercising and only moving at the gym, then these people will progress a little slower. So, it motivates them less. Zac: With the meditation in particular, because inevitably, especially when someone's starting out, you are going to fall off the wagon in some way, shape, or form. And having the self-awareness component and the ability to bring it back to whatever it is you are focusing on, probably helps them get back on track sooner than not. Lucy: Oh, 100%. And then that's what you need. You need the awareness to see the patterns of "When I stopped sleeping and I don't pay attention to X, Y, and Z. When I don't do my movement routine, or when I don't do my morning routine of reading, getting my coffee, doing my meditating, I now notice that I go to the gym less, I start bingeing at night." So, having this awareness of where you dropped off and what are the things that you need to do to get back is everything. Because if you don't have that, you don't know why you failed. So, it was just, "I failed. I suck." And then that's it. So, you don't even have the keys to even get back to where you were, Mindful movement Lucy: So, the idea of the mindful movement service that I created started out when I attended class. [caption id="attachment_13366" align="aligncenter" width="500"] Ahh the gold ole days[/caption] Zac: Yes. Lucy: Where he first introduced the idea of how the body and stress and trauma interact together. And how trauma and stress influences what you see in the body. And how you can use a movement practice, meditation practice, and even things like yoga to impact someone's stress or trauma. And how both of them are really connected. So that was when I first got introduced to that idea. And I worked with him online where he did some of his work with me, and then I took a yoga class. I am an ex-gymnast and super flexible, strong, and I take cues well. And yoga was very therapeutic for me. It was a time for 45 minutes for me to only pay attention to what was going on in my body. The muscles that I felt stretching, the muscles that I felt working, the cues that they were telling me to do, I was paying attention to that. And I got immense benefit with it when it comes to the struggles that I was having with my mental illness. But then I noticed that the people that really benefit from it are people like me who are really flexible, take cues well, are strong and have a background probably in gymnastics, ballet, dance, or ice skating. Zac: You got to express to yourself what you already knew how to do in just a unique way. Lucy: Yes. At the same time, I was starting to see the stuff that I was doing with our clients from a different perspective, because I train a lot of people in pain and who have an auto-immune disease. When they would try to cancel on me because they had a flare up, whether their back flared up for the fifth time in a few months or their Hashimoto's flared up. So, they were really fatigued. I would try to get them in the gym anyway. And instead of their full-on workout, I would let them do breathing exercises for about 45 minutes. So, with the information that I had and the outcomes that I was noticing, I thought for the longest time that because they did all the breathing exercises from a biomechanic standpoint, they were feeling really good because we just increased all these movement options. Which there's some truth to that, for sure. But I think I was giving biomechanics way more credit with the information that I had. Although I never did those breathing sessions myself, my client reactions were very positive, so I kept doing it. Sometimes they would even ask for those sessions because they enjoyed them that much. And they would take me aside and like shake my hand or like hug me. Like, "Thank you so much for letting me come in and do that." So, when I learned about stress and trauma and all of that stuff, and I took the yoga class, I realized maybe it's not all biomechanics. Maybe they felt so great because they just meditated for a whole entire hour. Zac: Yes. Lucy: And when they stopped paying attention to their body, there I was reminding them, "Keep tucking, keep reaching, don't lose it, keep exhaling." Because I'm very detailed with my coaching. And that's when I started thinking that I could create something or a service that gave me what yoga gave me with the detailed coaching and the way I see the body, which is really good at meeting people where they're at, who don't move well. People who don't take cues well, people who are deconditioned, people who are uncoordinated with their body, people who can't handle multiple instructions at once, which is about everybody. Which is most people. And that's when I kind of blended both of those worlds and created a service called mindful movement. Zac: You've essentially made yoga so much easier to execute for a lot of different people, which allows those less flexible people to get similar benefits. because you get a wide variety of clients. Have you noticed if mindful movement carries over into the gym? Lucy: Their ability to take cues. Zac: So, it's made your job even easier, even though you already make it easy with your coaching? Lucy: It's crazy. I can just sit down and not do anything. And I've been talking to them about it all week. Last week. "Will someone mess something up because this is way too easy?" So, we started the service last year, during the meditation challenge. It has since evolved from then; from the one-on-one sessions, and then into actual classes once the pandemic hit. Zac: What's a typical session like? So, you got, say, it's the first time someone is attending your mindful movement. What does that entail? Lucy: Oh, I would say it's very similar to like a strength training session with two or three try sets. We pick three different exercises, go through them. I don't do reps. I do more for time just because everybody moves at a different pace. It's a lot of the same cues that I use on the training floor, which, if you're watching this, it's focusing on the position, focusing on all of the skills or being able to coordinate your body in a way where you're achieving certain positions and certain moves. [caption id="attachment_13193" align="alignnone" width="810"] The only way to talk to Zac[/caption] I'm introducing one cue at a time and that's all they're paying attention to. And that's why, what I said before, it's making my job easier because that's all they have to focus on is that one cue. So, an example of that would be one that I like to start with is in the supine position with their feet in a . Usually, when you introduce this exercise, people try to put everything together all at once: "Okay, tuck here and I'll fully exhale and I'll keep the ab tension and reach and don't shrug and don't lose a tuck." It's usually a complete failure. Or it's not a failure because you're really good at coaching, but the client is not competent in that move. You might've gotten them there, but they don't even know how they got there. Zac: Yes. They need you to complete the tasks.. Lucy: I did that in the past so much, and it was probably an ego boost of like, I just got this person in this position. But then when I asked them "How was that?" They're like, "I don't know what just happened." Or they you them, "Where did you feel that?" And they say, "Oh, I don't know. Let me do that again." Zac: Yes. Lucy: So, with mindful movement, what I ended up doing was retracting all of those cues and introducing one cue at a time. And it's the example, the 90/90 position legs don't do anything. All they're focusing on is that full exhale. So, it's in through the nose, full exhale, and I'm telling them the count, try to get the 10 seconds and then just breathe in however. And then back over and over again. Breathe in through your nose, full breath out. And the goal is, each exhale you're going further and further and you're trying to count to like 10 to 12 seconds. And that's all they're focusing on. The way I see it is like taking a dance class. It's, you're focusing on like taking a step forward and taking a step back and taking a step forward. And you're just really getting used to like what that feels like. And then I build up on top of that. And so that's the first set. The second set, I tell them to do the same thing, "Full exhale, at the end of the exhale, you should feel some abs. So, hold that air out and even say in your head, holding onto the tension and then letting it go." And then that's what they're focusing on for, I...
info_outline Foundations of Athleticism and Health with James Cerbie 01/10/2021
Foundations of Athleticism and Health with James Cerbie What does it take to be a well-rounded athlete? Find out below! Perhaps you are into training or know it’s important, but what if you don’t have a particular goal? What if you just want to move better and look good naked in the process? How can I know what to focus my training on if I don’t have a goal? That’s where this interview with James Cerbie will blow your mind. He has carefully designed a training plan that builds all the essential performance qualities one needs to be a healthy human being. In this podcast, you’ll learn: What life proofing is, why it's important for your health and performance, and how to build it. The 5 fitness attributes you need to become athletic as can be Which metrics are useful to measure fitness qualities, and how to adjust your programming based on testing Has your progress stalled? How can you pivot your training to keep the gains going There are 4 categories of athletes, how does training differ for each? How can you build athleticism with minimal gym equipment? Is the performance vs health dichotomy really a thing? If you are ready to push the envelope with your training, become more athletic than ever, then you definitely need to give this a listen. Convinced that this training program is for you? Sign up for the Apex Athlete Team Training, which is open from January 11th-15th, 2021. You can sign up for it Missed the deadline but still want to hop on the gain train? James and the folks at Rebel Performance offer coaching year-round. Work with Rebel Performance Coaches Look below to watch the interview, listen to the podcast, get the show notes, and read the modified transcripts. Watch the interview Learn more about James Cerbie His website: His podcast: . You can check out the one he did with yours truly Facebook: Twitter: Instagram: Bio James Cerbie is the founder and head coach at Rebel Performance. He can be found lifting, drinking coffee, roaming in the mountains, reading research, or watching superhero movies. Show notes Here are links to things mentioned in the interview: - This was an awesome performance retreat that James and I spoke at a few years back. So much fun! - The spot in Vegas where ya boi works. - An excellent strength coach out of the Cinncinnati area. - One of the best bloggers out there. A person who learns things quickly and interviews high performers. - A nootropic supplement to help you be focused AF. - An interface used for coaching - This is where you can find James Transcripts What is life proofing? James: I've been an athlete my entire life, that's very much how I think of myself, my self-image. I can remember there being this moment of crisis when college ended, and I was fortunate to play baseball in college. So, I was always on a team, I was always training, I was always competing, it was always underneath this umbrella of being a well-rounded stack across the board athlete. When college ends maybe for some people with high school or some people that are lucky enough as professional. It's the Thanos finger snap moment where this thing you've known your entire life disappears. Fortunately, I had fallen in love with the weight room along my journey of planning sports. And so, I looked at the landscape said, you know, I'll be fine. I'll go compete in something like powerlifting, maybe I'll try bodybuilding. CrossFit was a thing at that point. Strongman existed. I'm gonna go try these things. I'm sure one of them is going to definitely do it for me, that's gonna be my thing. So, I started dabbling and trying all these things, just to come to the realization that none of them were for me. Just really frustrated in that journey in that process. Because I love training, I love throwing down but I couldn't find the right avenue or outlet for what I wanted. I wanted a blend of what these things gave me. Like, I don't want to just be a powerlifter. I'm not attacking any of those sports, they are all each incredible on their own, right? They just weren't the right thing for me. I'd get to about eight weeks into a powerlifting program and I would feel like a refrigerator. It’s like I can't sprint, I can't jump, I don't move. Like, I just hated the tradeoffs that I was having to make. And so, I said, all right, there has to be a better way of approaching this so that I can get the outcome I want, and then I've got to figure out how to make that competitive. So, I can still have a competitive outlet, I need to have a team component to this thing as well. And so that's where I started playing around with this concept of being Life Proof, or this concept of being Apex. It’s kind of saying, okay, I want to be well-rounded as an athlete. And I think if you're a human, you should want those things as well, right? Because, in my mind, if you're a human, you're an athlete. And what that means in my definition is I want to give you kind of five attribute bars: Strength hypertrophy Power Endurance Movement IQ If I can give you all five of those, if you have all five of those, then I think you are pretty Life Proof. You're gonna be able to handle whatever life throws at you. Exactly how high you want these attribute bars to go will differ from person to person. [caption id="attachment_13325" align="aligncenter" width="500"] Personally, I'm a level 35 physical therapist with Elven magic. (Image by from )[/caption] How much time do you have to train, how much you want to make your life revolve around being in the weight room and lifting? But I don't care if you're a 55-year-old CEO, I want you to have all five of these things so that you just do well in life. If you want to ramp that up to a much higher level, then we can do that as well. Are you the 23, 24, 25-year-old kid who wants to spend two hours training, you want to make your life will revolve around eating, training, sleeping, etc. We can bump those attribute bars up significantly higher for you. But regardless, I want all five and that's the point is I want to give you all five of those things. If you have all five then I think that you're probably pretty Life Proof. You should be able to handle just about anything that you're going to tackle in life. If you need to lift something heavy you can, look like a superhero, go rock in the mountains, do Matt Condon medleys, jump, sprint, throw. you have all your bases covered. Zac: Do you think powerlifters get triggered and offended with your disclaimer? [caption id="attachment_13326" align="alignnone" width="600"] the bigger the beard the more easily triggered, they say (Image by from )[/caption] James: Nothing against the sports I think they're all incredibly they do shit that I could never do. It's just not for me. And I have found that there are a lot of people out there who have dabbled and tried these other sports and feel the same way I do so. Zac: You sacrifice things James: A lot. Zac: I remember when we went to , there are these big dudes at the retreat that we went to, and they absolutely destroyed the weightlifting competitions we had. But then you go hiking and it's a struggle. Or we play a sport, frisbee on the beach. You're not gonna get picked first by any means. James: And that was the tradeoff that I wasn't comfortable with. I still need to be able to go sprint, jump, cut, do athletic things. for me, that's where power lives. Olympic lifting is cool. It's great. If you want to use it, awesome. Just not my interest. I would rather sprint, jump, throw, and cut. Zac: Yeah. And I think as social animals, unless you're going to be spending all day every day in those, you know, doing Olympic lifting, which is fine. I've watched people do that. But sometimes you might meet up with friends and go play something Spike ball as we've been doing a lot at You're limited in your capability of doing that and enjoying that. So, I think this concept is very useful. I also think that having a baseline you need at least this amount of a given attribute, and then you can expand upon whatever you want to depend on your task is very effective. I think a lot of people think that they have to push X number of weight in order to have success in whatever it is that we have in our movement realm. But that's most certainly not the case. When you came up with these five qualities, do you feel as though it filled that void of not having baseball in your case? I went through a similar crisis with running. Now obviously, I could have kept running because that was my sport. But I hated it. I only did it because I was decently fast at it. But did you feel as though it gave you similar satisfaction in pursuing that compared to baseball? James: Yes. So, the key there was in actually finding the other people, finding your tribe, finding your people who felt similar, who wanted to train in a similar way. And so, then you actually were able to get the team-based component back. So, it did successfully fill that void. And the first experiment that I essentially ran with that was The Silverback Training Project. It was a very big success for the people that we got on board. We saw improvement across the board. We have people hitting 50 to 100-pound PRs in the big three! I'm not talking about going from 100 to 150 pounds either. We're talking people squatting 500 for the first time, people deadlifting 600 for the first time, people who were in pain who are no longer in pain and feel good. 30% improvements on 10-minute assault bike challenges. And all these other met cons we we're testing. They're putting on muscle, they feel good. We're hitting three, four-inch PRs in verticals, broad jumps, we're doing better on 10-yard and 15-yard sprint tests. To go back to the attribute bar analogy, we're essentially taking all the attribute bars, and they're all getting moved up. And so that was a nice reassurance to see. One, conceptually, my thoughts on a whiteboard, when actually given to humans worked. Because there's always that thought that I'm gonna sit down and write a program and it's just not gonna work. But it does. Contrary to what a lot of people think, you can actually get a lot of progress across the board if you're smart in how you implement these things. But the biggest one was just seeing how the people came together. You filled that void for them, they got to compete again, they got to have a team. And so, it was a lot of fun to watch that transpire. We did it for a couple of cohorts, just to make sure it wasn't an anomaly the first time. And you see a similar thing happen every single time. So yeah, that was the first big win into that realm. Now we just need to spread the word and find more humans that believe in this concept. [caption id="attachment_13327" align="aligncenter" width="500"] Team work making the dream work and shit (Image by from )[/caption] Zac: It's kind of what CrossFit was trying to do. And there are some CrossFit boxes that probably implement this successfully is you want to be well rounded in all of these qualities. But then the issue is that because you're varying the workout so much, you don't get that progressive improvement in specific qualities. Whereas you're advocating that you can get improvement in all these qualities, but you have to apply the concepts of progressive overload in order to make that happen. And it sounds like you also measure each of these qualities to let you know, where we have to tweak the program to improve even further. The best tests to measure athleticism James: Strength is pretty straightforward. We don't use one rep max very often just because it's so skill and technique based. So, I use more three, five, and ten rep maxes. I want to see strength improve across a range. Hypertrophy is a much more difficult one to measure, I don't have a great performance-based metric for that. I think your performance on higher rep stuff or timed sets would probably be a little bit of an indicator, but we're probably going to use more just vanity metrics. Take a before and after picture. Do you look more jacked? Are you happy with this outcome? You could also test body composition. Looking