Do you have your daily dose of soft tissue work?

I have been reviewing my skills and knowledge (as is the path of development) according to how I work with my clientele. I strive for an approach that is effective, efficient and simple. Over the past month or so, I've been wading through data, trying new techniques and finding what works best for me and my clients. More or less, I've been a bit reflective.

1. SOFT TISSUE
2. STABILITY, MOBILITY (STRENGTHENING & FLEXIBILITY)
3. SPECIFICITY

I like to call this "The Three S's"

SOFT TISSUE:

Manual therapists can help improve function, reduce swelling, improve recovery, increase tissue viability, prepare athletes for competition, propagate rehabilitation and affect psychological well-being. In fact, the research is suggesting that the combination of soft tissue work and neuromuscular stretching such as PNF has a larger impact on ROM than stretching alone. This article (2011) by Renan-Ordin et. al., suggests that manual therapy specifically targeting trigger points (which is a local contraction in a small number of muscle fibers in a larger muscle bundle/motor unit that when compressed will elicit a pain response) followed by stretching provided short term benefits for men and women experiencing plantar heel pain. Can we assume that these fascial relationships are probable and responsive throughout the rest of the body? I do. Trampas et. al. (2010) state similar results here in a study including 30 males with tight hamstrings who were divided into two groups. Group 1 received stretching only. Group 2 received manual therapy in addition to the stretching protocol. Guess which group increased ROM? That's right - Group 2.

Best bet:

• Physical Therapist, ATC, Chiropractor or other tactile based clinician
• Massage Therapist (Sports/Kinesiology focused or equivalent)

Here are some tools you can use if you are not a state licensed manual therapist:

• Medicine Ball
• Tennis Ball
• Foam Roller

Below is an example of "The Stick".

If you would like to learn more about how to perform rolling, check out Mark Verstegen at Core Performance here. A true professional - his instruction is pristine.

Tip: Just ensure you are not rolling over any edema (swelling or bruising), varicose veins or those with chronic pain disorders such as fibromyalgia.

At Efficiency in Motion and NPTI Seattle, we focus on leading with soft tissue work during the preparation of activity (workout, game, etc...) on areas that are extremely over-active - then move directly into the dynamic prep. Afterwards, we slow it down and spend more time on soft tissue before moving into active and passive based flexibility exercises. We find this helps to improve ROM, movement efficiency, kinesthetic response and recovery after a hard workout.

As for the other two aspects listed above, we'll dive into that later. For now, begin to incorporate soft tissue into your life and gain the psychological and physiological benefits that many of us have been tapping into for years.

Enjoy!

A Good Day in the Neighborhood

I've recently been working with a client who had a complete right side iliofemoral replacement. Common symptoms included neck pain, low back pain and a feeling of overall tightness throughout her body from her shoulders to her pelvis. The low back pain would begin early in the morning and last throughout the day.

Upon assessment I found the following:

• During a prone glute assessment that her right side glute was significantly weaker than the right (go figure), however both were very weak.
• A overhead squat test shown a significant asymmetrical weight shifting to the right side, reduced shoulder mobility due to tight lats - she was unable to fully lift the bar over her head, it was stuck out front (confirmed this with the supine lat assessment).
• Active leg raise shown bilateral mobility issues, but more so on the right with excessive lateral rotation of the iliofemoral joint during full knee extension. Upon further investigation, I suspected her piriformis for the increased degree of lateral rotation.
• Client was unable to perform a complete toe touch with a feeling of stiffness in her low back and hamstring area.
• A seated T-spine rotation assessment suggested a severe limitation in her ability to fully rotate to either side (20-25 degrees bilaterally).

Session 1-3

We focused on mobility. She was experiencing a large degree of "stiffness". As such, I wanted to help her feel less restricted. I introduced her to glute and T-spine exercises, focusing on full range of motion and the control of eccentric forces. We wrapped it up with a bit of soft tissue on the hamstrings and latissimus dorsi stretch.

Session 4-8

My focus was on increasing scapulothoracic stability (hitch hikers), continued T-Spine mobility and strength through functional movement (primarily lifting with the glutes and shoulders). However, by the seventh session she became overly fatigued as she was training on alternate days. I suggested a reduction of training intensity and re-assessed her glute strength and T-spine mobility. She was able to activate the right side glute for 36 seconds and her left for 52 seconds. T-spine mobility had improved, but not markedly. By the seventh and eighth day, I introduced more soft tissue and flexibility protocols and less strengthening. I focused on the piriformis, hamstrings, adductors and latissimus dorsi - off and on static/PNF protocols.

