A funny thing happens whenever I inform someone (namely, guys) they need to hit their upper traps more. The immediately go into Bane mode:
Visions of heavy barbell shrugs, breaking Batman’s back, and walking around asking people “do you feel in charge?” run rampant.
It’s all well and good, I have nothing against shrugs. I draw the line against breaking people’s backs though. BAD BANE, NO!
Shrugs are undoubtedly a great exercise to build the upper traps. And the upper traps are kind of important when it comes to the ability to bring one’s arms overhead – they’re one of three muscles that help to upwardly rotate the scapula.
Via my time as a coach at Cressey Sports Performance (and even now) I work with a lot of people with shoulder issues. Training the upper traps directly has gotten a bad rap in recent years. But for athletes and lifters who are stuck in spine-extension based postures and can’t raise their arms overhead, training the upper traps can be a game changer for overall shoulder health and performance.
The key? Ensure they’re trained with upward rotation.
Continue reading my latest article on T-Nation.com HERE.
Except, you know, in this case “it” has less to do with the Night King, White Walkers, and the impending doom of man, and more to do with shoulder and hip assessment, corrective exercise, strength & conditioning, and programming strategies to optimize performance in the weight room.
Dean Somerset and I filmed our Complete Shoulder & Hip Workshop in Oslo, Norway this past spring and we’re excited to give everyone a sneak peak on what to expect:
Yes, the music is a bit dramatic. We were originally gonna go with “Wu-Tang Clan Ain’t Nuthin to F*** Wit” or “You’re the Best Around” from the Karate Kid soundtrack, but figured both were a bit more dramatic.1
In any case, we’d be honored for you to take a look. And stay tuned for a release date in the very near future.
There are many root causes of low back pain and discomfort, and there are many people who’s day to day lives are affected by it.
In my neck of the woods – Strength & Conditioning – the culprit(s) can often be displayed on the weight room floor. Lifters who routinely default into movement patterns that place them in (end-range) LOADED spinal flexion or extension are often playing with fire when it comes to their low back health and performance.
NOTE: this isn’t to say that repeated flexion/extension is always the root cause.
1) There’s a stark contrast between flexion/extension and LOADED flexion/extension. Many people have been programmed to think that all flexion/extension of the spine is bad. It’s not. The spine is meant to move, albeit under the assumption that one can do so without significant compensation patterns (relative stiffness), limitations in mobility, and with appropriate use of both passive (ligaments, labrums, and tendons, oh my) and active (muscles) restraints.
It’s when people start placing the spine under load in ranges of motion they can’t control – often in the name of social media glory – that bad things end up happening.
2) However, there are plenty of examples of lifters (mostly elite level, which is an important point) who have been utilizing techniques many fitness pros would deem incendiary with regards to the increased likelihood of spines all over the world resembling a game of Jenga.
A great example is a piece Greg Nuckols wrote HERE, explaining the benefits – biomechanically speaking – of a rounded back deadlift.
But back pain – specifically low back pain – can strike at any moment. I’ve heard stories of people hurting their back during training of course. But I have also, and I think many of you reading will nod your head in agreement, have heard stories of people messing up their back while bending over to pick up a pencil or to tie their shoes.
Or while fighting a pack of ninjas (hey, it can happen).
In pretty much all cases it comes down to one of two scenarios going down:
1. Ninjas attack.A one-time blunt trauma. Think: spine buckling under load, car accident, falling off a ladder.
2. A repetitive aberrant motor pattern. Think: tissue creep into sustained spinal flexion for hours on end at work.
Dr. Stuart McGill and his extensive research on spinal biomechanics has been the “go to” resource for many people – including myself – to help guide the assessment process and to attempt to figure out the root cause of most people’s low back pain.
A term he uses often is “Spinal Hygiene.”
It behooves us as health and fitness professionals to use the assessment as a window or opportunity to “audit” our client’s and athlete’s movement and to see what exacerbates their low back pain.
“Our approach in identifying the cause of pain during an assessment is to intentionally provoke it. Provocative pain testing is essential and irreplaceable when it comes to determining which postures, motions, and loads trigger and amplify pain and which ones offer pain-free movement alternatives.”
People who have more pain and discomfort in flexion (slouching, sitting, bending over to tie shoes) are often deemed as flexion intolerant. Moreover, people who have more pain and discomfort in extension (standing for long periods of time, bending backwards, excessive “arching” in training), are often deemed as extension intolerant.
Ironically, in both scenarios, people will find relief in the same postures that are “feeding” the dysfunction and their symptoms.
What’s the Fix?
Funnily enough, pretty much everything works. There are any number of methodologies and protocols in the physical therapy world that have worked and have helped get people out of low back pain.
It’s almost as if the appropriate response to “how do you fix low back pain?” is “the shit if I know? Everything has been shown to work at some point or another.”
Active Release Therapy, Graston, positional breathing, stretching, mobility work, rest, sticking needles in whereeverthefuck….it’s all been shown to work.
I’ve had numerous conversations with manual therapists on the topic and the ones who tend to “get it” and elicit the best results are the ones who take a more diverse or eclectic approach.
They’ll use a variety of modalities to best fit the needs of the individual.
That said, I’m a fan of directing people towards therapists who take a more “active” approach as opposed to a “passive” approach.
Both can work and both have a time and place. However one approach is less apt to make me want to toss my face into an ax.
Passive Approach = Ultra sound, electric stimulation, etc. This approach treats the symptoms, focuses on instant relief, and not necessarily addresses the root cause(s).
Active Approach = Is more hands on and more “stuff” is happening. Practitioners who fall on this side of the fence tend to focus more on the root cause – poor movement quality, positioning, muscle weakness, mobility restrictions – and work in concert with the patient/athlete to educate them on how to prevent future setbacks.
Above all, an active approach is about finding and engraining a neutral spinal position, and finding pain-free movement.
I think by now you know my preference.
Tony, Shut-Up, What’s the “Forgotten” Cause of Low Back Pain?
Well, to say it’s “forgotten” is a bit sensationalistic. My bad.
We tend to solely focus on either flexion or extension intolerance…and granted those are the two biggies.
However, have you ever had someone come in and pass those “screens” with flying colors only to complain of back pain or discomfort when he or she rolls over in bed, rotates, or maybe experiences an ouchie when they sneeze?
What’s up with that? And bless you.
Spinal Instability – That’s What’s Up.
Instability can rear it’s ugly head with flexion/extension based issues too, but it becomes more prevalent when rotation is added to the mix.