like a superhero just comes with the territory when you do what you're supposed to do training-wise and in the kitchen. Endurance is easy, we use a 10-minute challenge. You go as hard as you can for 10 minutes, and let's see where you're at. Four miles seems to be a pretty good threshold. I've had a couple people push five, which is outrageous. These dudes are freaks. They just have engines for days. We will also look at the resting heart rate and see if there are any drops. Zac: I can't push volume on a bike for whatever reason. And it's not because of the lack of the ticker. It's because of the local muscle fatigue for me. It's the same for lifting. Although I've gotten significantly better at tolerating more volume with a single move, which I need for a training effect, I have to vary the. exercises to train enough. I might do an Arnold press and only get four sets of whatever rep range. And then I just I cannot output anymore. But then if I change to an incline, then I'm right back in action. we're back. The cardiac adaptations are there, it's just the supporting structures aren't there to carry it out. So that's where a lot of my training has been going because that's what I know is the rate-limiting step. James: It’s those capillaries and mitochondria, bro. On the power attribute bar, I'm looking at jumps, sprints, and throws. Vertical, broad, lateral. I want to see multiple repeat jumps as well. 10-yard sprint, 15-yard sprint, maybe out to a 40 or 60. I don't have Olympic lifts in my model. It's not because they don't work, I just choose not to use them. I think that jumps, sprints, and throws are more effective and less technical. Movement is obviously really hard, so our measures are subjective; things feel easier, pain reductions, getting muscle fatigue instead of joint pain, etc. Oo the endurance side of the coin, are resting heart rates dropping? If I can get actual numbers, I want to get actual numbers. This allows us to see where we need to focus our efforts. Say all qualities but endurance are improving. We may potentially change volume or something else in their template. Zac: Then would you do things to maintain the other quality, so perhaps, you'd increase volume to potentially improve endurance components, but then you're just adjusting maybe it's less volume, less volume on the power components or, you know, you're doing less volume of the strength work? James: Yeah, I'm a big block periodization fan, physiologically. That just makes a lot of sense to me. And it works. So, I talk about all five of these attribute bars, but we need to appreciate that I'm not hitting the Go button on all five of these all the time because that can't work. It's more of how you stack the blocks together in a sequential fashion, that allows you to get this good development across the board. And so that's the biggest thing. It's making sure that we have you in the weekly training template for whatever type of athlete you are. And we can talk more about that. And then from there, it's just making sure we sequentially have a block of training that makes sense. What am I focusing on for these four to six weeks, and then what am I going to focus on for the next four to six weeks while I maintain these other things? So, when I have maintenance with progress, you are slowly bumping these things up over time. If you only zoom in acutely, you may only see one or two attribute bars going up. But when you zoom out and look at what happened over 12 to 16 weeks, we've got all qualities to improve. And that's what we're chasing. Zac: To be everywhere, to be nowhere. That extends to not just fitness qualities, but all things. You can't be an expert in all things mitochondria and real estate at the same time. Your outputs in each domain wouldn't be as high as if it were a focused effort. So too with training. But where I also think you are doing a far superior job compared to other people is you don't build one-trick ponies. You allow for adaptability. Mastering only one quality can help if pursuing a specific sport, but it puts you at risk for bad things to potentially happen when you have to call upon those other qualities. James: Yeah, and if you have a highly specific goal, and you want to be the best in the world of that highly specific thing, then you have to be a one-trick pony. And that would be good for you. If you want to be an elite level powerlifter, if you want to step on stage for bodybuilding, if you want to compete in Olympic lifting, I think all those avenues are incredible. And if that's your thing, and that's what lights your fire, go do it. That's awesome. But if those things don't light your fire, then maybe we think about training in a different way. Athlete archetypes Zac: Once you've established a life proof baseline, where do you go next? James: This is where it depends on what avenue are you in? Are you in a one on one training experience where you're getting a dedicated coach with individualized coaching? Because those conversations happen pretty often, and we get pretty detailed nitty-gritty into the weeds. Or you're doing more the team-based approach, where you're getting into a pre-written training template that you're funneled into based on your goals. So those go through more pre-determined cycles. We essentially will go through waves of hypertrophy, work capacity, focus block of training, and then we're going to go into a more strength, power, etc., focus block of training. If we decide on improving a specific quality like strength, we may lower the rep ranges and have that be the main focus. Then, we're blending power and throughout that with jumps, sprints, throws, etc. Endurance is getting thrown in there as well, whether or not we're doing a short to long, longer, shorter approach, etc. It kind of depends. But again, I think what we do first is we try to funnel the athlete into determining what is your specific archetype? Because the concept of life is very broad, so we need to narrow that down. We've found that people generally fall into one of four categories: Base athlete Stacked athlete Strong Athlete Tactical athlete Base athlete A base athlete cares most about movement. They want to move really well and feel good while sprinkling other pillars on top. These athletes will use more of a sensorimotor-based approach. Your big squat might be a heel-elevated Zercher squat because movement is the highest priority. https://www.youtube.com/watch?v=gmDnYnGWA-I Stacked athlete Stacked athletes want the five attributes to be as level across the board as possible. They want to be the middle linebacker of humans. For them, we're more aggressive at how we're chasing performance outcomes. They get put on a three training split: three lift days, two low conditioning days, one high conditioning day. Strong athlete The strong athlete cares most about strength and hypertrophy. Fantastic. You can put on a four-two training split into four lift days and two easy conditioning days. You’re not going to get the hard conditioning day, because there's nowhere to fit it into your scheme. Plus, you don't care that much about that outcome. But we still want the two low conditioning days because we need that at least low-level aerobic ability and capacity to feed into everything else that you're doing. Tactical athlete The tactical athlete cares most about endurance. They have more met-cons and medleys, rucking in the mountains. These athletes also are put on a four-two split as well. So, they have four "lift days" and two easy conditioning days. Their lift days are a bit different. They'll first have two big lifts (e.g. squat and press, hinge and pull, etc) and instead of accessory work, they'll do met-cons...
info_outline Lower Cervical Rotation 12/20/2020
Lower Cervical Rotation Can’t turn your head? Find out why So the neck, thorax, shoulders, and more are all related, but is there a convenient way to illustrate the interconnectedness of these areas? I think there is one test that can provide TONS of insight here. That test? Lower cervical rotation The ability to rotate the lower part of the neck can demonstrate how well you can move the uppermost parts of the thorax and can help differentiate if you need to drive interventions either below or above the neck. Want to know all about the importance of this often-overlooked test? Check out Movement Debrief Episode 142 to learn more! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - If you want to dive into myofunctional therapy and tongue posture, this is the post for you. If you want to peep some exercises for your tongue, check out the playlist - If you want to find a neuro or behavioral optometrist, one who looks beyond vision clarity, this is the place to find them. - My go-to place to learn how to do joint manipulations. - Does joint manipulation pose a risk for vertebral artery breaking? Not as much as going to your primary care physician. Read this article and prepare to have your mind blown. Cervical rotation assessment and treatment Question: "Hey Zac, What do you look for when you assess neck rotation and needs for lower cervical rotation?" Answer: Cervical rotation is an excellent measure that bridges that gap between craniocervical and thorax limitations. We will be separating measuring this area into upper and lower cervical contributions. The bulk of cervical rotation happens at C1-C2, which accounts for about 45 degrees of motion in each direction. The remaining 45 or so degrees happens in the rest of the cervical spine. You'll also get some thoracic spine movement down to T5-ish with cervical rotation. An easy way to measure upper cervical rotation is the classic . Here, you'll flex the neck until the chin is touching the chest, then rotate the head, shooting for 45 degrees each way. But how in the heck do you measure the remaining cervical rotation contributions? I'm glad you asked!!! There is a test called lower cervical rotation, where you essentially grab the neck and rotate it as a unit. The way you perform the test is by approximating your index fingers up against C7. Grasp the neck and rotate it as a unit, as you can see in the video There isn't really a "normal" degree on this test. You have to go by feel. Usually, the test is restricted if you feel an abrupt halt or block as you into the rotation. If you can't test someone manually, you can simply look at seated cervical rotation, then have the client actively perform the flexion-rotation test, and note the difference. So we have two areas to target: lower cervical rotation vs upper cervical rotation Lower cervical rotation If there is a limitation in cervical rotation in one direction, that means you'll have reductions in: ipsilateral posterior expansion Contralateral anterior expansion This limitation will occur all the way down to T5. Meaning that this test can be another test to determine if one needs upper thorax (T2-4) expansion. This test is especially useful if your supreme clientele has REALLY FLEXIBLE shoulders. Can't trust 'em! If you see a restriction here and you've already , then you want to drive activities that isolate rotation here. Movements such as , where the thorax rotates one direction and the head rotates the opposite direction, can be a useful way of targeting this region. You can also combine head rotation with humeral rotation, like with an Upper cervical rotation If you have cleared up everything else, yet you notice there is still a restriction in upper cervical rotation, you'll likely need to either drive upper cervical mobility or target the cranial sensory systems. Most people are either biased towards a forward head posture or a military posture. For the former, you'll need to drive slight OA flexion. You can accomplish this position easily with a If you need OA extension, simply cueing undouble chin during any move can be enough. Looking ahead in a can do the trick. You can also utilize in this area to attain desired outcomes. Let's suppose that you've tried this to no avail, you may have to consider affecting different sensory systems. This "fix" could either involves a dental (or ) to improve palatal tongue posture, working with a , or potentially impacting other sensory systems. When should I refer to an optometrist? Question: "How do you know if vision is a factor in limited cervical movement?" Watch the answer Answer: There aren't really hard and fast rules when it comes to determining when you need to make the optometric referral. It's usually a cluster of exhausting conservative options and history indicating visual disturbance. I cannot stress this enough: make the vision referral AFTER exhausting all conservative options. Meaning, you've stacked and taught other basic movement skills. If I bold and italicize at the same time, you know I mean bidness! The reason why I say this is because many times you can refer someone who doesn't necessarily need this discipline or doesn't have the fundamental movement skills needed to build upon visual training. Do the basics first. Now if you've gone after conservative measures and things just aren't bopping, you might consider a referral to a if you see some of the following medical history indicators: High prescription (4.0+/- or more) strabismus Lazy eye concussion history cataracts monovision Abrupt changes in prescription difficulty focusing, brain fog, have to consistently re-read, poor penmanship LASIK/PRK surgery, especially if botched blind in one eye There are likely others that I'll be able to contribute as I work on this referral source and knowledge base more. There isn't really a specific test that would point you towards seeing an optometrist, but one thing that I've seen is severely limited that doesn't improve with interventions. If you need to make an optometry referral, again, try to find a neuro optometrist. Working on visual skills other than sight is critical for influencing movement options. Sum up Lower cervical rotation involves addressing upper thorax rotation to improve mobility Upper cervical rotation involves address OA movement or sensory systems to improve mobility Vision therapy is pursued when all other options are exhausted and medical history poses signs that would warrant a consult. Image by from
info_outline Pelvic Gait Mechanics 12/12/2020
Pelvic Gait Mechanics An overview and novel assessment of gait mechanics Walking is one of the most fundamental movements we have as humans, yet how often do we see movement inefficiencies present in this common pattern? You know who I’m talking about. The person who has no arm swing. The waddler, the toe walker. Clearly, something is going awry, but how do we determine what? The best way to determine how to best improve gait abnormalities is by thoroughly understanding what normal gait mechanics look like. If we know what the biomechanical ideal is for gait, we can then work backward from where our supreme clientele starts at. Be ready to take your gait knowledge to the next level by checking out Movement Debrief Episode 141 below! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :(\ a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This book is the gold standard when it comes to gait mechanics. - Daddy-O Pops is one of the best PTs I know and is a big mentor to me. - She's an incredibly smart clinician who you definitely should check out. - This post is the fundamental concept I teach all of my clients. Here are some of my top articles outlining our inherent asymmetry in our bodies: Normal Lumbopelvic gait mechanics Question: Could you explain the lumbopelvic mechanics during the gait cycle? Watch the answer Answer: It's easiest to understand what the sacrum is doing by looking at the stance phase of gait. We can break this part of gait into three components: Initial contact: When the foot hits the ground Midstance: When the center of mass is over the midfoot Propulsion: When I begin big toe extension and transition to the swing phase on this leg [caption id="attachment_13226" align="alignnone" width="810"] Terminal stance = propulsion (Source: )[/caption] Let's use left stance as our frame of reference. When I am beginning left stance, the sacrum is oriented to the right. As I progress through left stance, the sacrum will begin to rotate to the left; pivoting around the left leg. During initial contact, the sacrum starts from a right orientation and begins rotating leftward towards a "centered" position. Here, the stance femur will be in flexion, abduction, and external rotation. The swing leg will be in extension, adduction, and internal rotation. The bias in the pelvis is more towards external rotation. [caption id="attachment_13227" align="aligncenter" width="500"] Early stance - sacrum is rotating to the left, towards a "centered" position[/caption] During midstance, the sacrum continues rotating left, and a frontal plane shift occurs within the pelvis. The left innominate will be higher than the right, placing the left femur into extension, adduction, and internal rotation. The bias in the pelvis is more towards internal rotation. [caption id="attachment_13229" align="alignnone" width="810"] Midstance - Pelvis rotates towards the left, and there is a frontal plane shift with the ipsilateral innominate higher than the contralateral side.[/caption] Lastly, with propulsion, the sacrum rotates fully to the left, with the right innominate being further forward than the left, completing the gait cycle. Though the left femur is still in extension adduction, and internal rotation. The bias in the pelvis is more towards external rotation [caption id="attachment_13230" align="alignnone" width="810"] Late stance involves the sacrum rotating all the way towards the left.[/caption] Once you've stood on your left leg like a boss, the exact opposite rotation occurs about the right leg. Determining phase of gait restrictions Question: How do you conclude which stance of gait is each pelvis stuck in? Watch the answer Answer: Though we don't necessarily get "stuck" in various positions, understanding what happens femorally during the gait cycle can give us an idea as to what areas we need to focus on. PUBLIC SERVICE ANNOUNCEMENT: Please, for the love of all the things I discuss on this site, make sure you can before doing all this rotational stuff I'm about to show you. If someone has fairly bilateral restrictions, they will benefit from bilateral work. You go too fast down this progression, and you won't get the results you'll desire. You aren't ready for the big move ;) Once you've stacked, and you see sizeable asymmetries present in the lowers, going through the different gait phases can be the cleanup your peeps need to move ever so freely! Let's dive into how. (left leg will be our reference) Initial contact and propulsion activities During left initial contact, the femurs are doing the following: Left femur: Flexion, abduction, and external rotation Right femur: Extension, adduction, and internal rotation If I have femurs that are in these positions, and I've lost dynamics within the pelvis, the following motions will then be restricted: Limited left hip extension, adduction, and internal rotation Limited right flexion, abduction, and external rotation If you see the above presentation, you are dealing with someone who needs to drive left sacral rotation and rotational hip shifting. The reason for these needs is because these gait positions require pelvic external rotation, which is appreciated during initial contact and propulsion. You'll want to start this shifty party up by rotating to the center position (initial contact activities). If driving left initial contact, you'll rotate the sacrum to the center with the left leg in front and the right leg back. One of my favorite moves to restore this motion is a Once you've nailed this position and got some motion improvements, then get ready to propel like you're on a boat (cue early 2010's). Here, you'll rotate the sacrum left with the left leg back and the right leg in front. Posterior hip stretching is money, as are . Midstance activities During left midstance, the femurs are doing the following: Left femur: Extension, adduction, and internal rotation Right femur: Flexion, abduction, and external rotation If I have an inability to reach midstance on the left, the common finding I see is: Limited left hip flexion, adduction, and internal rotation Limited right hip abduction, rotation can be either It's not a crystal clear as the previous iterations. I think left extension clears more in this scenario because the left femur is extending to reach midstance, but what I see restricted is the frontal plane hip shift needed during midstance. This hip shift is going to be the major focus of improving these restrictions. Any activity where a pelvic obliquity is created (left innominate higher than the right) is money for improving these issues. is one of my classics in this regard: Waddling gait Question: What can I do about a client with a waddling gait pattern? This person has limited hip extension and internal rotation, along with very stiff feet? Watch the answer Answer: You see that person who has that waddle waddle (probably not much shaky shaky), and you are thinking: "why in the hell does this person waddle?" The answer, folks, is pretty simple: Midstance deficiency As you remember (hopefully), there needs to be a frontal plane shift occurring in midstance, with the stance-side innominate being higher ipsilaterally than the contralateral side. At this gait phase, the ipsilateral femur will adduct and internally rotate. But what happens if you lack the ability to attain I'M GLAD YOU ASKED!!!!! If I can't adduct, the femur will aggressively abduct, causing the pelvis and trunk to sway ipsilaterally away from midline; hence the waddle: [caption id="attachment_13232" align="alignnone" width="810"] Waddling = you can't get into midstance, fam![/caption] Your solution to this problem is twofold: drive frontal plane shifting and pronation. A great move to achieve this goal would be the table side stride or any type of Sum up Gait involves the sacrum rotating around the stance leg, with an ipsilateral frontal plane shift midway through. Reduced external rotation-based measures respond well to activities mimicking initial contact and propulsionl internal rotation loss often improves with midstance activities. Waddling gait patterns indicate a loss of midstance mechanics. Photo by from