Session 9

She came in feeling better and stronger. She stated that she was able to withstand her back pain until well into the afternoon and that she felt less stiff in her pelvic region. I assessed her glute strength and found that she could activate her right side glute for over 1 minute, with her left side following suit - I was pumped! I incorporated a few exercises for her glutes and ST joint, stretched her hamstrings and piriformis (PNF) then sent her on her way.

Awesome!

Trapezius Anyone?

As I dive further into my study of the shoulder, its function never ceases to fascinate me. Coming across a study that reflected EMG activity of musculature during over head lifting with stable and unstable loads and surfaces, I found an interesting piece of information that suggests that the role of the trapezius is highly specific .

As their results suggest, increasing resistance using a barbell increases core activation. However, it does not reflect the same linear increase with the trapezius. Their results show little change in the root mean squares and external resistance of 79%, 86% and 89% of the stable surface, stable load lifts - meaning that regardless of load or surface, the trapezius will be firing with the same magnitude during over head lifting. The authors continue to state that the trapezius and it's role as a scapularthoracic (ST) and glenohumeral (GH) stabilizer is specific across all conditions. We also know that the trapezius plays a primary role in scapular elevation and upward rotation during the over head movement, but only after 90 degrees of humeral elevation, yet the forces this muscle has been shown to exert in the study is the same with lighter or heavier loads. In short, we need to condition the trapezius and encourage it's cocontraction with the serratus anterior, rhomboids and other ST stabilizers during rapid limb movement.

Look at it this way:

ST STABILIZERS > GH STABILIZERS > GH LIGAMENTS, CAPSULE & LABRUM

If there is any dysfunction/injury of the ST stabilizers, then the GH stabilizers have to work over time to stabilize the GH joint leading to an altered ball and socket relationship. This can progress to further joint dysfunction, placing increased stress on the ligamentous tissues and possibly pain.

Glenohumeral Ligaments - The Last Line of Defense!

This article is on the ligaments of the glenohumeral joint in reference to “resisting” external rotation forces. Using cadavers, Kuhn and others isolated the glenohumeral ligaments in various positions of external rotation of a neutral or Abducted shoulder then applied incremental forces to anterior-chain tissues (subscapularis and/or long head of the biceps brachii).

Interestingly, two things were found: The capsule works as a “cylinder” that resists external rotation forces and secondly, the biceps brachii plays a role as a dynamic stabilizer during abduction by resisting external rotation forces. This tells me that if things break down in the shoulder (bursitis, tendonitis or rotator cuff tears), then not only will the biceps brachii and glenohumeral (GH) ligaments be the last ditch defense in stabilizing the glenohumeral joint, but will also be responsible for controlling external rotational forces.

Here’s the practical app: This can be very useful to understand with the many externally rotated positions many people place themselves during training: Shoulder presses, lat pulldowns, pull ups, reaching, chopping. By strengthening the scapulothoracic (ST) joint, we can spare repetitive stress on the tissues within and around the GH joint and encourage a fully functioning shoulder complex. Let’s start conditioning the mid/lower traps, rhomboids, serrati anterior to help propagate the forces from the lower body and trunk to into the shoulder with reduced stress on the GH tissues!

Increasing Upper Body Strength by Understanding Shoulder Function

Recently I've held a few workshops for a group of personal trainers and personal training students on shoulder function with a focus on scapulothoracic (ST) stability. After reflecting on my presentation and the many great questions that were asked, I wanted to find a simplistic way to approach a very complicated joint by addressing three concepts. Here they are:

FORCE COUPLES

By understanding the muscles that create a "pull" on a bone or joint, we can better understand its role as a stabilizer or mobilizer. In reference to the ST joint, the trapezius, serratus anterior, rhomboids, pectoralis minor and biceps brachii all have attachments to the scapula and pull in different directions to ensure proper joint kinematics - or "force-couple relationship".Humphery, 2004 discussed how important the force-couple relationshipo of the ST joint as being the "hinge for all functional strength and power". Below is an example of the trapezius and serratus anterior force-couple relationship.