The body doesn’t operate in one plane of motion, and it’s when people meander out of the sagittal plane and venture into frontal and/or transverse plane movements, when they begin to get into trouble.2
The muscles that provide intersegmental stability to the spine may be under-active and may need some extra TLC.
I’ve worked with people who could crush a set of barbell squats (they handle compression and shear loading well), but would complain of l0w-back pain whenever they did anything that required rotation.
The fix is still going to be helping them find and maintain spinal neutral – I don’t feel this is ever not going to be a thing. Kind of like too much money in politics or LOLcats.
In addition, gaining motion from the right areas – hips, t-spine, for example – will also bode well.
However, I’d like to offer some insight on what exercises might be part of the repertoire in terms of “pain free movement” when spine instability is a factor.3
The Stuff Most People Will Skip (It’s Okay, I Won’t Judge You)
One word: planks.
Dr. McGill has stressed time and time again that improving spinal endurance (and hence, stability) is paramount when dealing with back pain. They key, though, is performing them in ideal positions.
I chuckle whenever someone brags about holding a 5-minute plank. When in fact all they’re really doing is hanging onto their spine….literally.
1. It’s a bonafide way to help people gain a better understanding and appreciation for creating full-body tension.
2. I like cueing people to start in a little more (unloaded) flexion, so that by the end they’re residing in a neutral position anyways.
3. When performed as described in the video below, 10s will make you hate life.
To up the ante you can also incorporate 3-Point Planks (where you take away a base of support, either an arm or a leg, and hold for time) or Prone Plank Arm Marches:
You can also incorporate Wall (Plank) Transitions where the objective is to cue people to keep the torso locked in place. Motion shouldn’t come from the lumbar spine then mid-back. Everything should move simultaneously, as follows:
Deadbugs
I’m a huge fan of deadbugs. When performed RIGHT, they’re an amazing exercise that will undoubtedly help build core and spine strength/stability.
A key component to the effectiveness of a deadbug is the FULL-EXHALE (check out link above). However, one variation I’ve been using lately is the Wall Press Deadbug (for higher reps).
https://www.youtube.com/watch?v=gmtsGHk34C0
Here the objective is to engage anterior core (pressing into the wall), to breath normally, and then to perform a high(er) rep set (10-15/leg) making sure motion comes from the hips and NOT the lower back.
If you want to build stability (and endurance) this is a doozy.
Stuff People Are More Likely To Do (Because It Involves Lifting Things)
1. Offset Loaded Lifts
This is an untapped, often overlooked component to back health and performance. Offset or asymmetrical loaded exercises are a fantastic way to train spinal stability and challenge the core musculature.
By holding a dumbbell on one side, for example, you have work that much harder to maintain an upright posture and resist rotary force:
Likewise, with offset presses, the core must fire to prevent you from falling off the bench. Unless you fall off because you’re drunk. If that’s the case, go home.
And we don’t have to limit ourselves to dumbbells, either. We can use barbells too.
2. Shovel Deadlift
3. Farmer Carries
Farmer carries – especially 1-arm variations – can be seen in the same light. The offset nature is a wonderful way to challenge the body to resist rotation (rotary force) and to help build more spinal stability.
4. 1-Legged Anti-Rotation Scoop Toss
Another option is to perform anti-rotation drills such as the 1-Legged Anti-Rotation Scoop Toss. As you can see from my un-edited video below….it’s tougher than it sounds.
5. Anti-Rotation Press
A bit higher on the advanced exercise ladder, the Anti-Rotation Press is another great drill to help hone in on increased core strength and spinal stability. To make it easier, use a longer stride stance; to make it harder go narrower.
This Is Not an End-All-Be-All List
But a good conversation stimulator for many people dealing with low-back pain nonetheless. Have you got own ideas or approaches to share? Please chime in below or on Facebook!
Remember that show diary on MTV? You know, the one that aired back in the early to mid-2000s?
The documentary style show centered mostly on musicians and celebrities and followed them through their daily lives.
Each episode started with said celebrity looking into the camera and saying…..
“You think you know, but you have no idea.”
And then for the next 60 minutes we got a true taste of the celebrity lifestyle, given an opportunity to witness their trials and tribulations with the paparazzi, hectic travel schedules, demands on their time, and what it’s like to demand a bowl full of green only M&Ms in their dressing room (and actually get it), not to mention the inside scoop on what it’s really like to be able to bang anyone you want.
Sometimes I feel like strength coaches should have their own version of the show diary, because when it comes to training athletes I feel like many people out there “think they know….
“…..but they have no idea.”
Oh snap, see what I just did there?
While I don’t think it’s rocket science, I’d be lying if I said there isn’t a lot of attention to detail when it comes to training athletes – or any person for that matter – and getting them ready for a competitive season. Everyone is different, with different backgrounds, ability level, injury history, strengths, weaknesses, goals, anthropometry, as well as considerations with regards to the unique demands of each sport and position(s) played.
By contrast, there are numerous parallels in training despite athletic endeavors or whether or not someone is an athlete to begin with.
We can take the Dan John mantra of:
Push, pull, hinge, squat, lunge, carry
Do those things, do them well, and do them often….and you’ll be better off than most. It’s complicated in its simplicity.
Much like Dan I prefer to train everyone I work with as if they’re an athlete. There’s something magical that happens when I can get Joe from accounting or Dolores from HR to deadlift 2x bodyweight or to start tossing around some medicine balls. Even better if it’s done while listening to Wu-Tang Clan.
They wake up!
They’re less of a health/fitness zombie, haphazardly meandering and “bumping” into exercises. Once they start to train with intent and purpose – and move – it’s game time.
That said, lets be honest: when it does come to training athletes there are many other factors to consider; many more than an article like this can cover. However, I do want to discuss a few philosophical “stamps” that some coaches deem indelible or permanent when it comes to training athletes, when in fact they’re anything but.
1) Strong At All Costs
There’s a part of me that cringes to admit this, but it needs to be said: strength isn’t always the answer.
Don’t get me wrong, I still believe strength is the foundation for every other athletic quality we’d want to improve.
If you want to run faster (<— yes, this matters for endurance athletes too), jump higher, throw things harder or further, or make other people destroy the back of their pants, it’s never a bad thing to be stronger.
When working with athletes, though, there’s a spectrum. If you’re working with a college freshman who’s never followed a structured program and is trying to improve their performance to get more playing time, you can bet I’ll take a more aggressive approach with his or her’s training and place a premium on strength.