info_outline The Difference Between Spinal and Pelvic Motion 12/05/2020
The Difference Between Spinal and Pelvic Motion Your tuck isn't what you think it is You’ve been all excited about teaching everyone to tuck their hips during exercise, then it happens: “Coach, my back HURTS!!!! WTF?!?!” That tucking must be a bunch of bs then, right? FALSE! Many peeps have a markedly difficult time differentiating pelvic motion (aka what is needed during the tuck) vs lumbar flexion (a common compensation seen when tucking). When you “tuck” using the lumbar spine, there is no change in the pelvic floor orientation, reduced leg activity, and increased spinal load, which can be straining on some of your favorite lifts. Want to know the difference and how to make your tuck feel great!? Then check out Movement Debrief Episode 140 below! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class: Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - If you want to deep dive into hip flexion, then you'll need to check this out. Improve your hip flexion like a boss with The is a progression from this. The difference between sacral counternutation and lumbar flexion Question: Hello Big Z!! I hope you are doing well. I have a question I hope you could talk about a little. Could you explain the difference between sacrum counternutation and the lumbar spine/pelvis flexing as a unit? What should be looking at in a client? Is it possible to see the difference? Thank you as always, for all the teaching you do. It does make a huge difference! Watch the answer Answer: The big difference between these two strategies is: Sacral counternutation changes pelvic floor orientation Spinal flexion can occur without changing pelvic floor orientation With sacral counternutation, the posterior pelvic floor concentrically orients, and the anterior pelvic floor eccentrically orients. You will also have a concomitant reduction of lumbar lordosis (some spinal flexion) that is oftentimes uniform. [caption id="attachment_13192" align="aligncenter" width="500"] Counternutation + lumbar flexion = YASSSS[/caption] Visually, when this is performed, you will see a subtle reversal of lumbar lordosis, with minimal hinging at specific segments in the lumbar spine. Counternutation will visually look like superior and inferior pelvic motion. [caption id="attachment_13193" align="alignnone" width="810"] You'll notice that there isn't really any indent in the ab wall as I do this. It's a good thing :)[/caption] We typically do not see this with isolated spinal flexion. Usually, this action occurs as a compensatory strategy when someone cannot alter pelvic floor orientation. [caption id="attachment_13189" align="aligncenter" width="403"] See how I can sweep the pelvis "underneath" me without changing the pelvic floor shape. And yes, your spine will turn green if you do this.[/caption] Instead, the person will typically flex at a particular segment or two within the lumbar spine. You may see one part of the lumbar spine bulge out when someone does this action. Visually, the pelvic will move more in an anterior direction. [caption id="attachment_13194" align="alignnone" width="810"] You'll see my pelvis dips forward, I crunch a bit, and have an overall stack is whack![/caption] This strategy is undesirable because it can increase strain in particular segments in the lumbar spine. The lack of changing pelvic floor orientation will also reduce the contribution of glutes and hamstrings to the movement, as rectus abdominis becomes the predominant tucker. If you are someone who attempted to make your squat more squatty and your back hurt as a consequence, this compensation is a probable reason for it. The solution is to drive more sacral counternutation with your tuck. There are a few different verbal cues that I like which helps attain this position: Back pockets to heels Pubic bone to nose Buttflap to thigh Tuck with abs relaxed If someone is still strugglebus when it comes to this strategy, having them arch their back, then un-arch their back slowly usually will clear this cheat up. Hip pinching at the bottom of a squat Question: I'm struggling with deep hip flexion and it feels like I'm "blocked" or pinched in the front of my hips when I try to sit deep in a squat or at the setup position for a barbell snatch. I noticed when I am good about prepping with your Wall Stride breathing that you gave me, I'm more comfortable in those positions, but it still feels somewhat blocked. It seems that hip flexion issues are complicated, but I wanted to try and make a little sense of it if possible and see if you had any resources. Watch the answer Answer: There are only about 120 degrees of hip flexion available. YET, peeps can squat well into 145 or even 150 degrees. HOW IS THAT EVEN POSSIBLE?!?!!? The answer, folks, is relative motion. As you progress through deeper hip flexion, there is a relative movement at the pelvis, sacral counternutation, that assists in hitting depths beyond what the femuroacetabular joint allows. This concept of relative motion is the same reason you can go fully overhead with your arm, yet only 120 or so degrees of it comes from the glenohumeral joint proper. So-to with the pelvis. Therefore, full thigh to abdomen hip flexion can only occur if the sacrum can counternutate. If this relative motion is absent, pressure will buildup in the anterior portion of the femuroacetabular joint at the end of available hip flexion, often creating a sense of pinching of blocking. The fix? Increase your counternutation skillzzz! I sequence improving sacral counternutation in a 4-step process. The first step is to increase sacral counternutation by working on squat progressions. work great for this. If bilateral counternutation efforts don't do the trick, then you have to begin rotating the sacrum. When I perform hip flexion unilaterally, the sacrum will have to rotate towards the flexed leg. This will present with increased counternutation ipsilaterally relative to a bilateral action. [caption id="attachment_13195" align="aligncenter" width="425"] And the sacrum will turn left![/caption] Performing asymmetrical exercises like are great ways of initiating this process. But sometimes even this movement isn't enough. Now is the time to introduce hip shifting-based exercises to complete the action. An early phase hip shift is more frontal plane in nature, mimicking pelvic position in midstance. The pelvis will appear at an oblique angle (one side higher than the other). is a great choice for this. If you want to push the envelope even further, you'll need to do a full-blown hip shift, actively rotating the sacrum towards the side in question. A is a prime example of this action. If you go through this progression, there's a good chance that your hip flexion will improve, and ought to be less pinchy. Sum up Sacral counternutation involves pelvic floor motion, whereas spinal flexion can occur without this motion. Flexion without sacral counternutation is an inefficient way to demonstrate intra-abdominal pressure. Hip pinching can occur when there is no relative sacral counternutation in deep hip flexion. Drive counternutation and hip shifting to restore this motion.
info_outline Manual Therapy 11/15/2020
Manual Therapy Does manual therapy have a place? Manual therapy is one of the more polarizing topics in the movement world, and no doubt you might wonder if this modality is efficacious for improving pain and/or movement. The evidence on manual therapy in isolation is mixed, but perhaps the modality itself is not the problem. Perhaps the problem is not having a model that can explain the utility of manual therapy, when to use it, and why. With a decision-making model, manual therapy is something that can most definitely fit within the interventions you like. Ready to see how manual therapy can be best applied for your supreme clientele? Then check out Movement Debrief Episode 139 below! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - manual therapy is better than exercise for hip OA. Oops. - They are a big con ed group in my profession. Never taken a class, but they do a lot of research. - These guys do A TON of research on manual therapy. You'll want to check out all the work they've put out. - My mentor Daddy-O Pops himself. He says lots of wise words on how to build a model. - This article overviews the neurophysiological effects of manual therapy. - This paper goes into some of the viscoelastic properties of tissues in relation to manual techniques. - This article gets in the weeds in all the right ways for manual interventions. - This is the team ya boi works with. Finally, a comprehensive model to help peeps in Las Vegas. - A post I did outlining some of my favorite manual techniques - They have quite a few useful ribcage mobilizations. - A great text that has a ton of manual therapy options. - I've heard good things about their manipulation course - Expensive as hell, but a great review of anatomy and a pretty quick technique - Love this very gentle soft tissue technique - A potentially useful way to apply dry needling. - One of the classic places to learn joint mobilizations - His joint mobilizations are great, as movement is involved along with it. Is manual therapy effective? Question: I've been in a "structural integration" training program (aka rolfing), and can't help but notice that some prominent PTs seem to hate any method of manual "myofascial release" or which seems to have an effect on the myofascial matrixes and ease of movement in portions of the body. Why is this? Clearly, people do improve from manual therapy, and while it is not the only answer, and can be better or worse, it seems to be wholly discredited as a pseudoscience, implying merely a placebo effect. But shouldn't there be credence to the case-studies, instead of picking-and-choosing studies with the intent to discredit contrasting strategies? To be frank, it seems like unnecessary bullying, as each professional seems to have a tendency to smack-talk other modalities. In short, do you think manual therapy (increasing "fascial glide") is useless or inefficient, or that they may be a synergy between manual therapy and coached movement? Thank you for what you do. Watch the answer Answer: To say that manual therapy is useless is a bit hyperbole. Although the evidence isn't definitive (what is in our field), there are where it has shown to be effective. In fact, in hip osteoarthritis, manual therapy has been shown to be than exercise (GASP!!!). To completely throw out manual therapy is potentially missing out on a worthwhile treatment that can help your supreme clientele. Chances are, it's likely more than a placebo. There are and viscoelastic changes that can occur because of manual interventions, and there are several other variables that we simply aren't measuring. For me, manual therapy plays a role in my care, with the intent that it is used to change objective tests meaningful to both myself and the patient. There are three specific instances in which I use manual techniques: As a regression from active exercise Symptom management Patient preference If a client cannot achieve the position they need to be successful (e.g. sacral rotation or a full exhale), you can use manual interventions to put them into the position needed, building context so the client can at some point actively get there. [caption id="attachment_13124" align="aligncenter" width="500"] Took me FOREVER to draw this[/caption] I also use manual techniques if someone needs increased symptom relief after exercise. Sometimes, a local input can help reduce symtpoms for a shorter period of time, allowing them to exercise more effectively. Lastly, if a patient wants to be touched, I do not see the harm in getting them the hands on contact. We are social creatures, social grooming is in our DNA, give your surpreme clientele a bit of what they want, then you'll have the buy-in to give them what they need! What manual therapy techniques do I recommend? Question: What types of manual therapy techniques do you most recommend? Watch the answer Answer: There isn't one specific technique that is going to lead to profound results versus others. You have to choose what you are comfortable with executing and which changes relevant objective measures. That said, I discussed some of my most used techniques It's a bit of an older post, but much of the framework remains. There are different methods that I gravitate toward now then in that post. Here is the list: Ribcage and pelvic mobilizations: Some of these I've gotten from PRI, some from , and some I've just made up. Joint Manipulations: Mostly spine and extremities, often for symptom relief and to gain particular ranges of motion. Dry Needling: I don't use often, but I do have some of my population request it. It's quite effective and can be performed fairly quickly Soft tissue mobilization: I've taken ART in the past and which are both my top choices. The former for speed, the latter for those who are a bit more sensitive or acute in symptoms. Sometimes I'll just do some classic manual contact holds. Joint mobilizations: I've grown to appreciate the utility of these techniques more. I'll usually start passively, then glide into a position while the patient peforms the movement with me, and then choose an active exercise to reinforce. The Best Manual Therapy Techniques Question: Do you use manual therapy for example to release posterior lower compression? Watch the answer Answer: Yes. You can see many of the techniques I use in the video, but the major key is to use your hands to "block" the places you don't want air, which forces air to go in the places you oh so desire. Sum Up There is some research to support manual therapy and is particularly effective when applied in a cohesive model There is no specific technique that is better than others Utilize test-retest methods to determine treatment efficacy. Photo by from
info_outline The Essential Gym Equipment 11/08/2020
The Essential Gym Equipment If you want to improve your movement capabilities, is there gym equipment that can help you? If moving better is important to you, you’ve probably wondered what gym equipment would best help me reach that goal? Gym equipment is endless and often gimmicky, so what would the essentials be to get me to where I want to go? Fortunately, you can improve your movement capabilities without much equipment. Being able to position your body with many of the coaching tactics we discussed is the #majorkey That said, there are some equipment pieces that make coaching WAY EASIER. And I’ll tier this for you fine folks based on your budget :) If you are just building a home gym or beefing up your current gym, then check out Movement Debrief Episode 138 below! Watch the video for your viewing pleasure, or listen to the podcast if you can't stand the sight of me :( If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. The best exercise equipment to get Question: Would love to see a video on the best equipment for building a performance/rehab gym in regards to the model you use. Even the brands/model ....safety bar, ramps, hex bar, etc. Answer: To improve movement options, you don't really need a whole lot of equipment. You just have to ensure that you can challenge your body to get into positions it normally struggles with. The hope is then that you are crushing life once that happens. That said, the right piece of equipment can help quite a bit at enhancing both your movement and fitness. Here is a list of stuff I would look into, depending on what your budget is: The home gym essentials - These are essential to improving your depth, which is a critical motion to improve your movement options throughout the body. A heel ramp makes it easier to vertically displace the pelvis. I like the one that my boy Levi Kirkpatrick makes get large. Olympic lifting shoes can also be an alternative, to which The are the best. If you want to save some buck, use books - These are useful to do supported lower body activities and can incorporate rotation through the trunk. Dowel rods work great as well. - These are quite versatile and offer way more loading options than dumbbells. They are much easier to hold for squats as well. - These are adjustable dumbbells that can save you space. - these are great bands that provide versatility in loading for pulldowns and chops. - These bands are great for jumping, chops and lifts, unloading exercises. They rock! - These make any kneeling or inversion-based activities go WAY better. BFR cuffs - These can help provide a great training effect at a fraction of the workload. My favorite brands are , , and . - When you get too strong for bodyweight stuff, this is a must. - I love these for step-ups and more! Gym equipment for a bigger space and a larger budget - Having decline capabilities is a must, as the slight inversion is great for improving your movement options. - A must. It's a great middle-ground between a squat and hinge. - If you are going to be lifting heavy weights, this is a must. If you get a retractable wall mount version, it'll save you space. - These are useful for adjusting the height of your pulls but are also great for grading step-ups, jumps, and everything. - A classic to get jacked. - A great piece of equipment for improving frontal plane mobility, pronation, and gives you tons of variety. You can do hamstring curls, body saws, the possibilities are endless. - Use for pushes, drags, pulls, all types of awesome stuff. - The amount of variety you can get to do with bodyweight stuff is endless with this piece of equipment. - You want something with a hard surface to land on and is adjustable. If you are doing any jumping, this is a must. - Once you've nailed box jumps, hurdle jumps are the next logical progression. - You want something that you can move in multiple directions. - Great for nordic hamstrings and side hangs. Specialty bars - I don't use often because you can accomplish most things with the regular stuff. If I had my choice, , , and would be my top choices. also sounds appealing but I haven't played with it. - Great for resisted sprints, backpedals, and more. The best part is your hands can stay free and move! The best cardio machines that also improve your movement - I love it because you can alternate pushing, pulling, and rotation! - Another great way to drive rotation. - One of the best options to drive frontal plane conditioning. Your ribcage is going to be opened up like cray cray. - Resisted crawling for conditioning? Drivinng all types of thorax rotation? I'm sold. - Although the free-running treadmills are dope, I like the classic ones to drive high incline walks and to run on when they are turned off. If you got the money and space Buy machines. Straight bodybuilder stuff. I love these for the following populations: geriatrics, obese, deconditioned, post-surgical, and variety with peeps who do a lot of free weight work. It's just fun.