PLANES OF MOTION

Multi-planar movement is a staple of every day life, rehabilitation and athletic development.Oyama, et. al., 2010 compared three-dimensional scapular kinematics during 6 scapular retraction exercises and found that all involved the force couple relationships of the trapezius and serratus anterior and encouraged posterior tipping, lateral rotation and depression of the ST joint - this is of great significance as I believe this will allow the scapula to rest properly upon the posterior thoracic cage at the desired 35-40 degrees which sets the client up for good posture statically and dynamically. Below is a diagram of the three planes of motion of the ST joint.

STABILITY WITH RAPID LIMB MOVEMENT

Planks are great - but we need to get away from ONLY implementing static stability exercises. This is where I believe many fitness professionals become stagnant. "Stability" has almost become the buzz word within the fitness world, but what does it really mean? Stability can best be defined as the ability to control force. These forces that are applied to tissues can originate inside or outside the body - think biomechanics & physics.

Our goal should be to prescribe a progessional training regimine that will allow our clients to improve static stability using isometric and reduced tempo movements with the intent of encouraging the same joint stability during rapid limb movement. In this article, Roy, et. al., 2009 shows a short term improvement with rehabilitating impingement syndrome patients gaining almost immediate benefit by changing the magnitude of forces and incorporating limb movement. Limb movement in this study was performed at "normal daily task" tempo - however, this definitely sets the stage for further investigation and theory that rapid limb movement can further encourage joint stability. In short, moving the arms rapidly can be a viable progression in improving ST dynamic stability - particularly during upward rotation.

Check out this exercise next time you're in the gym!

Gym Magazine Readers

Do you really think you're getting the best workout by staying on the treadmill, elliptical or recumbant bike always going slow and reading a magazine for 1-2 hours?

C'mon now. If you want to get sculpted and in-shape then you need to train like an athlete. Let's be honest: Generally speaking the most overweight individuals are on the aerobic equipment, while the most in-shape individuals are moving weights. This is not by accident. Recent studies have consistently shown that by increasing the intensity of your workout you can burn up to 10-15% more calories within a day than you would if you just "took a Sunday stroll".

Now, I'm not saying that long slow distance or walking is bad. I'm saying that if you want a hard, sculpted body, then you're going to have to force your body to adapt - lift something heavy many times!

Learn how to lift weights properly. Take initiative in your own health. Take your workouts to the next level.

Increase your intensity!

Choosing the Right Fitness Professional

I was asked very recently about how to choose a good personal trainer. In my opinion, a good personal trainer will not just be a "trainer", but a fitness professional. The professional must take into account the needs as well as what the client wants - which often may not be the same. Here is a general approach to a good fitness professional:

ASSESSMENTS:

Assessments help us determine what the client needs (movement analysis), what direction we will be taking our client (road map) and any special considerations that relate specifically to the client (injuries, health issues and goals). The professional will use this information to develop a periodized program specific to the client.

If a professional does not do any assessments or show a plan for success, then I'd call foul.

BEHAVIOR CHANGE vs. OUTCOME

An outcome would be losing 10 lbs. A behavior change would be encouraging a client to be accountable for their weekly training and meal frequency. If a behavior is changed, then the outcome will follow with a focus on implementing these aspects PERMANENTLY into their lives.

Placing your focus on the outcome will leave the client psychologically unchanged in their approach to a plan and can set them up for a fall.

RECORD KEEPING

Does your trainer wing it? Do they ask you what YOU feel like doing in the workout? Answer this: Why pay them if YOU are going to be dictating the workout. I often tell my students, there is a large difference between winging it and changing on the fly. No plan = winging it. Implementing planning flexibility in a changing environment = changing on the fly.

On top of this, how will the trainer record the client's success? It's through validity and reliability that testing (assessment) protocols are founded. If there is no value, how can the trainer help the client? They won't.

Find the value and measure the success. Photos, workouts, re-assessments, body measurements - ANYTHING.

SUMMARY:

Ultimately, I look at everyone as an athlete regardless of age, gender or goals (it's the strength coach in me...). Next time you're with your trainer, or you are thinking about hiring a trainer - take these bits and use them to your advantage.

Good luck!