When working with a professional athlete – who’s already performing at a high level, and is worth millions of dollars – is it really going to make that much of a difference taking their deadlift from 450 lbs to 500 lbs?
Moreover, we’ve all seen those snazzy YouTube and Instagram videos of people jumping onto 60″ boxes:
It may get you some additional followers and IG “street cred”…but man, the risk-reward is pretty steep if you ask me. I’m not willing to risk my career (and that of my athletes) for some stupid gym trick.
Besides, if I wanted to I’d up the ante and have them do it while juggling three chainsaws. BOOM! Viral video.
To that end, I like Mike Robertson’s quote which sums my thoughts up the best:
“I think athletes need to be using the weight room as a tool to improve efficiency and athleticism, not simply push as much weight as possible – MR”
2) You Don’t Have to OLY Lift
Some coaches live and die by the OLY lifts, and I can’t blame them…..they work. But as with anything, they’re a tool and a means to an end. They’re not the end-all-be-all-panacea-of-athletic-and-world-domination.
I don’t feel any coach should receive demerit points – or be kicked out of Gryffindor – because he or she chooses not to implement them into their programming.
Lets be real: If you know you have an athlete for a few years, and have the time to hone technique and progress them accordingly, the OLY lifts are a good fit. It’s another thing, too, if you’re competent.
I for one am never guaranteed four years with an athlete, nor am I remotely close to feeling competent enough to teaching the OLY lifts. And that’s okay….
I can still have them perform other things that’ll get the job done:
This is probably the part where some people roll their eyes or maybe scroll past, but hear me out.
I think it’s silly when I see coaches on Facebook argue over bilateral vs. unilateral movements and try to win everyone over as to which is best.
They’re both fantastic and warrant attention.
Where I find the most value in single leg training:
Serves as a nice way to reduce axial loading on the spine when necessary.
It can be argued all sports are performed – in one way or another – on one leg, so from a specificity standpoint it makes sense to include it.
Helps to address any woeful imbalance or weakness between one leg and the other.
Places a premium on hip stability and core/pelvic control.
All that said, I do find many people are too aggressive with their single leg training. It’s one thing to push the limits with your more traditional strength exercises like squats and deadlifts, but when I see athletes upping the ante on their single leg work to the point where knees start caving in and backs start rounding that’s when I lose it.
I’m all about quality movement with any exercise, but more so with single leg training. I’d rather err on the side of conservative and make sure the athlete is owning the movement and not letting their ego get in the way.
Like that one time I posted this video and Ben Bruno shot back a text showing me a video of Kate Upton using more weight than me. Thanks Ben! Jerk….;o)
Unfortunately, some coaches are so set in their ways that they’ll never cross the picket lines. They’re either team bilateral or team unilateral.
How about some middle ground with B-Stance variations?
4) Recognize Positions Matter
I’m not referring to Quarterback or Right Fielder here. But rather, joint positions and how that can play into performance in the weight room and on the field.
If you work with athletes you work with extension.
As I noted in THIS post, anterior pelvic tilt is normal. However, when it’s excessive it can have a few ramifications, particularly as it relates to this discussion.
Without going into too much of the particulars, people “stuck” in extension will exhibit a significant rib flair and what’s called a poor Zone of Apposition.
Basically the pelvis is pointing one way and the diaphragm is pointing another way, resulting in a poor position; an unstable position.
Anyone familiar with the Postural Restoration Institute and many of their principles/methods will note the massive role they’ve played in getting the industry to recognize the importance of breathing.
Not the breathing that’s involved with oxygen exchange – evolution has made sure we’re all rock stars on that front.
Instead, PRI emphasis the importance of the reach and EXHALE; or positional breathing.
It’s that exhale (with reach) that helps put us into a more advantageous position to not only encourage or “nudge” better engagement of the diaphragm, but also better alignment….which can lead to better stability and better ability to “display” strength.
NOTE: this is why I’m not a huge fan of telling someone to arch hard on their squats.
When joints aren’t stacked or in ideal positions, it can lead to compensation patterns and energy leaks which can compromise performance.
5) You Need to Control Slow Before You Can Control Fast
It’s simple.
You gotta “control slow” before you can “control fast.” Use slow(er) tempos to allow people the opportunity to own joint positions.
Thoracic (mid-back) extension is kind of a big deal.
Without turning this into an anatomy lesson, t-spine extension is important for a variety of reasons. In no particular order:
It’s what the mid-back (T1-T12) is designed to do. However, due to the long hours many of us tend to accumulate at work and at home in excessive flexion (hunched over, rounded upper back), we lose the ability to get into and maintain extension.
In short: “good” posture can become compromised.
T-spine extension allows us to get into proper positions to lift things – it’s crucial for overhead activities (or elevating the arms overhead in general), deadlifting, squatting, and helping to offset “sheer forces” on the spine.
Lack of t-spine extension means you can never be Batman.8
Our scapulae (shoulder blades) are more or mess at the mercy of thorax position. For those who present with a more kyphotic/computer guy posture, the “resting” position of our scapulae can be affected (abducted, anteriorly tilted) which can (not always) lead to shoulder ouchies in addition to scapular dyskinesis.
There are numerous ways to address lack of thoracic extension, the most common being foam rolling the mid-back followed by corrective modalities such as:
Bench T-Spine Mobilizations
Rocked Back Extension-Rotations
Side Lying Windmill
We’d then follow all of that with strength-based exercises – cued well – to help “cement” things. Front squats, for example, would be a great fit here. The anterior placement of the barbell forces the upper back musculature to counteract the forward pull to keep the torso upright; in effect nudging trainees into more t-spine extension.
Another popular approach is to use the foam roller in a different way and pepper in some additional t-spine extension patterning.
You all know the drill: take a foam roller, lie on it, and lean back, waaaaaaay back.
Like this:
While intentions are good in this scenario and there is some mid-back extension happening, it arrives at the expense of movement coming from elsewhere…the lumbar spine (often times with the hips coming off the ground) in conjunction with a massive rib flair.
Thoracic movement is much more subtle than people think. I fear this is one of those cases where many people – fitness industry pros included – have grown infatuated with the notion more ROM (Range of Motion) is better ROM.
Not the case.
What T-Spine Extension on Foam Roller Really Looks Like
Note From TG: It’s July 4th. I’m in Maine. There’s no way I was writing a new post today, so I decided to repurpose the post below.