info_outline The Healthiest Home Office 11/01/2020
The Healthiest Home Office What is the best home office set up for health and productivity? No doubt your virtual work has increased since COVID began, but should you spend more time sitting, standing, or even on the treadmill as you work? Unsure what equipment is going to keep you healthy, productive, and moving like a BOSS? Surprisingly, there is a TON of debate around what type of desk or sitting recommendation is most effective for health and work output. The winner isn’t clear cut. If you want to beef up your workspace, then Check out Movement Debrief Episode 137 below to learn how. Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This provides an excellent overview on standing and treadmill desk efficacy. - A great studying measuring many standing desk-related variables - The blog through Harvard Medical School provides a great outline around standing desks - If you need to find a solid behavioral optometrist who looks at more than seeing clearly, this is the place. - They have great deals on electronics - She's the behavioral optometrist who I work with - This app helps reduce blue light - This is my favorite thing to hold my books while I read - My favorite headphones (I will likely get the newer version, but the XM3's were fire) - These are a great low budget noise canceling headphones - These are pretty inexpensive earbuds and sound great. - My colleagues swear by this chair. It's comfy as all hell. How to set up your home office Question: Hi Zac! Any chance you can squeeze in some recommendations on home office set up in your next live session? Curious if you have preferences for types of chairs, desks, standing vs sitting. Answer: With this whole COVID thing going on, there is no doubt a lot more remote work to be had, which comes with increased sedentarism. Anything that can be done to offset the lack of movement is going to be quite important. With the increased popularity of stand-up desks, are these worthwhile to invest in? As of right now, the research is mixed. Let's first look at the difference in mobility in comparing three options: sitting, standing, and treadmill desks. By measuring calorie burn in each position, You burn about eight extra calories per hour compared to sitting. Whereas a treadmill desk burns well over 100 extra calories per hour compared to both options. , but the research here is mixed. Though treadmill desks may have you moving more, there doesn't seem to be much difference between sitting and standing. The issue in both of these cases is a lack of movement. No one posture or position for long periods of time is desirable. This may contribute to increased tissue ischemia, and subsequent pain or discomfort. The key is you need to move! My other question was do these desks impact work performance at all? According to the aforementioned systematic review, most typing and mousing activities were not reduced with a standing desk. In fact, one study showed greater task engagement when working at a standing desk for 30-minute bouts. In comparison, a treadmill desk seems to reduce performance in typing, mousing, and other fine motor tasks. One thing that is missing in the literature is can meaningful work be pursued while you are standing or on a treadmill? No one is measuring if the next great American novel can be written well and without interruption on these devices. Or if Zoom calls can be performed while staying on task. We just have a lot of unknowns. Given the current body of literature, and the cost/benefit analysis (standing desks are HELLA expensive), I'm going to sit this one out for right now (HA!). [caption id="attachment_13061" align="aligncenter" width="810"] This is my current desk setup. The dual monitors KILL[/caption] What I would recommend instead is taking periodic breaks as you work. Go out for a walk, do some pushups or kettlebell swings; anything to break up the monotony. The research varies on how long we can focus, so find your sweet spot between 30 and 90 minutes, and get up and move. I go for short walk breaks of 5-15 minutes periodically throughout the day. Stay off screens during this time. You need to rest. If you are sitting, get a chair that's comfortable. I found an old chair that works well for me, but many of my colleagues swear by . When I'm due for a chair, I'll probably go this route. One other thing I would strongly encourage you to get is a separate bigger monitor, especially if you work on a laptop. This has been the biggest game-changer for me productivity-wise. If you have a small screen that you have to focus on for extended periods of time, your eyes will strain WAY more, which can fatigue your eye muscles; especially if you split-screen on your laptop. When you have a bigger monitor, your focus can be a bit more diffuse, which is a huge win. Doing this as well as air casting my movement consults on my TV has significantly reduced the eye strain I used to experience on calls, and I can keep better focus. I would also strongly recommend getting evaluated by a behavioral optometrist. I like . I worked with one in the past when I did , and my reading comprehension was quite a bit better. I also recently met with an with who I will be doing vision therapy to better help my ability to focus on screens. She also updated my prescription to help reduce eye fatigue. Even if you see well, your eyes may not work well together or have other skill deficits. Vision therapy can improve upon these areas. You may also look into and glasses to reduce blue light at night. Also positioning your desk near a window is big, as looking off into the distance periodically can help give your eyes a break from the constant convergence required for screen use. The other thing I would strongly recommend investing in is a good pair of headphones. Preferably ones that have noise-canceling, that way the volume can stay low, and your ears can stay protected. I have two pairs that I use. If I'm not moving around much, The Sony WH100XM3 () is amazing. Best noise canceling in da game. [caption id="attachment_13063" align="aligncenter" width="451"] Plus you look like a cool DJ on calls[/caption] If I have to move around for a call, they suck to demo exercises in. That's where a lot and can't do the ear coverage, the are my go-to. If you are someone who has to read a lot for your job, and you don't want to hold onto a big textbook, I strongly encourage that you get a bookstand. I like the brand. Sum up There is minimal activity or productivity differences between all desk types; movement is the key. Using a big monitor and glasses can reduce eye strain Use noise-canceling headphones to reduce ear strain Image by from
info_outline Incorporating Breathing into Training 10/17/2020
Incorporating Breathing into Training Struggle knowing where breathwork fits? You might be head over heels for all things breathing, but what if your clients aren’t? Maybe you are the person who struggles to get buy-in to breathing-based exercises? Or you are unsure where to put it into training. Or maybe you are looking for sneaky ways to incorporate the principles WITHOUT YOUR CLIENTS EVEN KNOWING. The biggest error peeps make incorporating breathwork into training is making it something separate. In fact, looking at movement in this fashion is an all-encompassing model. Following principles that go BEYOND BREATHING is a major key. Don’t worry folks, we will go over those principles, and make it SUPER EASY to get your clients all the benefits with less pushback. Check out Movement Debrief Episode 136 below to learn how. Watch the video below for viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This post outlines one of the most fundamental moves I teach clients - The place I work in Las Vegas - All things upper airway, this is THE podcast Increasing breathing buy-in Question: I know we talk about when working with a person on breathing, to have them breathe out for 15 seconds or think about blowing out a bunch of candles. But in pursuit of progression or keeping a client motivated and not bored. What do you find is a good standard to move them to the next progression (pullover to hanging breathing into a balloon)? Is it, you see them able to get abs immediately or are you looking for, say 3 sets of good position and breathing, everything? Is it table tests and you retest and find improved movement? Getting someone to breathe right can be slow and monotonous, so how can a professional present the roadmap of progression for a client buy-in? Watch the answer Answer: The biggest error most people make when attempting to is to make breathing something different than regular training. It's not. The positions coached during breathing exercises are fundamental components used during training. Think of them as regressions from skills you want clients to be able to perform. For example, a chair and wall tilt looks a lot like the squat when you tilt it right side up. [caption id="attachment_13032" align="alignnone" width="810"] Only with the highest levels of innovation and technology could a visual like this be created[/caption] Well, consider if you can't get into the positions we need you to on your back. How well do you think the squat will go? You probably won't die (except that one time), but you won't get all that you could from the movement. The low-level breathing positions help set the stage for the rest of the training program. They build context for what you need to do at higher intensities. It's just like if you wanted to play Stairway to Heaven on the guitar, you have to learn to put chords together first. So-to with training. Breathing is the chords, and if you get good at it, you'll be Jimmy Page in no time! And if you do them right, many times your clients will get smoked and have a HUGE training effect from them. I can't tell you the number of times when people get on point how cooked their hamstrings, glutes, and abs will become; key areas that will likely resonate with your clients. If your gen pop client gets the association that these moves build my glutes and abs, then you've won. Ideally, the concept taught in the breathing move would carry over elsewhere to training. So you should see a relative "stack" in most activities your clients perform. In terms of when you focus on different movement qualities, seeing test changes can guide your next focus area. In PT-land, these can change weekly to biweekly. If I'm training someone, it might be every block change. Now that doesn't mean that if your client can't stack that they aren't allowed to get off the ground. You may just modify your exercise selection to things with a lower error risk. Most people can do iso holds, med ball throws, sled push/pulls, and upper body movements in the sitting position. Select activities with the lowest error risk. Now I get it, you will have those clients who just won't be about getting on their back and breathing at all. We all have them. For those peeps, you may just consider working on tucking to "work the glutes and hamstrings" (tell them this because that will better resonate with them) and coaching loaded exercises as best as possible. Just like the above client who doesn't move well, choose moves that your client will be able to perform with fewer coaching requirements. The best part? Your clients will still be breathing while they train, so you can still get some good movement benefits. Where should I put resets in the training program? Question: Is there any value to inserting "movement restorative" exercises/positions in between reset breathing sets to facilitate or further drive the resetting process? I ask, especially when in coaching breathing to start the session, sometimes the clients are geared up to get into a movement - either from being stimulated to get the work going or from a stressful meeting, etc., so I see the struggle to maintain a degree of focus in accomplishing the reset work. Watch the answer Answer: Totally! A lot of involves sneaking in these moves during the rest periods for clients. It'll save them time, keep them loose, work on the movement qualities they need, and potentially enhance recovery. Aside from choosing the particular resets, they need to work on specific limitations, you can choose activities that will complement the areas being trained. For example, if someone is doing some heavy upper body stuff, could be effective at increasing motion in the upper body. Or if you have someone squatting, may enhance depth by reinforcing the positions needed on the squat. Conditioning for different infrasternal angles? Question: Would certain types of cardio benefit one postural archetype more than another? If I’m working with a compressed a-p person and a wide ISA person with the same goals, would your cardio choices differ? Watch the answer Answer: In a perfect world with unlimited equipment, absolutely. Just like we can pick loaded exercises to reinforce particular movements, this doesn't change whatsoever for conditioning tools. For example, certain cardio machines may be effective for driving particular movement adaptations: Versaclimber: Increase ISA dynamics and frontal plane pelvis mechanics Jacob's ladder: Improve spinal rotation Elliptical: Improve spinal rotation Airdyne (high seat): Improve spinal rotation with an external rotation bias Airdyne (low seat): Improve spinal rotation with an internal rotation bias Rowing: Improve squat mechanics Sled drags: eccentrically bias posterior ventral cavity. Slideboard: Improve frontal plane hip and ankle motion The options here are limitless, but if you lack the equipment, you might not be able to be that specific. Don't worry, your client won't be doomed to movement failure, there are a myriad amount of other benefits you can get from cardiovascular work aside from movement skills. Regarding specific energy system adaptation, it depends on what task we are trying to improve. If in the early stages of training, I may bias more cardiac output or extensive tempo intervals; both to build work capacity and because aerobic exercise may enhance learning. From there, it depends on your client's goals. If hiking is the prime target, high-intensity continuous training may be a great choice. If they need to be faster for a sport, you may do speed work. As with anything, look at the demands needed of the terminal task, your client's movement, and physiological capabilities, and give them what they don't have. Sum up Breathing is not a special part of training; the positions are taught as components needed for more challenging movements Breathing exercises can be used to increase motion or to maintain motion potentially lost from challenging moves Conditioning exercises can be chosen to improve motions needed for longer durations.
info_outline Airway Dentistry with Dr. Brian Hockel 10/14/2020
Airway Dentistry with Dr. Brian Hockel How a dentist can improve your sleep, breathing, and more If you have perfect sleep, NEVER mouth breathe, and have excellent tongue posture, then you can skip this post. But if you are like the rest of us, no doubt you or your clients struggle in one or many of these areas. What if all of these issues were related to the structure of your mouth? That’s why I interviewed , a dentist who I work with personally, and a leading expert in the field of dentistry and airway orthodontics. [caption id="attachment_12956" align="aligncenter" width="600"] The legend![/caption] In this podcast, you’ll learn: How facial structure can impact breathing and tongue position Why a CPAP doesn’t really fix sleep apnea How a well-trained dentist can improve mouth position to enhance your sleep and breathing How occlusion, tooth contact, may not be the exact science that people make it out to be What you need to look for to find a dentist who can best help your sleep and breathing If the health of your airway is important to you and you want to get your sleep on fleek, then you need to check out this interview. You can watch the interview Learn more about Dr. Brian Hockel His website: His practice is located in Walnut Creek, CA 64598. Bio As a graduate of the University of California, San Francisco, School of Dentistry in 1989, Dr. Hockel is a general dentist in private practice with a focus on orthodontics that aims to prevent or treat airway problems like sleep apnea. He aims for more permanent solutions to Airway-Friendly Smiles, going beyond the dental oral appliance approach, often having to reverse previous orthodontic treatments. He has lectured nationally and internationally on topics of facial growth guidance, orthotropic, and airway orthodontics, and is an orthodontic instructor for the Academy of Airway and Gnathologic Orthopedics (AAGO). He is also co-founder of the Team Airway Study Club, a co-founder and board member of the North American Association of Facial Orthotropics, and a board member of the AAGO. Show notes Here are links to things mentioned in the interview: - He is our mutual physical therapy colleague, and a dear friend. - A lightwire appliance that is often used when there is cranial dysfunction present - An appliance that aims to expand the palate in multiple directions. It's akin to the Invisalign of palatal expansion - An appliance that is used for sagittal palate expansion - A neat study that positively affected PTSD symptoms by targeting sleep. - If you have never heard of UARS, then this is a must-read - An excellent in-depth article on all things bruxism, grinding, clenching, and more. Modified Transcripts The difference between conventional dentistry and airway dentistry Dr. Hockel: I think a lot of it has to do with the understanding of how we get to where we are and what the underlying causes are of some of the problems that we're dealing with. And then the connections to what we're doing in the orthodontic world, the orthopedic world. By that I mean if you understand that our growth really affects our function, especially of the airway but certainly of the jaw joints and of the bite, how those relate to each other? if someone says “we are the way we are because of our genes; we're just going to grow.” “This is a set shape to the skull, a set position for the jaws and it is what it is and make the teeth fit within that confine of the skeleton.” That's going to lead you to a very definite approach in orthodontics. As opposed to the belief that the way we posture our mouths and the way we use the muscles of our mouth and head and neck, that's going to affect how our face grows at a young age. Then as an adult, it's going to affect the function of the airway, again of the joints and that maybe if we look for the underlying causes and address them, we can have other successes beyond just getting the teeth to fit. So it's looking beyond how the teeth fit together and looking at the overall structure; jaws, airway. It turns out that the roof of the mouth is the floor of the nose. The nasal airways are our next-door neighbor that way going up and the oropharyngeal airway is right behind the tongue. We're always looking at the back of the throat but we don't recognize that that's where the air has to go to be able to breathe. So there are neighbors in the dental world and it turns out that the things we do affect them. Zac: It's a lot more than making a pretty smile in terms of the impact that you can have on someone's health and well-being. What kind of implications or negative things have you seen from people who don't respect that? We've spoken before having this conversation about some people who are just doing retractable orthodontics which maybe you can talk about. They're just pulling teeth so things can fit and the smile can look nice. What are some of the implications of not taking into consideration the structure of the face? Dr. Hockel: It might be an overstatement to say that most orthodontists are focused on just making the teeth pretty because obviously there's a lot of science that goes into how we try to make the teeth fit. Jaw joints and even airway are in the conversation, though the latter seems to be lip service. The best way to answer your question would be to use a term that was coined by in Southern California, he calls it ERRS (extraction retraction regret syndrome). He purposely called it errs because it's based on the answer to your question, what are the errors that we've been forced to live with? The first is kind of an aesthetic one where people don't like the way they look and with a lot of traditional orthodontics. There's a feeling like maybe the teeth are further back in the face than they should be or the lips seem sunken in or thin. There might be a feeling like the face has lengthened after orthodontic treatment has been done. Then there's the whole functional side and this includes, both the airway and the jaw joints and also includes the bite, of course, the way the teeth fit together can be affected by that. How we chew and how we breathe, they can go hand in hand. If you bring teeth too far back in the face, the tongue doesn't have enough room, the chewing motions of the jaws can be affected and of course, the dimensions of the oropharyngeal airway can be affected. People who live with this for a long time and have been told this or that thing is all in your head and you just need to learn to deal with that. [caption id="attachment_12855" align="alignnone" width="810"] How embarassing[/caption] We who work in the orthodontic profession may be saying your bite is fine, everything fits together, it meets every possible standard that or criteria that I could have treated it to. So whatever you're not happy with, it's not what I did and maybe I did treat to the best standard of care that's out there. But we're learning now that there are things beyond what we've been held to and by ourselves and others and what we try to achieve that have really profound and far-reaching effects that we weren't even aware of. Zac: I mean you just think of this area of the body, you have most of your sensory systems there. There’s a lot of prime real estate that could potentially be influenced in one direction or the other. It's intriguing that you're saying the wide-ranging effects that can happen on this. I remember I read years ago about people who had PTSD. They put an appliance in the person's mouth as treatment in this randomized control trial and it had a profound impact on symptoms. We can have large substantial changes on someone's health and well-being by affecting this area of the body in the way that you're talking about. Now you weren't always into the airway side of things so in your career what led to you appreciating this side of dentistry more? Dr. Hockel: I think it was contact with doctors like Bill Hang and . John Mew is an orthodontist in the UK who for many years developed treatments that were based on what he called the tropic premise. That was the belief that the jaws are going to grow to the position that they most commonly adopt, so keep your jaws closed, pointed forward they're going to grow forward. Keep them apart, pointed away from each other they're going to grow away from each other. It turns out that the treatments he was doing to get the face to grow to what was a better proportion, more aesthetically pleasing result; it was also making a difference with the airway. Initially, he didn't really even realize this so he's one of these people that looked at the results of what he was doing and actually saw something really good. There were a lot of us that looked at the results of what we were doing with more traditional methods and saw that we weren't doing things that were good. Bill Hang, who I already mentioned, is probably the biggest influence on how I’ve been