It coincides with Dean Somerset’s Ruthless Mobility, which is currently on sale at half-off the regular price. The sale ends TODAY.
Toodles!
I started with a new client yesterday. As is the case every time I work with someone new I’ll sit down with him or her (in this case her) and attempt to get all the pertinent information I’ll need to help them achieve their goals and to write an effective training program. Things like injury history, what their training has looked like previously, training preferences, perceived barriers on what’s limited them in the past, favorite 80’s cartoon, you know, all the important stuff.
Please tell me someone out there remembers Disney’s Adventures of the Gummi Bears!?!?! And please tell me someone else out there tried to make their own version of Gummiberry Juice (which, when drunk by humans, gave them superhuman strength) as a kid by combining Mountain Berry Punch Kool-Aid with actual gummy bears???
No? Hahahaha. Well, uh, me neither. That’s just stupid talk! Yeah, that’s what it is……stupid.
So anyways, along with the brief Q&A I’ll also perform an extensive movement screen so I can gain a better understanding of how someone moves and whether or not they present with any distinct compensation patterns which may (or may not) be “feeding” into their dysfunction or pain.
Many people have been programmed to think that increased range of motion is good – and that the more we have of it, the better off we are.
Yes and no.
For those who are stuck starring at a computer for ten hours a day and have little to no amplitude (ROM) in their daily lives (and as a result have the movement quality of a hipster wearing a pair of jeans 3 sizes too small), working on improving their mobility would absolutely be a priority and help to improve performance in the gym and their quality of life.
For someone like the individual I was working with yesterday, however – who had plenty of ROM, to the point where she was borderline hypermobile, yet still was under the impression she had “tight” hips – going out of our way to “stretch the tight” and work on improving mobility could have more deleterious effects than good.
She came in with a history of left hip/ITB pain, and upon testing her hip internal range of motion on that side, it was limited.
Pretty strange for someone with plenty of laxity, right?
As is par for the course, she has spent years stretching her hip in hopes of improving her mobility in an effort to get better.
It hasn’t worked. Yet, I was able to improve her hip IR by a good 10-15 degrees in a matter of 30 seconds without “stretching” her hip. It was priceless to see her reaction when it happened.
So, how did I do it?
I’m Gandalf, duh!
Okay, in all seriousness what I did was work on her REACTIVE STABILITY, which is a term that Dean Somerset has tossed around for a while now.
The Cliff Notes Version: the body will limit a movement into ranges of motion it deems to be either risky, pain producing, or “un-known.”
This is often referred to as PROTECTIVE TENSION, which is what the body creates to help support an injured area.
If I test someone’s hip IR and it’s limited I can’t just assume it’s due to shortness or stiffness of specific muscles. It can definitely be a factor and the main culprit for some people, but it’s something I feel far too many fitness professionals gravitate towards because of an archaic mindset or because it’s “what’s always been perceived as the problem.”
As many of you know Dean (Somerset) and I are good friends. If you ever hear a joke that starts with an American strength coach and a Canadian exercise physiologist walk into a bar……
…..it’s probably us.
He and I have done several workshops together and I’ve had the opportunity to see Dean perform his voodoo assessment stuff each and every time. And it never ceases to amaze me.
One of the best “party tricks” he’ll use in our workshops is exactly the protocol I described above. In short, what he’s found (and I can confirm) is that reduced hip internal rotation is often a symptom of something not working and the body will compensate by forcing surrounding musculature to chronically fire and “tense,” impairing ROM, and thus mobility.
To be more succinct: lack of hip IR = reduced lateral stabilization.
Have someone do a (correct) side plank, have him or her focus on deep, forceful breathing and watch what happens.
Awesomesauce, right?
The side plank helps work on lateral stabilization, which in turn tells the over tensed muscles to chill out, improves reactive stability, which then in turn takes away the “perceived threat” and ROM improves.
It’s not a catch-all for everyone, but you’ll be surprised as to how often it works. I should also note that it’s not something that will stick long-term. Typically the increased ROM will last a few hours, maybe a day. But for something like this to last at least now we know that it’s not a situation where we’re going to tell someone to “just go stretch.” We need to work on improving (lateral) stabilization.
And this is the type of stuff that Dean covers in Ruthless Mobility.
To reiterate, there are PLENTY of people who need to work on improving their mobility in the traditional sense – mobility drills, stretching, etc – and Dean covers that in droves here. So whether you or some of your clients need to work on mobility in specific areas (t-spine, hips, etc), this resource provides a TON of options.
Dean’s not a small human being. He practices what he preaches, and it’s amazing to see how supple he is in his own right! Trust me: you’re going to be watching the videos and think to yourself, “is that Dean Somerset or Houdini?”
But of more value, and more germane to the point(s) I made above, Dean covers stuff that most fitness peeps gloss over or fail to understand altogether. And that’s why I wholeheartedly feel this is THE next “go to” resource on the topic.
Not only do you get 4-5 hours of brilliant content, but you also earn valuable CEUs to boot. So there’s that to consider as well.
Ruthless Mobility is currently on sale at a heavily discounted price, but the sale ends tonight (July 4th). Get on it people. You won’t be disappointed.
Nevertheless, in conjunction with Dean Somerset putting his Ruthless Mobility resource I sale TODAY (through July 4th) I wanted to share a few thoughts on the topic (mobility/movement/general badassery) that maybe some of you reading would find useful or interesting or mildly captivating.
Captivating like this picture of a kangaroo punching someone in the face:
1. Anterior Pelvic Tilt Doesn’t Always Have to be Fixed, Nor Is It Bad. Everything Will Be Okay. Seriously.
New Client: “I’m so excited to work with you. I was told by my previous trainer I had anterior pelvic tilt.”
Me: “Okay, explain.”
New Client: “Well, I went in for my assessment and he told me I had anterior pelvic tilt and that it needed to be addressed and that he’d write me a program to fix it.”
Me: “I see. How long did you do the program for? And, was it fixed?”
New Client: “I worked with him for eight months, and I don’t know if it was fixed. All I know is that we did a metric shit-ton of stretching, corrective exercise, and very little strength training.”
Me: “Well, that’s unfortunate. Excuse me while I go toss my face into a brick wall.”
Okay, the brick wall comment didn’t really happen…but everything else stated above was said verbatim as I sat down with a new client recently.
Without going into the particulars I went on to state that roughly 7 billion other people in the world “suffer” from anterior pelvic tilt, and that it’s truly reached pandemic levels of clusterfuckedness.
In short: I explained that, aside from scenarios where excessive anterior pelvic tilt may be causing pain or movement dysfunction, having it was not a disease or a scenario which always required intervention.
In fact, APT is considered anatomically neutral. I.e., Your lumbar spine has a natural lordotic curve.
No, it’s not. According to a published study by Herrington 2011, 85% of males and 75% of females presented with an anterior pelvic tilt, 6% of males and 7% of females with a posterior pelvic tilt, and 9% of males and 18% of females presented as neutral. Anterior pelvic tilt is also the most common postural adaptation in athletes according to Kritz and Cronin 2008, and it seems to naturally occur with athletes that do a lot of sprinting. Therefore, it’s actually normal for healthy individuals to possess APT, and the average angle of anterior pelvic tilt ranges from 6-18° depending on the study and methods used to determine the angle, with around 12° appearing as the norm (ex:Youdas et al. 1996, Youdas et al. 2000, Christie et al. 1995, Day et al. 1984).”
As I recall, there’s no definitive test or “screen” which can correlate “x-degrees” of APT and one’s vulnerability to pain and dysfunction.
Some people have APT and walk around in considerable pain, while others have APT (even excessive APT) and have no issues what-so-ever.
However, those coaches with an acute eye for assessment and movement can often use a plethora of screens and tests to ascertain whether or not APT may be something that’s needs to be addressed.
@bensy8585@tonygentilcore1 It needs to be controlled when necessary. Ex: squatting in APT = poor pattern. PPT to neutral, squat cleans up.
To reiterate, APT is not always wrong (or bad)…but it can be problematic once we start allowing ill-prepared people to load the pattern and not only that…begin to add repetitions and/or speed.
Often, it’s the LACK of ability (or our proclivity to refrain from) posteriorly tilting the pelvis when bad things start to happen.10
As Tony B mentions above: There’s a big difference between cueing someone to arch like crazy (and thus encouraging excessive APT, resulting in poor positioning and increased instability) and cueing someone to posteriorly tilt the pelvis to nudge them into a more neutral spinal position.
NOTE: As Mike Robertson notes in THIS article, there is no such thing as a bad cue. However, there does exist poor cues when they’re not applicable to the individual or are used haphazardly (because you heard someone else use it).
2. Thoracic Spine Endurance is Often Overlooked
A huge shout-out to Mike Reinold for hammering this point home in a recent Inner Circle I watched on How to Improve Thoracic Extension.
Mike noted that in order to improve t-spine extension it is important to work on mobility (Windmills, Bench T-Spine Mobilizations, Quadruped Extension-Rotations, etc), however we can’t dismiss the importance of ENDURANCE in order to maintain it.
Mike also noted that with regards to posture, “sitting upright is fictitious.” The amount of hours many of us spend in a flexed position far out-weigh the number or hours we’re upright. As such, keeping an upright posture is freakin exhausting.
My words, not his.
Building spinal endurance (not strength) is key here.
Don’t get me wrong: strength is (and always will be) important. A healthy dose of horizontal rowing (DB rows, seated rows, chest supported rows, Seal rows) is never a bad thing.
However, when we’re talking about our “posture muscles” – the muscles that need to be on all day in order to keep us upright – endurance is the name of the game.
3. Lack of ROM Isn’t Always Because You Need to Stretch More
The second someone is told that they lack range of motion (ROM) in any part of their body, they’re immediately shown 37 different stretches and ways to “smash” their tissue.
Many end up cranking this joint and yanking that joint till their blue in the face.
One of the more common examples I like to use here is lack of shoulder flexion (or ability to elevate the arms above one’s head).
Many people are unable to do so without some form of compensation via forward head posture, rib flair, and/or excessive lumbar extension. Picture on the left.
The fix can be any number of things: addressing lat length, fighting a zombie, poor anterior core control, poor tissue quality in the pecs/pec minor, you name it.
And none of those approaches would be wrong. Fighting zombies is awesome.
However, stretching tends to be the “go to” modality for many fitness professionals, and frankly it isn’t always the answer.
Oftentimes, taking the time to teach people to get 3D expansion of the rib cage with their breath (front, side, and into the back) and then learning to fully exhale (to get rib cage down and promote better engagement of anterior core) will help to “open up” the thorax.
I can’t tell you how many times I’ve tested someone’s shoulder flexion and saw an immediate 10-20 degree improvement after having them perform ten good breaths.
I call it my Gandalf moment.
Except, you know, I’m not a wizard.
Did Someone Say Gandalf?
For more insights on the topic and wizard-like shenanigans I’d recommend checking out Dean’s Ruthless Mobility.
You get FIVE hours of content (digital or DVD) from one of the smartest coaches I know on assessment, corrective exercise, and how to get people moving better.
What’s more, CEUs are available AND it’s on SALE at close to 50% off the regular price.
Today’s guest post comes courtesy of Canadian health and fitness professional, Dave Smith. He shares some excellent advice on how we can better assess our clients’ willingness to change.
Have you ever had a client who was extremely eager to jump into the health and fitness lifestyle?
They’ve bought their new fancy running shoes, pedometer, sweat pants, and they’re ready to go.
You sense this eagerness, and to help them, you construct an intensive diet and training plan that will help them achieve their goals.
1 week passes – everything is going well.
2 weeks pass – they’ve missed a training session.
3 weeks pass – they’ve missed 3 training sessions and only followed the diet plan for 2 days of the week.
4 weeks pass – they’ve given up. Dieting and training just “isn’t for them.”
We’ve all had these types of clients in the past, and it can be very misleading – one day they’re inspired and motivated to be healthy, the next day they’ve given up and are back to their old ways.
It’s important that when you’re working with new clients, you assess the stage that they’re at regarding to how willing they are to make changes.
You have to see past the initial excitement that they may have, and make a proper assessment of their level of dedication to changing.
The 5 Stages Of Behavior Change
The Transtheoretical Model is a handy little tool that you can use to assess your clients willingness to change – in this case, a change in their training and eating habits.
These 5 stages are:
Pre-Contemplation: The person is not planning on taking action at all
Contemplation: The person is aware that their behaviour is problematic, and is beginning to educate themselves on the changes necessary
Preparation: The person is preparing and is ready to take action in the near future
Action: The person is making changes to their behavior
Maintenance: The person has now made those changes a habit and is a part of who they are
Using these 5 stages, we are able to assess our clients and their willingness to change.