able to connect the dots between the airway and what we do in the orthodontic and orthopedic world. I thought I had every answer that I needed at one point and I suppose sometimes we get that state of pride in our careers. At first it can be unnerving to learn something new but then you can get to a point where you're kind of in a zone, you feel comfortable and I felt like I had a tool to treat pretty much every type of bite problem that I could come across. It was right then that Bill Hang dropped into my life and taught me to look at things in a very different way that included growth direction, growth guidance, developing more space for the tongue, looking at the oral posture. Especially looking at what was happening with the airway and how things affected that. Like most of the people who've heard Bill Hang, there was some of it that I readily accepted and other things I was skeptical about. I had to go home and think “I don't know if he's really right about what he says about the ” for example. I’m going to go home and look at my cases a little more critically and I just shook my head as he was right. There were things going on that I didn't want to have going on right under my nose because I wasn't paying attention to it. So now my attitude is “just don't cause any harm, don't do anything that's going to make anything worse.” “And if you're doing something that has made other people worse and you're not sure if it's going to make this person in front of you worse, just don't do it,” it's the safest thing to do. Zac: Yeah and I imagine too if you're not taking into consideration things like oral posture airway and things like that just because of how important respiration is. You could have wide-ranging effects of doing harm that you didn't know you were doing. Dr. Hockel: Right or at least miss the opportunity to do good, to me that's just as bad; if I had an opportunity to do something a lot better for someone and I missed the chance, I don't like that. Zac: Was that hard for you to have that kind of paradigm shift? Dr. Hockel: Yeah my wife would tell you, I was in a very difficult mental state during those years. It was a big paradigm shift and very emotional and around that time we had a lot of little kids around the house. It’s hard to realize your professional foundation isn’t as solid as you thought it was. I knew however, that I needed to keep growing and learning; not being foolish to where I thought I knew it all. Zac: Yeah, that's when you know you need to retire or quit. What types of patients would benefit from airway orthodontics Dr. Hockel: I think the people that search me out know that there are important ramifications of the types of treatment we do in orthodontics and in growth guidance. And they don't want something bad to happen to their kids or they're an adult that has already seen something that happened to themselves. We talked about extraction retraction regret syndrome and there's either an emotional component or an aesthetic component, more often I see the functional component. People will come wanting to know what they can do to improve their situation as an adult and some of them might come very bitter about what was done with them in orthodontics. It's unfortunate because the person who treated them was only treating what the standard of care was at that time and they probably did a very good job. [caption id="attachment_13014" align="alignnone" width="500"] Making kids unhappy in more ways than one since 1960 (Photo credit: )[/caption] I don't see too many people who were treated by an orthodontist who did a bad job; they were just doing it with a very different philosophy of how to treat and why to treat. So there are the moms with the kids that want them to grow right, that's a group of people who have young kids and they want to catch them as early as possible. The earlier we get to kids the better. I’d rather get kids at six days old and talk to the parents at that point. Make sure there's no tongue tie, make sure you're breastfeeding as long as you can, try to switch to solid food as early as you can, and the whole concept of baby-led weaning. Take away bottles, pacifiers, and sippy cups. So it's not classic orthodontics to talk to a parent about their child when they're that young. And yet, if they follow what advice I’m giving them, it can help minimize what I might have to do later on. I think the goal would be for us to really find as far upstream as we can go to find the causes that can be addressed so that we don't have to treat them at the stage where we are. Even at age four and five when I’m treating a child that young in a way, it'd be better if I could have got them earlier. Tongue ties Zac: It seems like even the concept of having your child have a tongue-tie release is very controversial. I read stuff on the internet all the time where it's like “oh, we don't need to do that” and it's unfortunate because it can definitely negatively impact things like breastfeeding and things of that nature. Let's say I have a kid and I say “Dr. Hockel, do unto this child what we can do to minimize any negative effects,” where would you start? Dr. Hockel: Well those things that I just tossed off a little bit of a list when they handed me that little scissors to cut the umbilical cord in the delivery room for my kids. I look back on it now and think I probably should have just looked around like lifted their tongue going “okay, I’ll just do that first! Tongue ties can affect speech and growth. When they’re really bad and a lactation consultant picks it up and says you're not able to breastfeed because of the tongue tie, they deal with it. Or if a speech pathologist says your child can't make those sounds because he's tongue-tied, they deal with it. But there's a wide range of restricted mobility of the tongue that can come before you ever have any of those kinds of troubles and it does affect the tongue posture. There's research that's being done now by but it’s going to take time to build the evidence body. at Stanford that when you have a tongue tie, there's a correlation with narrow palates, and it kind of makes sense, it’s common sense. The tongue is the scaffold of the palate so if it isn't able to posture up against the palate, how is it going to grow wide and up and forward? It's going to tend to be narrow and down and back. While we cannot expect adults who get a tongue tie release to grow differently, we do know that the muscles of the head and neck can be in better balance with good oral posture. I’m not an expert in cranial osteopathy but I’m told that the cranial bone and the balance of how they fit together and move, you know cranial bones move right? [caption id="attachment_12694" align="aligncenter" width="329"] Now I got the loosest tongue in the game...wait....[/caption] Zac: Haha yes I do! Dr. Hockel: Some adults will report some wide-ranging improvements of symptoms and you got to be careful about that. Because they'll tell their story on the internet and somebody else thinks “oh if I go get my tongue-tie release, all my troubles are going to go away.” It is controversial probably because there's such a wide range of techniques in doing it. Back in the day, I got my laser in 1999 and I thought “oh, there's a tongue-tie, I’ll just release that tongue-tie with my laser” and it's like getting a lightsaber on Star Wars. There's no bleeding and all of a sudden the tongue can just elevate really easily. Mainly, all I was treating was that flap of tissue on the outside not knowing that there were deeper fibers that of fascia or even the mylohyoid going deeper that needed to be dealt with. Then the scar tissue would come because I wasn't having them do exercises afterward and the scar tissue ends up restricting the tongue down even more than it was before. Doing it the wrong way is oftentimes going to make things worse and not any better at all so the data points that people have to compare to are very limited. The unfortunate thing is we currently lack a body of knowledge out there of training. It's changing slowly because people know improvement when they feel it. You can't put an idea in somebody's head that effectively after I do this all of a sudden you're just going to imagine that you have a tension release in your whole head and neck area. They're going to tell you stuff like that or you see a child who has a tongue tie and you get a certain growth direction improvement. Then don't treat the tongue tie and you see the growth direction tend to drop back, that's kind of the lost opportunity side of it. You want to get everything going in your favor for optimal mouth posture. Facial underdevelopment Zac: Now if you have someone who was breastfed, had a tongue tie release, did myofunctional therapy, addressed nasal patency, do you see a reduced need for orthodontic services down the line? Or do you think that our altered cranial shapes are generational? Dr. Hockel: If I had seen that happen here or there, that's such a small number of patients, it's really anecdotal and there's confirmation bias. I’m not sure how valuable that would be, I do know that I see patients who were breastfed very early on and their parents follow Westin Price. They feed them really well and try to avoid sugar and stuff, they avoid bottles and pacifiers, avoid milk, avoid wheat and they seem to be doing all the right things. Yet there are still issues there so there's so much that we don't understand about it. I feel like we're just at the tip of an iceberg and we're doing our best, we know certain things do affect it and we're trying to change those but we don't know everything. I can sympathize with the mother who says that “I’ve done all this, what else do I need to do?” Well, sell everything you own, give it to the poor and then maybe… I don't know. Zac: It's hard, especially in health and wellness. You want people to do everything right. They eat healthily, they're sleeping and they're doing all of this, but sometimes there are genetic factors, epigenetic factors, and exposomal factors outside of your control that are the rate-limiting steps. It's unfortunate. But life's not fair either so I get that. Airway orthodontics for children Dr. Hockel: can be used for kids in a particular age range. There’s a narrow window because orthotropics is growth guidance, and if you're trying to guide growth you need growth to be able to guide. There are actually a couple of different windows where you can do it but for practical reasons, it tends to be a better fit somewhere in the 7-10 age range. In England, they'll say eight is too late, but in America, we tend to do it at nine or ten as well. The older you get, the less growth...
info_outline Squat and Deadlift Details 10/10/2020
Squat and Deadlift Details Minor tweaks in the squat and deadlift for MAJOR results Sure, you got the broad concepts of squatting and deadlifting down, but what about some of the nitty-gritty details? You know, the finer things. Have you wondered if… Buttwinking is safe or will it break you? There’s a way to build squat depth in someone with SUPER STIFF hips? Mixed grip deadlifting can create changes within the body? For each of these questions, various principles we’ve discussed in the past play a role. In some cases, buttwink may be a normal component of the squat. Attacking hip mobility in a specific order may better help improve squat depth Mixed grip deadlifting can be GREAT for improving rotational capabilities. Let’s fine-tune these wonderful movements to get the most out of them. Check out Movement Debrief Episode 135 below. Watch the video below for your viewing pleasure If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55 pm!) (Early bird ends July 18th at 11:55 pm!) (Early bird ends August 22nd at 11:55 pm) (Early bird ends October 3rd at 11:55 pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This article outlines spinal mechanics during back squatting, implicating that the lumbar spine becomes kyphotic during the movement. - This provides an evidence overview on whether or not spinal flexion is a safe position. It's a close to a diss track as we will get in rehab. - This book takes a completely different look at the function of the spine as a mobile area, not a stiff supporting structure. The research presented in this is quite profound. - The infrasternal angle dictates we should focus on certain limitations in some people, others in those who are built differently. This debrief provides the guide. - This ramp is the best in the biz to improve your ability to squat deep. I coach all my clients on this ramp. - This is the spot that I work at in Las Vegas. We've built a cool model because we integrate several disciplines to help our clients reach their goals like whoa! - This article mentions how trunk lean changes depending on what shoes you wear. - This article looks at how different our ribcage and ilial shapes are. Butt wink during squats Question: Quick question about squatting. I know the stack is important but what are your thoughts on “butt wink” especially when loaded? I'm not sure if I'm getting a good view here but it looks like some lower lumbar flexion at the bottom. I know Stuart McGill is big time against this and has his research with loaded posterior pelvic tilts which caused a lot of pain. So I just wanted some clarification or some perspective if you have the time! Watch the answer Answer: Ahh that dreaded butt wink. A wink that catches your eye in all the wrong ways. But is it a bad thing? For those who do not know, the butt wink is when you have what appears to be a dramatic posterior pelvic tilt at the bottom of the squat. It looks like The buttwink is most commonly seen on the back squat, although can be seen on other squat variations as well. Ideally, a along with maximal sacral counternutation. While there isn't much research I could find that looked at exactly what is biomechanically happening with a buttwink. I hypothesize that it is likely increased lumbar flexion that occurs at the sticking point of the squat in order to attain depth and increase verticality. Sacral counternutation is subtle, lumbar flexion is dramatic. The reason why the buttwink is most common in back squats has to do with bar placement. The bar position on the back pushes the thoracic spine forward, increasing extension. Since the thoracic spine and sacrum have matching curvatures, there is likely an increase in sacral nutation at the starting position. This position is likely why the back squat is a tad more hinge-y than other variations. However, you still have to hit depth, fam. So if counternutation is HELLA tough because of the starting position, I can create vertical pelvic displacement by flexing the lumbar spine. In fact, we see this in As soon as a barbell goes on the back, the lumbar spine becomes kyphotic. Totally out of your control, and these authors argue doing the converse may negatively impact squat performance. SORRY!!!!! These thoughts lead me to believe that buttwink during a back squat is likely normal (GASP). But wait, isn't spinal flexion bad?!?!?!?!?!?! [caption id="attachment_12998" align="alignnone" width="810"] And they turn red too when they hurt right??!?!?! (photo credit: )[/caption] We really don't know. While there are some in vitro experiments demonstrating flexion being bad for the discs, in vivo research does not seem to demonstrate any issues with loaded flexon whatsoever (I deep dived into this topic ). However, there aren't really any in vivo studies looking at lifting heavy loads with lumbar flexion. Does that mean McGill and flexion-phobia win??? NOT NECESSARILY Reading (and the studies within this great book) has really made me realize just how controversial and unclear the in vitro studies on spinal health are. According to research in this book, it appears as though compression (as we notice with axial loading) is not necessarily sufficient for disc or spinal injury. In fact, inducing some lumbar flexion with lifting may better allow us to recruit thoracolumbar fascia and posterior ligamentous structures to assist in lifting heavy ass weights! Muscles alone, especially the erector spinae, cannot produce sufficient force to move the weights we are trying to lift when it comes to back squatting. Therefore, recruiting other tissues to assist in the lift is ESSENTIAL. We may only be able to lift maximally with some degree of spinal flexion, which can be attained via a posterior pelvic tilt. I would argue then tucking to some degree is not only safe but likely required to squat well. The buttwink is the body's best way to attain that position given the constraints the back squat provides. Ideally, we ought to see less buttwink in anteriorly loaded squat variations, as these exercises allow for better verticality and place the sacrum in less nutation. For these moves, tuck with reckless abandon, with a caveat! Ideally, you want the tuck to occur predominately in the sacrum to enhance squat verticality. If you overflex at the lumbar spine, the pelvis will translate forward and be anterior relative to the thorax. This translate into: UHHH FAM, YOU CAN'T STACK I've been emphasizing this subtle change over the last month, and anecdotally the clients that both and I work with have noticed favorable changes. Tucking with the lumbar spine was likely the issue I had made with a lot of the heavy lifting bros who ended up getting some back discomfort when they tried to "tuck" on their squats. The problem was they couldn't get the tuck through the pelvis, then they loaded their spine in a position that they weren't well adapted to, and problems ensued. (My fault, fam). Making the movement more sacral (think tailbone pulled to the ground), would likely change the response these peeps had to the squat. Squatting deep with restricted hips Question: If someone is clearly a better hinger than a squatter, has only 5 degrees hip IR, and also limited hip ER, which would you attack first? I know you said if you go after primary compensation first interventions can be less successful, so I want to make sure I get this right from the start. Watch the answer Answer: Building the squat is WAY important, as being able to hit it @$$ to Gra$$ is an expression of being able to eccentrically orient the posterior aspect of your body. Yet, one of the hardest peeps to get the squat on point with is those who have multidirectional hip limitations. It's especially tough because the So what to do? I'M GLAD YOU ASKED! The first starting point to determine the order of operation is the The ISA will help you determine whether the internal or external rotation loss is . Secondary compensations ought to be Secondary compensations are as follows for each ISA: Narrow ISA: Decreased external rotation Wide ISA: Decreased internal rotation If you want to increase external rotation, you have to target posterior expansion. High or low depth hip flexion activities are money. A simple could be a good starting point. Internal rotation restrictions require anterior expansion to occur. For this, you are either looking at mid-range hip flexion exercises or If you want to target both internal AND external rotation limitations simultaneously, are absolutely money. The reason being is because gravity will push the viscera downward, letting the goods do the pelvic expansion for you! Hip shifting can also be quite effective at driving anteroposterior pelvic expansion. Hip shifting is merely pelvic rotation, which requires both anterior and posterior expansion. When you hip shift to the left, you will get left posterior expansion and right anterior expansion. is great for that. Make sure you stack before you shift though fam, otherwise it'll fail miserably. Lastly, once you've ironed out the movement restrictions, you should probably practice squatting. To make your squats EASY AF, I would strongly recommend How do mixed grip deadlifts influence movement? Question: Would lots of exposure to HEAVY mixed grip deadlifts influence the infrasternal angle (ISA) over time? I have a few clients with asymmetrical ISA (wide right, narrow left) who are strong (200kg+ deadlifts) and they all historically have opted for right hand supinated, left pronated especially for near-maxes. I guess it could be a chicken-egg situation where they opt for that strategy based on structural constraints, or the structure is re-inforced by that strategy? Watch the answer Answer: We don't have any studies to demonstrate if the infrasternal angle (ISA) can be changed with particular activities, or if a particular ISA biases someone towards certain activities. We must also factor in that some asymmetry within the ISA is normal secondary to our asymmetrical organ anatomy. Interestingly enough though, I think we can see some links between the asymmetrical ISA listed above and the preferential grip. Asymmetry in ISA presentation is likely due to spinal sidebending. In the above case, the spine would have a leftward sidebend through the thorax. Though not perfect and differ within a few factors (sagittal plane orientation, rotational center, etc), Fryette's laws would dictate that sidebending and contralateral rotation are paired mechanics in the thoracic spine (Type I mechanics). as organ asymmetry creates a rightward spinal rotation in this region. Guess what folks??? A supinated right arm and pronated right arm would also rotate the spine to the right. I would argue this grip is likely favoring the normal asymmetry that is present in us all. To offset this asymmetrical presentation (especially if movement options are lost), activities that rotate the spine left can be quite helpful. Aside from switching your deadlift grip up from time to time, would be a prime example. Sum up Butt wink involves lumbar flexion to help attain a vertical position during squatting and in some variations (i.e. back squats) is normal. Improve squat depth by addressing secondary compensations first, working on anteroposterior pelvic expansion, and squatting Asymmetry in the infrasternal angle is normal, and may contribute to preferences in deadlift grip per Fryette's Laws of spinal mechanics. Photo credits
info_outline How to Improve Shoulder Internal Rotation 10/04/2020