The Reason Why The Stages Of Change Are So Important
Understanding the stages of change is crucial for being able to properly assess a new client’s ability to build new habits.
For example, let’s look at a new client that we’re working with named Jimmy.
Jimmy’s a cool guy. He’s 32 years old – wife and two kids, works a standard office job.
So Jimmy comes to you looking for a training and diet plan that will help him with his goal. He seems extremely eager, energetic and ready to go all out with the new plan that you’ve written up for him.
But you’ve seen this too many times.
Too many times clients have come to you with the energy of a kid in a candy store, only to have that energy drained after a mere three weeks.
Not only have they upset themselves, but it can also can give the impressions that the service you’re providing is sub-par.
The reason why it’s important to recognize the 5 stages of behaviour change is because it allows you to see past the initial excitement and assess your client’s willingness to change in a long-term perspective.
So now when Jimmy comes to you ready and wired, it’s your job to ground his excitement and assess where he’s really at.
Not only will it prevent him from being upset in the future if he decides to drop off at the three week mark, but it also prevents the chance that your reputation is tainted.
3 Questions For Assessing Your Clients
To do this assessment, here are three questions you can ask Jimmy that will bring down the initial wavering excitement levels and decide if he REALLY is ready for change.
1. Have you tried anything previously to make progress towards your goals?
If Jimmy tells me he’s tried everything from calisthenics to Olympic lifting, there’s a good chance that he’s probably in the preparation stage. He’s searching for answers but hasn’t figured out an appropriate action plan.
This is shown by Jimmy’s inability to pick a path and stick with it. This might also tell you that Jimmy is looking for a “magic pill” to solve his problems. Maybe he’s looking for the quick fix rather than sticking with one plan.
2. What, specifically, has stopped you in the past from reaching your goals?
This is where you get to see if Jimmy comes up with an external excuse or not.
If Jimmy tells you he hasn’t had enough time because of work, or because his wife and kids have kept him too busy – you can recognize that he’s probably in either the Contemplation or Preparation stage.
While he sees value in adding more muscle to his frame, his priorities lie elsewhere.
Throwing him into an intensive program is doomed to fail (at this point).
Jimmy needs to be introduced to change more slowly.
3. Using a scale of 1 to 10 (1 being “there’s no way” and 10 being “definitely will do”), would you be able to exercise for _minutes for _days this coming week?
This is the ultimate test of Jimmy’s willingness to change.
In this case, Jimmy says that he’s probably at a 6 when it comes to exercising 45 minutes, 4 times per week: He’s got a lot of commitments next week, but he’s ready to “try his best.”
Is a 6 rating really that convincing?
Do you really want to give a client a task that has at least a 40% chance of failure? (I say “at least” because most clients overestimate their ability to take on change in the beginning!)
Identifying a Willing, Ready, and Able Client
Question #1 gets the ball rolling. It lets you see how new or experienced your client is with training and nutrition, and also his level of interest in these two areas.
Question #2 throws a curve ball to the client. He is perhaps thinking you’re just asking a basic question, but really you’re screening the client to see his attitude and willingness to change.
If your client blames the reason of not reaching their goals on external factors – deflecting the reason to things such as not enough time, too busy with work, the wife not cooking healthier meals or the kids bringing home junk food – then this is a sign of someone who’s in one of the earlier stages of change.
Again, the notion of wanting change is there, but perhaps not at the expense of other enjoyable things in life.
However, if they take responsibility for their actions or lack of, then that’s a good sign of someone who could possibly be ready to get started.
Question #3 is the true test of a client’s willingness to change. “Action speaks louder than words”, and we’re about to find out how loud their actions really are.
Any number they give you shows their level of commitment to following a training and nutrition plan.
Any number between 1 and 3 is a sign that they’re probably not ready for much of a change.
A number between 4 and 6 is an okay, mediocre response. A small change may be possible.
A number between 7 and 10 is a good sign that they’re ready to go. Let’s take them into Action.
Changing Your Plan For Different Behavioral Stages
You can’t give a client an intensive, thorough training and nutrition plan when they’re not ready to change, so it’s important to identify which stage your client is at and adjust their needs from there.
Remember, the majority of them are going to say “they’re ready for everything right now” when their excitement levels are high, but it’s your job to assess how willing they truly are.
Clients that are in the Precontemplation stage need help finding their “why.” Help them see why it’s important to work out and eat healthy. You can relate it to having more self-confidence, living longer so they will be able to spend more time with their family etc.
Once you find their why, keep tapping on that pressure point.
Clients that are in the Contemplation stage will benefit by showing what they can achieve as well as the sacrifices they’re going to have to make to achieve it. Also a basic level of the how to achieve their goals will help them.
Clients that are in the Preparation stage will benefit from organizing a custom plan for them. Sorting out times that they’re able to exercise, recipes that are healthy and they also like etc. Anything that is customized for them and moves them towards taking action.
When the client has reached the Action stage, they’re now to start working on the fitness plan that you’ve customized for them. Remember to not jump the gun and start with extreme exercise sessions to begin with. Gauge where your clients fitness levels are at and work your way up from there in small steps.
Once your client is in the Maintenance stage, you’re now able to just keep the ball rolling and help them so they don’t fall back to their old ways. Spice things up every now and then with different exercises, challenges; perhaps increasing their training frequency or adding some extra healthy snacks.
Remember, you’re the professional. You’re the leader. It’s up to you to properly assess a new client and then deliver a program that has the highest likelihood of success.
About the Author
Dave Smith is a professional fitness and weight-loss coach who was chosen as “Canada’s Top Fitness Professional” in 2013. He shares awesome health and weight-loss tips through his blog and podcast that you can find at makeyourbodywork.com.
I often joke that “lifting weights isn’t supposed to tickle.”
When you’re pushing, pulling, carrying, thrusting, and otherwise hoisting things around for the heck of it…you’re bound to end up with a few bumps and bruises along the way.12
Honestly, I can’t think of the last time my body was 100% devoid of any type of soreness or semi-nefarious “huh, well that doesn’t feel fantastic” sort of vibe.
I’m not referring to pain. Nothing that diminishes my ability to live my day-to-day life. Just, you know, sometimes my first step out of bed or sitting down to drop it like it’s hot isn’t the most enjoyable experience in the world.13
(Anyone who’s performed heavy squats the day prior can commiserate).
A lifetime of playing sports and training will do that to a body.
But that’s the point.
Lifting weights and pushing the body outside it’s comfort zone is what allows us to adapt and come back stronger and more resilient; to take on the world (or the squat rack) and tell it to GFY.
All that said: it still sucks donkey balls when the inevitable happens. We take things too far, go too heavy, or move juuuuust the right way for something wrong to happen.
Arguably, nothing stagnates or deflates progress more in the gym than a jacked up lower back.
Statistics will say that we’ve all been there. Or, alternatively, as fitness professionals, have worked with someone who’s been there.
So I figured today I’d shoot from the hip and fire back some quick-hitting suggestions/insights/alternatives to consider when working with someone dealing with low-back pain.
In No Particular Order
1) Except for this one. This is super important.
I’ll kick things off with the grandiose, off-kilter statement that if something hurts…don’t do it.
https://www.youtube.com/watch?v=a1Y73sPHKxw
Fucking profound, right?
Dr. Stuart McGill will advocate for provocative tests/screens to be performed – slump test, toe touch, McKenzie drills, etc – in order to figure out the root cause or possible source of someone’s back pain.
The stark contrast should be done outside of that window. It’s imperative as a coach, trainer, clinician, wizard, to demonstrate pain-free movement to the client/athlete. The objective should be to mute or pump the brakes on pain and start to mold more of a “movement quality” campaign.
Dr. McGill often refers to this as “spinal hygiene.”
A more “user-friendly” text would be his latest book, Back Mechanic.
3) Back to “spinal hygiene.”
The good Doc refers to this as:
“The daily upkeep of your back. It includes your recovery exercise routine as well as changes to your existing daily motions all day long. Success in removing back pain requires removal of the movement flaws that cause tissue stress.”
This could refer to something as simple and innocuous as teaching someone how to sit in a chair properly, or even how to stand up from a chair.
As counterintuitive as it seems, those who have more flexion-based back pain will feel more comfortable in flexion. Likewise, those with extension-based back pain will feel at home in extension.
It’s weird.
So, often, taking the time to clean up activities and endeavors outside of the gym will be of most benefit.
As the saying goes: “we as trainers/coaches have 1-2 hours to “fix” things, and the client/athlete has 23 hours to mess it up.”
Other things to consider:
Walking. This is an excellent fit for those with low-back pain. It’s just important to make sure they’re not defaulting in forward head posture and a slouched posture. McGill refers to this as the “mall strolling” pattern. One should be more upright and swing the arms from the shoulders (and not the elbows). This provokes more of a “pertubation” to the body helping to build spinal stability.
Grooving more remedial hip-hinge patterns like I discussed in THIS article. Getting someone to dissociate hip movement from lumbar movement is a game-changer..
Pigging back on the above, the hip hinge creeps its way into EVERYDAY things like brushing one’s teeth or bending over to pick something up off the ground (golfer’s lift). Anything that can be done to spare the spine (discs) and make it less sensitive to pain is a win – no matter how trivial the activity.
4) Synchronous Movement
Learning to “lock” the ribcage to the pelvis is another key element to managing back pain. The abdominal brace is of relevance here. Basically the entire core musculature – not just any one muscle (ahem, transverse abdominus (drawing in method) – needs to work in concert and fire synchronously to spare the spine and offer more spinal stability.
One drill in particular that hammers the point home is the Wall Plank Rotation.
Here an abdominal brace is adopted and the objective is to “rotate” the entire body as one unit, locking the ribcage to the pelvis. Many will inevitably rotate through their lumbar spine and then the upper torso will follow suite.
5) Neutral Spine – Always (But Not Really)
The spine IS meant to move.
Neutral spine is paramount, but it benefits trainees to tinker with end-ranges of motions (in both flexion and extension) if for nothing else to “teach” the body to know how to get out of those compromising positions – especially when under load.
During our workshops together, Dean Somerset will often demonstrate to the trainees how squatting into deeper hip flexion (unloaded, and to the point where butt wink happens) can be of benefit to some people. The notion of learning where a precarious position is (and how to get out of it) is valuable.
I’ll use the simple Cat-Camel drill to teach people that it’s okay to allow the spine move.
Also of Note: I’d argue we’ve been so programmed into thinking that all spinal flexion is bad and that a baby seal dies every time we do it, that it’s caused a phenomenon referred to as reverse posturing.
The idea that more and more people are now “stuck” in extension, and thus at the mercy of a whole spectrum of other back issues (spondy, etc).
Suffice it to say: we can’t discount Rule #1…helping to build improved spinal endurance/stability.
Plain ol’ vanilla planks come into the picture here.
This:
Not This:
This:
Keeping people honest and accountable on proper position (not “hanging” on passive restraints and dipping into excessive lumbar extension) is kinda of important.
Rule of thumb is to be able to hold a prone plank 120s, side plank (per side) for 90s. McGill will note it’s a RED FLAG if there’s a huge discrepancy between right/left sides.
I prefer more of an RKC style once someone is ready. This helps to build more bodily tension, to the point where everything – quads, abs, glutes, eye lids, everything – are firing. Ten seconds is torture when done right.
However, we can always graduate to less vomit in my mouthish exercises. As much as planks are baller and part of the equation to helping solve someone’s back pain, they’re about as exciting as watching a NASCAR race.
6) A few favs include:
Elbow Touches
https://www.youtube.com/watch?v=AUgz2U65KPc
Progressing lower and lower towards the ground.
Farmer Carries – all of them
Offset Loaded Exercises
I love offset loaded exercises for a variety of reasons. But most germane to this conversation is the fact that there’s a heavy rotary stability component when performing them.
Getting people moving and performing more traditional strength & conditioning drills – assuming they’re pain free and of high movement quality – will help to get them out of “patient mode,” and more excited to stick to the plan.
7) A Few Other Ideas to Consider
Don’t be an a-hole and marry yourself to the idea that everyone HAS to deadlift from the floor and that everyone HAS to pull conventionally.
Sometimes we have to set our egos aside and do what’s best for the client/athlete and what’s the best fit for them. I think the trap bar deadlift is a wonderful tool for people with a history of low back pain.
To steal a quote from Dr. John Rusin:
“Without sending you back to Physics 101, the forward position of the barbell causes a less than optimal moment arm to stabilize the core position in neutral while moving some serious loads off the floor.
During the traditional deadlift, the center of mass (barbell) falls in front of your body, therefore causing the axis of rotation of the movement to be farther away from the load itself. This all translates into increased shearing forces at the joints of the lumbar spine, putting all the structures, including intervertebral discs and ligaments at increased risk of injury with faulty mechanics of movement.”