How to Improve Shoulder Internal Rotation Losing internal rotation may not be a shoulder problem If you’ve been told you have GIRD, a forward head posture, or you slouch with reckless abandon, read on! These issues are often linked to reduced shoulder internal rotation; a motion necessary for throwing, pressing overhead and reaching behind your back. So the fix is to sleeper stretch and then the angels will sing right?!?!?!? I was young. I needed the work! Uhh….no fam! Instead, your whack shoulder motion can be profoundly influenced by altering dynamics within the ribcage. The ribcage forms the base for your shoulder girdle. If you can’t move the foundation the way you want to, then you won’t be moving your shoulders the way you want to. Ready to figure out assessing AND improving this important motion you and your clients NEED? Then check out Movement Debrief Episode 134 below. Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video . are some testimonials for the class Want to sign up? Click on the following locations below: (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 25th at 11:55pm!) (Early bird ends July 18th at 11:55pm!) (Early bird ends August 22nd at 11:55pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] (POSTPONED DUE TO COVID-19) Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Learn all things infrasternal angle with this post - This post dives into which compensations you should focus on first. -You will learn all things upper airway when you dive into this post. - Want to learn how a dentist can improve your sleep, forward head posture, and more? Then this post is a must-read. - Learn how the scapula and humerus move during each phase of shoulder flexion. - Here we discuss the best ways to improve mobility in the uppermost segments of the anterior chest wall. Rounded shoulders and shoulder internal rotation Question: How do I improve my shoulder internal rotation, and by that I mean dealing with shoulders that have rolled forward and not budging no matter what drill I try? Watch the answer Answer: For visual reference, we are going to assume in this case the person in question has a depressed anterior chest, increased hinge in the thoracic spine leading to the appearance (not necessarily actual) of increased kyphosis, and a forward head position. See the picture below for reference: [caption id="attachment_12963" align="alignnone" width="810"] Notice how the ear is head of the shoulders, the scapulae are rounded forward, and the humerus appears internally rotated (thumbs are pointing inward is the tell). Or were you just staring at my booty??? MY EYES ARE UP HERE![/caption] While there are several variations to this position (which will influence testing) and "causes," the axial skeleton change that puts someone into this orientation is a concentric anterior thorax. This would be synonymous with a down pump handle or an inhaled axial orientation. The sequence of the anterior thorax becoming concentrically oriented has an end result in decreased shoulder internal rotation. Here's how the sequence happens: Concentric anterior thorax pulls shoulder blades forward (scapular abduction and internal rotation) Humerus externally rotates to position arm back to center (concentric external rotation). Humeral external rotation bias causes decreased humeral internal rotation [caption id="attachment_12964" align="alignnone" width="810"] Anterior thorax concentric, scapular IR, humeral ER = Decreased shoulder internal rotation[/caption] Before we go into what to do about it, it's SUPER TOUGH and likely unnecessary to sweat changing static posture for a few different reasons: Postural presentations have structural influence. You can only change how you look insofar as your structure allows. We aren't static creatures, we move. It is more important to be able to change into several different postures Sustaining any singular position for too long is undesirable. Lack of motion leads to tissue ischemia and problems With that in mind, let's first look at what we need to do to improve the dynamics of this presentation. Thorax treatment for rounded shoulders The first line of defense should be to improve thorax movement options and shape. If the pump handle is down, we need to raise it up like Josh Groban! To improve movement in this region, the best choice is to do one of the following: Reach between 60-120° of shoulder flexion Drive shoulder extension and scapular retraction Exercise choice will depend on which (ISA) you are dealing with, as this changes the "cause" of this position. Narrow ISA: concentric anterior thorax is due to skeletal structure () Wide ISA: concentric anterior thorax is a secondary compensation. Therefore, what you go after changes with each presentation. For the narrow ISA, you need to restore structural dynamics to elicit a change. A narrow ISA has reduced lateral ribcage dimensions, so you need to do things to expand that. can be useful in this regard. If we did the above move to a wide ISA, who has increased lateral ribcage dimensions, this would not be the best choice to improve ribcage dynamics. If you , the serratus anterior will aid in lateral ribcage compression. Once you've got these moves on point, and need to clean up the last bit, can drive more air in the front. Cervicocranial treatment for rounded shoulders Now I would be remiss to say there aren't upper airway influences to this bias. Rounded shoulders are often associated with a forward head posture. A forward head posture can be a compensatory action for the inability to nasal breathe: You can't breathe through your nose for whatever reason Tongue posture sits low to open the oral airway Forward head posture occurs to increase airway size Depressed hyoid position occurs Now, diving into ALL the possible treatments goes beyond this post, but can play a major role in improving dynamics in this region. The two major keys you will need to focus on will be: Attaining a palatal tongue posture Elevating the hyoid For palatal tongue posture, this involves placing the tongue on the roof of the mouth and holding it there. Simply working on can improve this position. If you want to get ya hyoid up, son, then you need to get your swallow on point! is an excellent drill to focus on this limitation. Exercises for shoulder internal rotation Question: If someone is missing shoulder IR, how do you decide if you load an exercise either in the suitcase/low hold position or the goblet position Watch the answer Answer: As we mentioned above, shoulder internal rotation restrictions are likely due to a concentric anterior thorax. The treatments (uh, hopefully, you know from above fam!) would be to place your arms in one of the following positions: Reach between 60°-120° of shoulder flexion Drive shoulder extension and scapular retraction The goblet position is roughly between 70°-90° of shoulder flexion, so I think it's pretty easy to see how that can help improve internal rotation, but what about the suitcase position? How do those lovely suitcase carries influence thorax dynamics? I'm glad you asked! The reason why suitcase carries are useful activities has little to do with the weight side. The #majorkey is actually the swing arm. When you swing your arm to and fro, you are driving trunk rotation. Since the weighted arm is minimally moving, it gives your trunk a fixed point to rotate about; making the suitcase carry money for anteroposterior expansion. Where air will go depends on what arm swing position you are dealing with: Arm forward rotates trunk contralaterally Arm backward rotates trunk ipsilaterally The will influence where the air will go: Left rotation: Expansion left posterior and right anterior thorax Right rotation: Expansion right posterior and left anterior thorax Since you'll rotate both directions with the suitcase carry, you'll get a bit of air EVERYWHERE. That's why I coach the suitcase carry If someone has difficulty keeping the stacked position on the suitcase carry, working drills that drive hip extension and humeral extension can prove useful, as these actions will challenge your ability to keep the stack in this move. come to mind. Pec minor strain Question: Can u do something on pec minor strain (right side). Seems to keep recurring every time I perform any chest exercises. Keep up the good work! Watch the answer Answer: First, let's look at the pec minor anatomy. [caption id="attachment_12965" align="alignnone" width="626"] Ain't no muscle finer than pectoralis minor (photo credit: )[/caption] Proximal attachment: ribs 3-5 Distal attachment: coracoid process of the scapula Actions: elevate ribs (pump handle), downwardly rotate and protract the scapula Now if you doing HELLA chest work because you want them pecs like whoa, then that may contribute to the concentric bias of the anterior chest wall. This bias would make pec minor eccentric proximally. Couple that with pulling the shoulders back for bench press and such, and you get a stretched AF pec minor. This could be a contributing factor to the strain. The solution is simple: get air into the chest to drive some concentric activity into the pec minor. Hell, even get some reaching forward to protract the scapula. Put the pec minor in the orientation it's not in. This will restore contractile options in the pec. A great move would be any type of . Horizontal adduction Question: You mentioned limitations in horizontal adduction. How do you assess this? Are you just holding the ribcage down and then adducting the arm until the ribcage starts coming up? Or are you holding the scapula down? Watch the answer Answer: You want to isolate the movement to the humerus. The big issue that will happen when you run out of humeral room is the scapula will go along for the ride. And I don't want the scap in my car ;) So, you'll want to pin the scapula down with your thumb. Then pull the humerus across the body. You are looking to get the olecranon to get slightly past the nose, which is about 135°. Horizontal adduction measures T2-4 anterior expansion, so you'll want to drive stuff that involves the following: Horizontal adduction Humeral extension trunk rotation One of my favorites that has been killing it because of the cervical rotation component has been . I'll even do this as an iso, it's been that good. Abdominal overactivity during exhales Question: What do you do about ab overactivity on exhales? Watch the answer Answer: Generally, if you see too much abs during the breathing sequence, there are a few simple tricks you can do to get the abs to chill. Make sure the tuck is ab-less. A lot of times, peeps will kick in the abs to perform the tuck instead of the glutes and hamstrings. This will then lead to further concentric activity of the abdominals during the exhale. WE DON'T WANT THAT! So ensuring that they can get a tuck without kicking in the abs is WAY important. Working on a can be a great way to teach this action. 2. Exhale slower Most people exhale WAY too quickly, which will greater bias superficial abdominal musculature, limiting your desired thorax expansion. I usually tell these people to either go 50% slower than what they did or make the exhale be 15 seconds long. No one will exhale for 15 seconds, but they'll get the idea. 3. Use prone or quadruped When your stomach is facing the ground, gravity will push the viscera anteriorly into the ab wall, thus creating an eccentric abdominal orientation. Sum up Rounded shoulders are caused by a concentric anterior thorax, which reduces humeral internal rotation. Reaching 60°-120°, humeral extension, trunk rotation, and horizontal adduction can all improve anterior thorax mobility. Reduce pec minor strain by driving air into the anterior thorax and reaching. Horizontal adduction is tested by pinning the scapula down and going across the body. Reduce ab overactivity by tucking without abs, exhaling slower, and using prone/quadruped. Photo credits
info_outline Which Limitations to Treat First? 09/20/2020
Which Limitations to Treat First? Improve your exercise selection by learning what limitations to prioritize So you have all these limitations you’ve found. You may inevitably ask yourself: Uhh...where do I start, fam!?!? While you can get results with just about anything, prioritizing certain aspects over others can enhance your success rate. If you hit the right dominos, you can knock down the entire stack (and talk to Zac). But how do you know what is important and what is not? That’s what we will dive into in this debrief. If you want to reduce the overwhelm of your assessment findings, and better categorize your supreme clientele, then you gotta check out Movement Debrief Episode 133. Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends October 11th at 11:55pm!) (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 4th at 11:55pm!) (Early bird ends April 25th at 11:55pm!) (Early bird ends July 18th at 11:55pm!) (Early bird ends August 22nd at 11:55pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - A great article outlining basic movements within the thorax - This article outlines how the diaphragm pull changes as it goes through full excursion. - This article looks at how we differ from one another in both ribcage and pelvic structure. - This book has some cool graphics on the different body archetypes. You'll see some dope ribcages - Bones don't touch #EBP #watchugondoboutit - In this debrief, we dive into scapulohumeral rhythm and more. Inhaled vs. exhaled spines Question: Hey zac I am a little confused by this wording: "An exhalation-biased spine compensates with an inhaled (wide) ISA." If they are in an exhaled state wouldn’t that mean the ISA would present narrow? Thanks! Watch the answer Answer: Inhalation and exhalation strategies are a reference to normal as the reference guide. You have to know these first to really be effective with this nomenclature. Because you NEVER EVER EVER see people exhibit normal respiratory mechanics, I've moved away from talking this way. But don't worry, fam. I'll iron this out for you :) When discussing compensatory mechanics, we are using axial skeleton position as our initial reference point. So you have to know what the inhaled and exhaled spinal positions are. To keep it ridiculously simple: Inhaled spine = Spinal curves are pushed backward Exhaled spine = spinal curves are pushed forward Here are the directions the spine moves in these cases If someone has reduced movement options, they may not be able to move the spine so well in the opposite direction. One can have an inhale-biased spine and may hella suck at exhaling the spine. The reason for this bias is likely due to anthropometrics and genetics. The problem: you still have to complete the respiratory cycle! An easy way to compensate is at the lower ribcage. These ribs are more flexible due to lacking a sternal attachment. This is where we get all hot and bothered by infrasternal angles (ISA)! Someone with an inhaled spine will have an exhaled lower ribcage (narrow ISA), and one with an exhaled spine will have an inhaled lower ribcage (wide ISA). You wouldn't have matching inhaled and exhaled positions at the spine and ribcage unless we are exhibiting full respiratory movement options, which NO ONE does. Why? Your guess is as good as mine! Can cranial issues limit movement? Question: Can you help a person having jaw and visual issues causing movement limitations? Watch the answer Answer: Though cervicocranial influences—occlusion, upper airway, vision, etc—can most certainly impact movement restrictions, the frequency at which someone needs to go down these paths to get changes is overstated. The overwhelming majority of people lack mastery of movement basics: aka . If you cannot get the stack, squat, shift, reach, all of these things anyone ought to be able to do, then don't even consider working with a dentist or optometrist to improve you movement. Especially considering the current lack of research supporting efficacy in these treatments (not to say that they don't work, but there are hit or miss results). The human body is INCREDIBLY adaptable, and many can get decent changes despite visual and dental influences. Caveat: if you have upper airway or visual pathology, then I recommend pursuing these routes, but not to improve your movement. For example, if you have sleep apnea or bruxism, you should find a good dentist to improve health in those areas. If you have a lazy eye or botched LASIK surgery, vision therapy could be quite impactful. Prioritize the interventions best suited for the problem, the low hanging fruits. If you did that well (and trust me, you didn't), then go into addressing other possible influences. Should I address the right or left side first? Question: We usually focus on helping clients shift into their right side since they are buried into their right side. I've heard that sometimes, but you need to integrate right side before left. What does that mean? Watch the answer Answer: First off, be careful with what language you use to discuss what is going on with someone. If you tell them they are buried, that may encourage maladaptive beliefs about their bodies. No fun, and WAY more likely to have poor outcomes. But on the real, prioritizing left vs right side misses one things that's extremely important: The stack. There are several reasons why I prioritize the stack first before trying all types of wild and crazy single arm, single leg, shift this, twist that, go right then left then right exercises: Bilateral movements are easier to teach and learn compared to unilateral moves Although there is a unilateral restricted pattern, most people have restrictions bilaterally and have unique limitations that require unique solutions Unilateral movements require greater movement excursion and make one more prone to compensation because of difficulty Think less formulaic of right first then left, and , critical thinking, and to get the outcome that your supreme clientele deserve. Primary and secondary compensations Question: I frequently see you referring to primary and secondary compensations. I must have missed the day at university where they defined these. Any chance you could define them in one of your videos? I'm not having luck finding definitions elsewhere. Watch the answer Answer: Let's provide the definition better than that Blackstar song (which is a tall order): Primary compensation: A restriction that counteracts structural bias to stay upright Secondary compensation: A restriction that counteracts the primary compensation to stay upright Let's look at a wide ISA for example. If you remember from our exhaled spine discussion from above (you read that, right?!?!), a wide ISA's structural bias would tend to the spine falling forward. Think the sacrum nutating "causing" a forward fall. You don't want to fall forward. You'll totally have a bad time. To counteract these forces, a wide may concentrically bias posterior musculature to maintain an upright posture. This would be the primary compensation. A wide ISA with a primary compensations. I do tattoos as well if you are interested. How would you know if you were dealing with a primary compensation? Remember the following heuristic: Concentric backside: Decreased flexion, abduction, and external rotation Concentric frontside: Decrease extension, adduction, and internal rotation So in the case of a wide ISA with a primary compensation, you'd have the following findings: Decreased flexion, abduction, and external rotation measures Normal extension, adduction, and internal rotation measures Now suppose that the primary compensation for this wide overcorrects, and this person starts to fall backward. SNAP! Now what do we do? This problem is where secondary compensations are useful. This bias counteracts the forces the primary compensation induces on the body. In the case of the wide ISA, the secondary compensation would involve concentrically biasing the frontside of their body. That font tho For this person, you'd likely have restrictions (and in some cases, hypermobility) in all planes. Flip flop all of the above for a narrow ISA, and then you'll have an idea of the differences between primary and secondary compensations. Infrasternal angles and compensation order Question: So treatment for wide ISA with only primary compensations and narrow with 2º compensations are very similar. And treatment for narrow ISA with only primary compensations and wide with 2º compensations are also very similar. So to determine treatment options, is it almost more important to just see if that person is more concentric on the front side or backside since the ISA is not that relevant when the person has 2º compensations? Watch the answer Answer: Although peeps can develop restrictions in similar areas, that doesn't mean that you need to ignore their body structure and the compensatory order. These areas still matter when it comes to intervention selection. The big reason is because of what "causes" the restriction. Let's take the case of someone who has a concentric bias of the anterior thorax (aka a down pump handle). Both a narrow and wide can present with this, but each has a different way of achieving this restriction: Narrow ISA: anterior concentric thorax is a primary compensation Wide ISA: anterior concentric thorax is a secondary compensation So the reason the narrow has this limitation has to do with the ventral cavity structure, wheras the wide has this limitation to mitigate a posterior concentric bias. Though both archetypes need air in the front, we have to respect the structural differences between the two. To improve this restriction in the narrow ISA, I need to make that person's ventral cavity structure dynamic AF. Meaning, I need to expand the ventral cavity laterally. Choosing a move which "squishes" the body front to back can be useful in that regard. A great example of this would be a Whereas with the wide, the anterior restriction occurs to counteract the posterior restriction. I do not want to choose an activity that squishes the body front to back. That would potentially reinforce the limitations caused by structural bias. If I choose the lazy bear for my wide, the scapular external rotation occurring from the 90-degree reach would further concentrically bias the backside of the body, which the wide already has. This is why a lot of times your clients who have a flat upper back struggle feeling ANY posterior expansion. You are robbing Peter to pay Paul, and I hear they're both jerks anyways! You can see how ignoring the structure may not get you your desired outcome. What would be a better choice would be something that involves a 120-degree reach. You get less posterior compression reaching in this direction, and the upward rotation will give serratus anterior leverage to compress the lateral ribcage. You'll still drive air forward AND you are helping make the wide structure more dynamic. is great for that. Does that mean if you give a narrow ISA an overhead reach you'll kill them?!? No (except that one time). But you may not give your client the activity with the best odds of success. Put some respek on the structure, and prioritize well. Addressing multiple limitations at once Question: If a narrow ISA has external and internal rotation limitations you say to address the external rotation limitation first. What happens if you address both at the same time? Watch the answer Answer: Killing multiple movement restriction birds with one stone is totally effective and encouraged (especially because birds scare me, I'll tell you the story one day). The easiest way to make this happen is by encouraging some type of rotation in your peeps. When I rotate, I drive relative external rotation on one side, and internal rotation on the other. It's great for those who have anteroposterior restrictions. You can easily achieve this with a or if you are feeling frisky, a Caveat: Make sure your clients have the stack first! Wide infrasternal angle breathing strategy Question: What cues would you use for wide ISA breathwork? Watch the answer Answer: The goal with exhalation for wides is to close the infrasternal angle. Make it smaller. So the #majorkey is to use pursed lips AND breathe slowly. This action increases resistance enough to recruit external obliques to close the lower ribcage. Some of my favorite cues to give are: Flicker birthday candles Do an impression of a windy day You are the big bad wolf, blow the house down Sum up Inhaled and exhalation nomenclature use the spine as a reference point. The lower ribcage compensates when there is a loss of spinal respiratory dynamics. Cervicocranial influences can affect movement, but conservative measures should be pursued first barring pathology. Use testing to determine interventions, while emphasizing bilateral before unilateral exercises. Primary compensations occur to counteract structural bias, whereas secondary compensations occur to counteract primary compensations. One must consider both structure and compensatory order when selecting interventions. Both anterior and posterior restrictions can be simultaneously addressed with rotation. Wide infrasternal angle presentations benefit from slow, purse-lipped exhales.