The trap bar deadlift results in a better torso position for most people and less shear load in the spine. For anyone with a history of low back pain this is a no-brainer.
Use an incline bench rather than a flat bench when programming pressing movements. It’s just an easier scenario for most people and less “wonky” of a position to get in and out of.
Too, program more standing exercise variations – standing 1-arm cable rows, pull-throughs, landmine presses, Sparta kicks to the chest.
During the Complete Hip & Shoulder Workshop in Seattle last weekend I spoke on the importance of the test/re-test concept with regards to assessment.
It’s nothing fancy or elaborate.
You test something – whether it be range of motion or maybe a strength discrepancy – implement a “corrective” modality if something’s deemed out of whack, and then re-rest that shit to see if it worked.
The test/re-test approach helps set the tone for any future “corrective” strategies or programming considerations you’ll do as a coach or trainer.
In addition, and something I’d argue is equally as important, it also provides an added layer of value to the assessment.
If you’re able to demonstrate to someone a significant change or improvement in ROM or reduction in pain/discomfort by implementing a drill or two, and it’s something they’ve been struggling with despite countless interactions with other fitness professionals, what’s the likelihood they’ll bust out their checkbook or Bitcoin wallets (<—depending on their level of geekery)?
I suspect highly likely.
It demonstrates a perceived level of “mastery” and knowledge-base towards the assesser (you) and, in a roundabout, reverse psychology kind-of-way, delves into the “pain center” of the assessee (athlete/client).
In this example it can refer to literal pain such as a banged up shoulder, knee, or lower back. But it can also speak to pain in the figurative sense too. Someone who’s frustrated and “had it up to here!” that they can’t lose weight, or maybe an athlete who was cut from their high-school team would have a degree of “pain” that would incentivize them to take action.
Show someone success or a clear path of action, however little, and they’re putty in your hands.
Of course this assumes you’re not some shady shyster who tries to up-sell the benefits of some super-secret concurrent, 47-week, Easter-Bloc training program you copied from Muscle & Fitness or, I don’t know, organic raspberry ketones laced with mermaid placenta.
People who promote and use smoke-and-mirror tactics are the worst.
But lets get back to the topic at hand.
Test/Re-Test
One of the main screens I use with my athletes and clients is their ability to lift or elevate their arms above their heads.
Shoulder flexion is important for everyone, not just overhead athletes and CrossFitters.
If someone lacks shoulder flexion, and they’re an athlete, it’s going to affect their performance. A baseball pitcher may be “stuck” in gross shoulder depression, which in turn will have ramifications on scapular positioning and kinematics, which in turn will result in faulty mechanics and compensatory issues up and down the kinetic chain.
Conversely, regular ol’ Hank from accounting, who likes to hit the gym hard after work, if he lacks shoulder flexion, he too could have numerous issues arise ranging from shoulder and elbow pain to lower back shenanigans.
Shoulder flexion – and the ability to do it – is a big deal in my opinion. And it’s a screen that should be a high-priority in any fitness professionals assessment protocol.
So lets say I’m working with someone who lacks shoulder flexion. I test it both actively (standing, picture above) and passively (on a training table).
I surmise that it’s limited and that it may be feeding into why a particular person’s shoulder has been bothering him or her.
I can use the test/re-test approach to see if I can nudge an improvement.
Now, as I’ve learned from many people much smarter than myself – Mike Reinold, Sue Falsone, Dr. Evan Osar, Dr. Stuart McGill, Papa Smurf, etc – you shouldn’t rely on any ONE screen/corrective.
Everyone is different, and what works for one person might not even scratch the surface for another.
With regards to addressing (lack of) shoulder flexion15, there are a handful of “go to” strategies I like to use.
And then it’s just a matter of seeing which one sticks.
1) Encouraging a Better Position
In order to elevate the humerus (arm) above your head, the scapulae (shoulder blade) needs to do three things:
Upwardly rotate
Posteriorly tilt
Protract
The ability to do so is vastly correlated with the thorax. Those who are super kyphotic (ultra rounded upper back) will have a hard time elevating their arms overhead. Often, the simple “fix” here is to foam roll the upper back and work on more t-spine extension and you’ll almost always see an improvement.
Bench T-Spine Extension
Side Lying Windmill
But what about the opposite? Those who are stuck in more “gross” extension and downward rotation?
I.e., the bulk of athletes and meatheads.
Here the shoulder blades can be seemingly “glued” down.
In that case some positional breathing drills to “un-glue” the shoulder blades (and to encourage more 3D or 360 degree expansion of the ribcage/thorax) would be highly advantageous.
All 4s Belly-Breathing
It’s amazing what a few minutes of this drill can do with improving shoulder flexion ROM, without having to yank or pull or “smash” anything.
2) Allow the Shoulder Blades to Move
Some people simply don’t know how to allow their shoulder blades to move. A prime example is this past weekend.
An attendee who’s a personal trainer – but also competes in figure – mentioned how her shoulders (especially her left) had been bothering her for eons, and she couldn’t figure out why.
We had her perform this drill.
1-Arm Quadruped Protraction
In reality, both protraction and retraction are occurring, but many people have a hard time with the former.
The idea here is to learn to gain movement from the shoulder blade itself and not via the t-spine.
Here’s another angle (because, triceps):
https://www.youtube.com/watch?v=eyNFNxqFlSc
After a few “passes” with this drill, she saw an immediate improvement in her ROM. What’s more, the following day when she showed up for Day #2, the first thing out of her mouth was “my shoulder feels amazing today.”
That’s a win.
3) Pin and Go
Another route to take is to have the person foam roll their lats. Not many people do this, and there’s a reason why: It’s un-pleasant.
I’ll have the person spend a good 30 seconds or so on each side and then have them stand up and perform a simple SMR drill using a lacrosse ball against a wall.
They’ll “pin” the teres minor down (basically, find the tender spot behind their shoulder and hold it there) and then work into upward rotation.
https://www.youtube.com/watch?v=9OiGt_O1FvY
Another five or so passes here, and I’ll re-test.
Many times I’ll see a marked improvement in their shoulder flexion.
Caveat
NONE of this is to insinuate that anything mentioned above will work for everyone. The idea is to understand that it’s important to “test” a number of modalities and then re-test to see if you find an improvement.
If you do, you’re likely barking up the right tree which will make your corrective approach and subsequent strength training more successful.
properly, or even how to stand up from a chair.