info_outline Shoulder Flexion Troubleshooting 09/12/2020
Shoulder Flexion Troubleshooting Can’t get overhead? Let’s figure out how! If you can raise your arm fully overhead WITHOUT compensating, don’t read any further! But if you are like most of us, reaching overhead probably draws its fair share of LOLZZZ. Exhibit A Yet raising your arm overhead is HELLA important for things like lifting weights, moving your neck freely, and even rotation through the ribcage. So if ya ain’t got it, you might want to work on it! That’s why I put out this debrief for you that dives into mechanics, what directions to reach and clarifies any confusion that may surround arm elevation biomechanics. Let’s channel our inner Josh Groban and raise you up (your arm that is). Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends October 11th at 11:55pm!) (Early bird ends January 17th at 11:55 pm!) (Early bird ends March 14th at 11:55 pm) (Early bird ends April 4th at 11:55pm!) (Early bird ends April 25th at 11:55pm!) (Early bird ends July 18th at 11:55pm!) (Early bird ends August 22nd at 11:55pm) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - This debrief goes into scapular movements during respiration, compensations, and more. - This article is essential to understanding scapulohumeral rhythm - He is a PT colleague of mine who is my go-to guy for all things upper airway. Scapulohumeral rhythm Question: Been reviewing your scapula debrief and the motions getting me a little hung up. I've always thought that shoulder flexion, upward rotation, ER, and posterior tilt were together? But you're saying the scaps upwardly rotate, internally rotate, and anteriorly tilt? What's the reasoning behind this or something I'm missing in research? People always drove into my brain upward rotation and posterior tilt helps clear space for shoulder flexion. Any relationship or misunderstandings there? Watch the answer Answer: When discussing the motion of the scapula and the humerus during shoulder flexion, it's all about timing and location. We typically break down shoulder flexion into 3 different phases: 0-60° 60°-120° 120°-180° During these distinct phases, you have different actions happening at both the scapula and the humerus that will drive expansion into various areas. First, we need to know what the starting position is for the scapula. “Scapman Begins” you might say...Or not...Whatever! Most of this stuff is drawn from this article , so please check this awesome study out if you haven’t. The resting position of the scapula is: 41° internal rotation 5° upward rotation 16° anterior tip Humerus starts in slight external rotation There’s going to be some slight variations among peeps of course, but this is a solid starting point. Now, let’s look at how the humerus and scapula move throughout the three phases. Phase I: 0°-60° There is pretty much no movement of the scapula in this phase. It’s all humerus. No joke. (Damn I’m on fire today!) Most of the humeral action is biased towards external rotation. If the humerus externally rotates, then the scapula will relatively internally rotate. How do I know that? I’M GLAD YOU ASKED!!!! It has to do with the posterior cuff muscle’s proximal line of pull. The arrow denotes how the scapula would move. Looks like internal rotation to me big dog (Photo credit: ) If I contract the proximal end of these muscles to the distal attachment, you’ll notice how the medial border would lift away from the ribcage. This action, my fine fellow fam, is scapular internal rotation. Glorious, right?! If the medial border is away from the ribcage, the scapular external rotators (rhomboids, traps, subscapularis) will be eccentrically oriented. Since the big dogs are posterior, you’ll get more posterior thorax expansion in this phase. In particular, T6-8 because of relative scapular downward rotation compared to later phases. O°-60° = Humeral external rotation = scapular internal rotation = T6-8 posterior expansion Phase II: 60°-120° In this phase, the scapula has to pick up some slack to clear room for the humeral head to do its thing. So it’s gotta move! The big scapular movements that happen during this phase are: Upward rotation External rotation Posterior tipping These combined actions suction the scapula up against the ribcage, enhancing stability and reducing stress load on the cuff muscles. When you see peeps winging and whatnot, that’s typically an inability of this phase to properly occur. Just like in phase I, scapular external rotation is associated with a relative humeral internal rotation. Peep the line of pull of your big internal rotator, the subscapularis: This pull would put the medial border up against the ribcage #scapularER (photo credit: ) Same song and dance. Proximal pull would compress the scapula up to the ribcage, and life is good. Due to scapular external rotation, the posterior thorax is more restricted from airflow. Thus, airflow in this flexion phase predominately occurs anteriorly. The bias is at T6-8 level in the early range, and likely T2-4 in the later range. 60°-120°= humeral internal rotation = scapular external rotation = anterior expansion (T6-8 early, T2-4 later) Phase III: 120°-180° The grand finale, and the most confusing part of scapulohumeral rhythm. Scapular upward rotation, external rotation, and posterior tipping continue to happen with reckless abandon. BUT. There are a few major keys that happen which allow for posterior thorax expansion during this phase: The humerus maximally externally rotates (creating a slight internal rotation bias The scapula orients into the scapular plane (45 degrees anterior of the frontal plane), which positions the scapular back near the resting position (which was internal-rotation. the more lateral position of the scapula away from the spine increases eccentric orientation. The upward rotation will eccentrically bias the downward rotators (rhomboids), which have a location posteriorly For these reasons, you will get some posterior expansion at T2-4 as you reach overhead. 120°-180°= Humeral external rotation = relative scapular internal rotation (though the scapula is still actively externally rotating) = posterior expansion (T2-4 level). Anteroinferior glide during shoulder flexion Question: Could you explain what to do if someone overstretched the ligaments in their shoulder. Like after doing the shoulder flexion test and their humeral head pops into your thumb when it's in their armpit, what can I do to restore normal flexion and how can I continue to keep that person resilient? Watch the answer Answer: Sometimes, when testing shoulder flexion, you can feel the humerus glide anteriorly and inferiority if you place your thumb in the client’s armpit. It’s all types of fun. If shoulder flexion is more external rotation-bias, what I think is likely going on is a combined internal rotation and abduction action that causes this excessive gliding, hence the pop forward. Is this actual tissue laxity? Ehhh. It’s hard to say. I’ve seen this glide change quickly with interventions, and my skills are DEFINITELY NOT that good. I think it’s unlikely a true tissue laxity, which would likely need surgical repair. An alternative story is there is an eccentric bias of anteroinferior tissues to compensate for a lack of scapular upward rotation needed for full shoulder flexion. You can guess the fix right? Get air in the back with a low reach, and you ought to be rocking and rolling! I usually start with something like Then progress to a to drive rotation and more isolated posterior expansion. Improving shoulder flexion Question: You and others have mentioned that when someone who is compressed in the dorsal rostral thorax and it is proven with your shoulder flexion assessment between the ranges of 60°-120° among other measures, that you would intervene with low reaching exercises below 60° flexion in various positions depending on the presentation of the ISA. Is it possible that in this instance we could intervene with a position that includes reaching in that 60°-120° degree compressive range if we IR at the humerus? Watch the answer Answer: If you peeped the scapulohumeral rhythm component above (uhh, why haven’t you read that yet fam?!), you probably garnered one thing: Shoulder flexion is hella complicated. In fact, the entire arc of flexion involves both anterior and posterior thorax expansion to be completed. Although I love shoulder flexion as a test, it is more a gross measure of thorax expansion with a bias towards posterior. Whereas shoulder extension is similarly a gross expansion measure with a bias towards anterior. In order to know where you need to drive air, you have to look at segmental expansion within the thorax. Get your tight green wrestling pants on and lather up in baby oil, because we’re about to break it down Degeneration X-style. Filling the thorax with air is similar to filling a cup of water. The cup fills bottom-up completely. Or coffee. Yeah. Let's go with coffee (Image by from ) So to do the lungs during progressive shoulder flexion. The fill occurs in a sequential manner that corresponds to scapulohumeral rhythm. Remember this general expansion trend with scapulohumeral rhythm: 0°-60°: lower posterior expansion (T6-8) 60°-120°: T6-8 anterior expansion in early phases, progressing to T2-4 expansion in later phases 120°-180°: T2-4 posterior expansion, with likely some anterior T2-4 expansion as well. With that in mind, you have to look at other individual tests to determine where you have to drive specific airflow to get changes in shoulder flexion: T6-8 posterior expansion - shoulder external rotation at 90° T6-8 anterior expansion - shoulder internal rotation at 90° T2-4 posterior expansion - shoulder horizontal abduction T2-4 anterior expansion - shoulder horizontal adduction T2-4 anterior AND posterior expansion - Lower cervical rotation Oh, just checking your ribcage expansion, NBD. Before you get all wild and crazy with your specific expansion efforts, make sure you have the stack. If you don’t have the stack, you have no base to drive this segmental expansion, and you won’t be able to talk to me, and I’ll stay forever lonely. I NEED YOU FAM! Once you have the stack, then you can pinpoint where the mobility restrictions are, then fill up your cup! If you have decreased shoulder external rotation (less than 90°), I’d go with a . If you have decreased shoulder internal rotation (less than 90°), I’d go with a You can combine expansion in both these areas by driving If I reach with my right arm, that will drive anterior expansion on the right and posterior expansion on the left. If you have decreased shoulder horizontal abduction (less than 45°), I’d go with something that drives rotation with a more horizontal plane-bias. The is a go-to for me. If you have decreased shoulder horizontal adduction (less than 135°), you can use similar rules above and drive horizontal adduction. are money here. You can also go with to improve this movement: Lastly, if you want to drive anterior and posterior expansion with the upper segments, you can combine unilateral reaches with cervical rotation. The is an absolute beast-mode for this. Manubrial Expansion Question: How would you differentiate an overhead reaching exercise for purpose of upper anterior ribcage expansion (manubrium) VS upper posterior ribcage expansion (T2-T4)? Watch the answer Answer: The thing with expansion anywhere is that it’s not on/off switches with exercises. You can get expansion with a variety of moves and positions. If we want to bias expansion into the manubrium (anterior T2-4), we have a few different options: High reaches (say 100°-180°) - because of circumferential expansion when going overhead Humeral extension - Due to scapular anterior tilt. And downward rotation biasing pec minor Cervical/Trunk Rotation - Due to general anteroposterior expansion that accompanies rotation Inversion - Due to gravity assisting the lungs in filling top-down Some of my favorite activities to make this happen have been listed above. I didn’t talk much about inversion, but my two money moves are and Sum Up Scapulohumeral rhythm involves combined posterior and anterior expansion, with the overall tendency occurring toward scapular AND humeral external rotation. An anteroinferior humeral glide during flexion (barring injury) occurs due to eccentric bias of the inferior humeral tissues. Specific limitations in thoracic expansion can be addressed by corresponding shoulder flexion loss with other measures. Manubrial expansion (T2-T4) occurs by using high reaches, humeral extension, cervical/trunk rotation, and inversion. Image by from
info_outline Lumbar Spine Troubleshooting 08/31/2020
Lumbar Spine Troubleshooting Lower back presentations that struggle with breathwork You’ve spent all this time perfecting breathwork into your practice...then it happens: This exercise hurts my back! WTF amiright!?!?!?! The activities we’ve been painstakingly learning about, and then your client feels pain THE WHOLE TIME you try it. This is especially true with: Lateral shifts Radiculopathy CRAZY Lordotic spines What’s going on here? Many times, especially if symptoms are high, the issues I see people make involve either progress WAY too quickly or going after the wrong impairment. But don’t worry folks, I’ll do my darndest to make these presentations ridiculously simple for you. If you have troubled lumbar spine presentations and you are unsure where to go, then you’ll definitely want to check out Movement Debrief Episode 131. for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends October 11th at 11:55pm!) (Early bird ends January 17th at 11:55 pm!) (Early bird ends April 4th at 11:55pm!) (Early bird ends April 25th at 11:55pm!) (Early bird ends July 18th at 11:55pm!) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies: Bill Hartman has dispelling misconceptions around anterior pelvic tilt. It's. a must-watch. If you have no clue about the difference between primary and secondary movement compensations, this debrief should help. You'll better learn when to apply certain exercises in a specific order to maximize movement improvements. - This position is fundamental for improving movement options. If you are just getting into coaching exercises in this fashion, this is the post. - If you want to learn the theory and practical components of many of the concepts I discuss, this man is pushing the field more than anyone else. - Although I disagree with a lot of his treatments, this book is an excellent resource on lumbar spine anatomy and biomechanics. - If you work with people in persistent pain, you MUST read this. It goes into the physiology surrounding how this happens and may help you learn how to better serve these clients. - One of the smartest trainers in the field. Excellent with physiology and pushing the training envoelope. - A great group to learn neurodynamics and pain science from. - Mike is THE GUY for learning the biomechanical aspect of neurodynamics. I also did reviews on his book which you can check out here. is a great neurodynamic move to apply with any posterior neural restrictions. If you haven't seen the , here is a good example. - If you are afraid of flexing your spine, you NEED to check this out. Hyperlordosis and rib flares Question: What are your thoughts on someone who has a combination of hyperkyphosis and hyperlordosis with ribs flare? Could these be due to mouth breathing as compensation for improper breathing patterns? And how would you try to improve it? Watch the answer Answer: First things first, we need to dispel some preconceived notions regarding posture. Some might call this a diss track (and by some I mean me): Static posture in and of itself doesn't mean much. There is no singular cause for exhibiting a certain posture. There are likely structural, genetic, and behavioral influences that predispose someone to look a certain way, posture included. We are mobile creatures, what is more important is expressing as many different movements as possible. So really, fam, don't sweat the posture you possess. What is more important is being able to move. What could be an issue is an inability to move out of this posture. Examples may be an inability to reduce the lumbar lordosis or rib flare. This deficit may indicate restricted movement. The most important piece to improving your movement is The easiest way to teach this concept is in the sidelying position. The reason being is because its gravity eliminated and minimizes rotational effects on the body. Check it out From here, the pinnacle of lumbar spine curve reversal is achieving a full-depth vertical squat. Teaching the stack in this maneuver is the first line of defense, and is a great way to do that. From here, the best loaded version that makes stay vertical "easy" is the Flexed Lumbar Spine Question: What is the lumbar spine looks relatively flexed and the arch starts at the thoracolumbar junction? Watch the answer Answer: Although we cannot rely on static assessments, there may be some tests that indicate there is a loss of lumbar "extension" that may lead to drive an appropriate amount of this motion. Here would be typical test findings: Decreased hip extension, adduction, and internal rotation measures Full hip flexion, abduction, and external rotation measures If you have someone with this finding, choosing hip extension-based exercises are primo, as this will help restore normal sacral nutation, and subsequent lumbar lordosis. One of my go-to's is a glute bridge variation like Lateral shift Question: Hey Zac, can you talk about a chronic lateral shift? Your take, management, and prognosis Toughest group for me. Watch the answer Answer: A lateral shift is likely a compensatory action the lower back takes to offload an irritated nerve root and/or disc. It typically involves lateral flexion away from the affected area with a side glide. You'll the top half of the body gliding away, and the lower half gliding towards. And they always have back hair. ALWAYS! In acute instances, this shift is useful at protecting the injured areas, but less desirable once the tissues have healed. If looking at this shift from our perspective, you'd see two components that we'd need to address: thorax translated away from the lesion An oblique pelvis where the ipsilateral innominate "sits" lower than the contralateral. With this presentation, the first line of defense is OF COURSE.... The Stack With the translation of the lower thorax, the lower ribcage will need to be dropped down to promote expansion of the involved side. The sidelying tilt progression per above is a great starting point. Once you've gotten adequate ribcage positioning, squat progressions shown above are useful for opening up the neural foramen. If your squat is on point, doing shiftwork that emphasizes oblique pelvic movement can assist in maximizing both expansion AND compression of the involved area. I start most peeps with a to introduce this concept. Then I'll progress to a With my terminal exercise being a or lunge. Add some rotation in the mix to REALLY get nuts! If you've tried these activities and movement/symptom issues persist, could be a great next place to go. A simple way to incorporate these concepts is by slouching the spine during an offending movement and performing the movement. I dive into this concept a bit more . Radicular symptoms during exercises Question: I was wondering what kind of modifications you may make when teaching the stack and trying to restore movement options when a patient experiences radicular symptoms during resets? I’m having good success with other treatment approaches for controlling their symptom profile, but am struggling to address their true underlying compensations/patterns without eliciting the radicular symptoms. Watch the answer Answer: These symptoms are often associated with , so do we do prone press-ups, and the angels will sing? Ehhhhhhhhh..... While I don't F with McKenzie a whole lot, we can apply similar principles by emphasizing anterior expansion. Moves that bias sacral nutation and air into the chest. Some of my starters include a The sink squat we have shown previously is also another money move. I also like to emphasize hip extension and adduction to drive sacral nutation. is pretty bomb.com for this. My hypothesis as to why this approach works is because, in order for us to create movement, we need to have a contractile gradient. Certain things need to be concentric, and certain things need to be eccentric. If we cannot establish a gradient (e.g. someone who has multidirectional limitations), this will likely lead to altered loading patterns when we perform an action. Perhaps in the case of radiculopathy, we may not have adequate segmental mobility going into certain positions, and increase strain occurs over the affected area. Chasing anterior expansion helps create this gradient while choosing a direction that does not evoke symptoms. This may allow for more even loading distribution when you inevitably flex on fools. And we always gotta flex on fools ;) When to hip shift Question: What test results would indicate when someone needs to get their shift together (aka a hip shift)? Watch the answer Answer: Typically, I use hip shifting to clean up the last bit of motion that I wouldn't normally get with stacking. If someone needs those last 10 degrees of rotation in any direction, a shift would be indicated. However, milk the stack until that cow is DRY fam. Generally, if someone can attain a good looking squat to parallel, they can probably shift without too many issues. Then, you may help them get their shift together! Is the Jefferson Curl useful? Question: I'm interested in some version of the gymnastics drill the "Jefferson curl" (extension from full forward-fold flexion but with hands-on legs) for those with narrow ISAs. Some say that loaded /unloaded flexion drills are is just accumulating tissue damage, but I have doubts, assuming a person doesn't jump up to loading too quickly. Watch the answer Answer: I'll preface that the Jefferson curl isn't something I've really messed with a whole lot, so take what I have to say with a grain of salt. First things first, I agree with you, caller, on doubting the flexion avoiders. I went ether on this topic , and basically there is no evidence to support that flexion is dangerous under load. Most in vivo experiments say otherwise. But does that make The Jefferson Curl useful? The assumption we have here is that people can segmentally flex at all, which most peeps who are tight like a tiger cannot. So is the curl doing what we think it's doing? Maybe not. However, if you have someone who does has some segmental flexibility, I could see it being a useful progression. The person who comes to mind is the narrow infrasternal angle type who needs to progress nutation while maintaining an inhaled spine. In that case, it could be effective. You'll also get some tissue tolerance into flexion, which is never a bad thing. Sum Up For someone who has hyperlordosis and cannot reverse the curve, focus on the stack and progressing the squat to improve movement options. Truly flexed lumbar spines require driving sacral nutation through hip extension. Lateral shifts can be improved by stacking and working on oblique shifts in the pelvis. If one gets radicular symptoms with resets, chase anterior expansion before driving posterior expansion. Hip shifts are effective at cleaning up mobility deficits. Use this activity when you can squat to parallel The Jefferson Curl is likely safe to use IF you have some degree of segmental motion at the spine and need to progress sacral nutation under load. Photo credit:
info_outline Functional Muscle Contractions 08/24/2020
Functional Muscle Contractions Compression, expansion, limitations, oh my! Have you ever wondered how muscle contractions impact movement? Or why in the hell we are using fancy terms like compression, expansion, all that mess? Or how does tissue tension create movement limitations? I get it, the terminology and stuff can be confusing AF, but passing that learning curve will allow you to: Figure out why movement limitations happen Better make decisions based on the infrasternal angle Determine how loading changes contractile orientations Are you ready to take your programming and exercise selection to the next level? Then check out Movement Debrief Episode 130! Watch the video for your viewing pleasure. If you want to watch these live, add me on . Show notes Check out promo video are some testimonials for the class. Want to sign up? Click on the following locations below: (Early bird ends October 11th at 11:55pm!) (Early bird ends January 17th at 11:55 pm!) (Early bird ends April 4th at 11:55pm!) (Early bird ends April 25th at 11:55pm!) (Early bird ends July 18th at 11:55pm!) (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. - Bill is a great resource and thought leader on compression, expansion, joint mechanics, and so much more. - This was an amazing study that looked at knee joint surfaces under load and extreme end-ranges. THE BONES NEVER TOUCHED!!!!!!! Mad props to the guy who underwent the scope to demonstrate this. Yikes! - This app is my go-to for looking at anatomy in 3d. It's basically the destroyer of all anatomy textbooks. - This article illustrates how an extension-biased thoracic spine manipulation (Gasp, we touch people!??!?!) improved lower trapezius activity. Perhaps this indicates the lower trapezius as a spinal extender? - This article is the gold standard read if you want to learn all the ins and outs of scapulohumeral rhythm. How do movement limitations happen? Question: How can I tell if something is being held in place and can't change position vs something not being able to move any farther because it's already there (e.g. a door that can't close because it's already closed)? Watch the answer Answer: To learn how a movement becomes limited, we have to look at joint mechanics. Let's look at a muscle contraction. If I contract my biceps and my elbow flexes, anterior tissues become concentric. This pushes synovial fluid posteriorly, making posterior tissues eccentric. It looks like this, and my biceps wow and impress everyone: All we need are some POWS and BAMS and we got ourself a new anatomy comic If my resting bias was this state, I would have decreased elbow extension. The above graphic is how movement limitations happen. The limitation occurs because the elbow extensors cannot create enough tension to shift the synovial fluid in the opposite direction, changing the concentric tension of the elbow flexors. Therefore, the concept of a door that is already closed creating a movement limitations cannot happen. If the door were "closed" (aka a maximal concentric bias), my elbow would be flexed to the nth degree and I would have absolutely zero extension capabilities. Although I appreciate da biceps pump as much as the next bloke, we really do not see this much if at all in reality. the only times I can think of would be a contracture or severe structural compromise, which is rare. But Big Z, what about when I feel that pinch in the front of my hip when I flex, certainly the door must be closed worse than that Teddy Pendergrass song with Cialis, right?!?!?!? False. What would happen here is you would have a concentric bias of the hip extensors limiting hip flexion first. The then likely issue you have is a lack of relative motion occurring at the pelvis (aka you can't counternutate the sacrum, which would be due to concentric bias of nutaters), causing you to hit your perceived end range a lot sooner. In some people, this can lead to a pinch (and not the cool kind that makes you grow an inch). You can call me Robert Plant because the song remains the same: concentric bias limits fluid shift capabilities, creating a restriction in the opposing direction. Pursuing extreme flexibility Question: With pursuing extreme flexibility, 1) how much of this capacity is genetically and/or structurally determined (I've pursued this with little progress), 2) how pursuing this level of mobility would fit in or clash with your model, and 3) how and if this can be achieved without long term consequences? Watch the answer Answer: Let's break it down Degeneration X-style. Genetics and structure for flexibility Genetics and structure play a HUGE role in how well someone does with any activity. There's a reason elites at almost all sports have similar builds. Runners are tiny and long-framed, NFL linemen are built like fridges. For people who are very flexible, you need a structure that has a greater eccentric bias. Eccentric tissue action is needed to contort into wild position. The narrow infrasternal angle with a narrow pelvis has a structure built for eccentric bias. Thus, the narrow ISA has the best body type for flexible pursuits. That's likely why prepubescent females absolutely demolish gymnastics. They have narrow ribcages, and the pelvis hasn't widened yet. Also, because females are inherently more flexible than males, they are prototypical for this sport. See how narrow the ribcage is and how big the ribcage goes front to back? She's built to exhibit this type of mobility. Whereas ya boi strained every muscle in his body just contemplating this move. (Image by from ) Just because a narrow body type has the ideal structure for pursuing flexibility, that doesn't mean that people who lack this body can't pursue the task at a high level, they may just have a lower ceiling than someone who has equivalent features with a different axial structure. Another thing to consider is when someone began training for their given sport. If you started practicing something at a younger age, it is easier to develop structural adaptations needed for the sport. It's why kids have an easier time learning languages and musical instruments (the jerks). They have the plasticity to acquire skills easier compared to adults. It becomes much harder to alter your structure the older you are. Doesn't mean it cannot happen, but the ceiling is likely lower. Flexibility training and the model Pursuing extremes in any task can potentially compromise health, so one must do all they can to support the person as they chase the adaptations they need. If you are trying to be flexible AF, you will be trying to making your body more eccentrically-biased. It would be wise to do activities that help you generate concentric actions to not push you so far in one direction. Also, just because you are as eccentric as can be, it doesn't mean that you have FULL movement options. Many times, hypermobile peeps have a loss of axial skeleton measures. Hip extension restrictions are also common. If you train these types of people, I would look at axial measures (e.g. infrasternal angle, lower cervical rotation, etc) and movement quality under load to keep an eye on one's movement capabilities. Pursuing flexibility while minimizing injury risk The most important thing with chasing any physical quality is load management. If you are new to ANY activity, you have to progress slowly. Find a good program or coach that intelligently progresses you towards the task you want to do, and keep track of your workload as you do it. A 10% increase in anything—volume, intensity, new activities—on a weekly-ish basis is a prudent progression. You can also mess with measuring acute:chronic workload . Also, make sure you are keeping the areas you tend to get restricted flexible as can be, keep strong, and ya ought to be in bidness! Muscle compression and expansion Question: I've heard you mention the role of muscles in compressing or expanding (e.g. the serratus anterior's role in compressing the rib cage laterally). I was wondering how I would go about learning more regarding the roles of different muscles in compression and expansion, and how this information could be applied to exercise selection and progressing/regressing movements? Watch the answer Answer: I wish there was a good anatomy resource, but sadly I haven't seen a whole lot of anything consider proximal muscle actions, especially when it comes to the axial skeleton (like the serratus). Like this picture, you can't get a good picture of the curved shape of the serratus, so people think this muscle pulls the ribcage backward. WRONG. Check the superior view of an anatomy app and you'll have your mind blown. (Photo credit: ) Most of looking at anatomy this way comes from looking at tissue attachments and visualizing how the body was to move if it contracts. That's why an app like is so useful because you can view the body in ways that anatomy textbooks are limited. These thought experiments and checking yourself with biomechanical research could prove useful. But instead of sweating individual muscles, I'd prefer looking at how the body has to change its shape and positioning to complete movement tasks. Visualizing movement in this way makes you worry less about muscles and more about movement. Muscles do not act in isolation, so it may not be as realistic to think in isolated actions. Lastly, compression and expansion are terms commonly used in physics. Compression means molecules get closer together, whereas expansion is molecules spreading apart. Gases are the matter state which corresponds the most to these terms, whereas liquids and solids are significantly more challenging to change molecular distancing. Although we are composed of gases throughout our body, I question the accuracy of these terms when it comes to movement. I need to learn more. Moreover, compression is a scary term to use with clients. Think compression fractures. I don't want to risk them taking what I say in a maladaptive context. Because it's familiar, I gravitate more to concentric (compression) and eccentric (expansion) to describe movement. How loading influences movement Question: I just saw your debrief about reaching mechanics and talking with a colleague we have one doubt. He says that If you reach overhead, you will compress the upper thorax naturally, due to the upward rotation of the scapulae. Plus, when you add load (which is compression) you will further induce compression. But in your debrief you said that reaching overhead facilitate T2-T4 expansion Are the mechanics different under load? Watch the answer Answer: Upward rotation is often paired with external rotation when we are talking about arm elevation. Scapular external rotation will definitely make the posterior thorax as concentric as can be. BUT........ There are a few things we have to consider when going overhead that allow posterior thorax expansion to happen: The scapula rests around 41 degrees of internal rotation and moves minimally in the first 60 degrees of humeral elevation (posterior expansion allowed) Humeral external rotation creates a relative scapular internal rotation, which happens predominately at the lower and higher ranges of humeral elevation (again, allowing for posterior expansion) Although the scapula progressively externally rotates throughout range, the scapula aligns in the scapular plane (45 degrees forward from abduction) at the uppermost limits (giving me posterior expansion) (peep this article to learn more) When the scapula upwardly rotates, there will be some eccentric orienting of the downward rotators. The rhomboid perform this action, and run from C7-T5 (giving me some posterior expansion in the upper segments) Therefore, posterior expansion is TOTALLY possible as you elevate the arm.....until loading happens. Then all hell breaks loose, yuck.[/caption] When I start moving the big weights, muscles need to generate hella more tension to complete the task. Meaning you will get more concentric activity, and subsequent compression, of the posterior thorax. Therefore, heavy loading isn't all that helpful at getting your upper back mobility on fleek. You'd be better served before lower load activities, unilateral exercises, or rotational stuff to improve your motion back there. Sum Up Movement limitations likely occur when there is an inability to push synovial fluid into a restricted joint area, not because you are already in a particular range. Extreme flexibility has structural influences (narrower ribcages have better builds), genetic and epigenetic influences (how early did you acquire adaptations), and must be intelligently progressed through load management and maintaining appropriate movement options. To look at proximal muscle actions, performing thought experiments, and looking at three-dimensional anatomy representations are the best way to learn anatomy in this fashion. Heavy loading increases concentric demands of muscle to complete the task, reducing movement options. Image credit: