Movement Assessment Article Archives

Check out all my articles on assessing movement.  Explore the archives below or click the button to subscribe and never miss another post.


Assessing Shoulder and Scapular Dynamic Mobility

Assessing Shoulder and Scapular Dynamic MobilityA thorough assessment of the shoulder must look at the posture and dynamic mobility of both the shoulder and scapula.  More importantly, we need to assess the interaction between the shoulder and scapula and not look at the two in isolation.

Assessing Shoulder and Scapular Dynamic Mobility

Altered scapular dynamic movement can be influenced by many things, so a thorough assessment is needed.  Here is a clip from my brand new educational program with Eric Cressey, Functional Stability Training for the Upper Body. This is part of a lab demonstration of Eric Cressey and I assessing overhead arm elevation and the quality of shoulder and scapular mobility.  In this clip you can clearly see a side-to-side difference and we discuss some of the potential implications:

This is just a very small clip of some of the great information we cover in our Functional Stability Training for the Upper Body.  Click here or the image below to order now before the sale ends!

Functional Stability Training for the Upper Body

Assess Don’t Assume

SFMAI was fortunate last week to swing by and watch my friend Mike Voight teach the SFMA in Boston.  I met Mike’s co-instructors Josh Satterlee and Brandon Gilliam and was impressed with the course.  I have been SFMA certified for some time but I wanted to hear Mike’s take on the system.

I wanted to share with everyone a key theme that was presented that I thought was worth expanding on and sharing.  During one of the introductory presentations, Josh talked about how important the assessment process was and without it, we are just guessing.  This goes along with what I always say, “assess, don’t assume.” [Click to Tweet]

One of the points that was made was that sometimes we get lucky.

Perhaps your client can’t touch their toes and you instruct them to stretch their hamstrings.  Now this person can easily touch their toes.  Take a guess what you are probably going to tell the next 50 people that can’t touch their toes to do?  Probably stretch their hamstrings, because it worked so well on that first person!

We have all been guilty of getting stuck in our box of techniques.  Every time we go to a new seminar or learn something new on the internet, we try it on everyone.  Perhaps we get lucky and hit a bullseye on a few of those people.

We all know there are dozens of reasons why you may not be able to touch your toes, and realistically, hamstring flexibility is not often the reason!  You can’t recommend hamstring stretching unless you have identified that this is the specific reason why your client can not touch their toes.

Don’t be guilty of being stuck in your box of techniques.  Just because it works on one person, doesn’t mean it will work on the next person.  Everyone is unique and has unique needs.

Don’t get stuck in your ways.  As Josh said, chiropractors are great at mobilizing already mobile people and physical therapists are great at stabilizing already stable patients.  I thought that was hilariously accurate!  It really comes back down to your assessment.  I do use the SFMA but also many other assessments techniques (you can see some of them in my Functional Stability Training system).  They help guide me towards what my client needs, I’m not satisfied with being lucky, neither should you.

 

 

Is Resting Scapular Position Important?

Scapular posture assessmentA common component of any shoulder or neck evaluation is observation of scapular position and motion.  Posture assessment is popular and attempts to identify any asymmetries between sides.

As our understanding of the mechanics of the shoulder and scapular improve, the reliability and validity of assessing resting scapular position have recently been challenged.  Many authors believe that we may be overassessing and assuming dysfunction based on resting scapular position, which would imply that many corrective exercise strategies for the scapula may be either ineffective or inappropriate.

I have really changed how I assess and treat scapular dysfunction over the last decade.  My research has led my change in thought process, but other studies have also been reported in the literature.

 

Does Poor Scapular Position Correlate to Poor Scapular Mobility?

My exploration of scapular asymmetries and dyskinesis led me to first assess scapular position.  In baseball players, asymmetries of scapular position are common, and perhaps a normal adaptation.

While these resting static asymmetries were noted, I started to observe that these asymmetries seemed to become much less obvious during active movement.  As an example of this, we noted that the resting static position of the scapula on the throwing side was 14mm lower, which was statistically significant.  However, when the arms were abducted in the scapular plane to 90 degrees of elevation, the scapula was now symmetrical with the nonthrowing shoulder.

Scapular position

This really made me start thinking about the validity of resting static scapular posture.

To further evaluate this, we then looked at 3D electromagnetic tracking to see if poor static posture correlated to poor scapular mobility, or dyskinesis.  We looked at this in a few studies and found that resting static position does not correlate to poor movement patterns.

Several studies have shown that these scapular asymmetries are common in the general population too, so I consider my findings in the overhead athlete relevant to any population.  In my experience these same results occur in other populations.

 

Does Scapular Position Correlate to Injury?

The validity of static resting posture of the scapula has come into recent debate as tests such as the Lateral Scapular Slide Test, described by Kibler, has been shown to find asymmetries in both symptomatic and asymptomatic people.  Static postural tests like this have been shown to have both poor reliability and validity, meaning that we are not sure how accurate they are or what these tests actually measure.

Probably more importantly, however, is the finding that static tests have been unable to identify people with and without shoulder injuries, such as in this systematic review from the British Journal of Sports Medicine.

in a 2-year prospective study of over 100 recreational athletes, a recent study in the International Journal of Sports Medicine showed that static resting scapular position did not correlate to the future occurrence of shoulder pain.  They did note that the people who developed shoulder pain demonstrated decreased scapular upward rotation at 45 and 90 degrees of elevation, further suggesting that dynamic mobility is more important that static.

These studies are difficult to conduct but it appears that scapular asymmetries are common in the general population and do not correlate to injury.  That does not necessarily mean they do not feed into dysfunction, but the correlation may not be as factual as many think.

 

Recommendations

So what do we know about resting scapular position?

Based on our current understanding of scapular posture, it is hard to place a lot of emphasis on static posture as it does not appear to be reliable, valid, correlate to injury, or correlate to poor movement patterns.

I think one of the worst things you can do is assume dysfunctional movement will occur based on a posture assessment.  For example, you would not want to cue excessive scapular movement during arm elevation just because the person is resting in a certain scapular position.  You have a very large chance of just further facilitating your compensatory pattern by forcing the motion instead of finding the underlying cause.

People often seem to forget one VERY important fact:

The scapula is part of the scapulothorax joint.  The position of the thorax and spine will greatly influence the position of the scapula.  [Click to Tweet]

Perhaps an anterior pelvic tilt is causing increased thoracic kyphosis and scapular anterior tilt.  Perhaps a forward head posture is causing shortness of the levator scapula and causing downward rotation of the scapula.  Cueing movement without addressing the alignment, soft tissue restrictions, and other real issues is going to make this a lot worse.

These are just two examples but hopefully demonstrate the complexity of assessing scapular position and mobility.

To learn more about my approach, I have a recorded webinar for Inner Circle members that reviews how I assess and treat scapular dyskinesis, click here to learn more about my Inner Circle.

Scapular Dyskinesis

 

 

Do I still look at posture and scapular position?  Sure.  I start there, but realize that dynamic movement is likely much more important to assess.  I would not recommend that you apply corrective exercises based solely on resting scapular position.

 

 

 

 

How to Integrate Corrective Exercises in Rehabilitation and Performance Training

The latest webinar recording for Inner Circle members on How to Integrate Corrective Exercises in Rehabilitation and Performance Training is now available below.

Integrating Corrective ExercisesHow to Integrate Corrective Exercises in Rehabilitation and Performance Training

This month’s Inner Circle webinar discussed How to Integrate Corrective Exercises in Rehabilitation and Performance Training.  This is a follow up to my last webinar on Why Corrective Exercises Don’t Always Work.  In this webinar, I will discuss:

  • What corrective exercises really focus on
  • How to  classify corrective exercises into specific components
  • My system for determuning which corrective exercises to perform
  • What you can do to maximize the effectiveness of your corrective exercises
  • How and when to integrate corrective exercises into your rehabilitation, fitness, or performance enhancement program

 

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

Can Tight Hip Flexors Cause Tight Hamstrings?

I like the title of this article – Can Tight Hip Flexors Cause Tight Hamstrings?  It is sort of like a riddle, isn’t it?

I was working with a client recently that is knowledgable and understands anatomy fairly well.  He came to see me for several reasons, but high on the list was “my hamstrings are tight” followed by a poor attempt at touching their toes.  His hands were about 3 inches from the floor with his knees bent!  He added, “I don’t know why I can’t touch my toes, I have been stretching and working on my hamstrings for months!”

After spending time assessing him from head-to-toe, I shared with him that I thought his hamstrings were “tight” because his hip flexors were tight.  He thought about it for a second and then tried to call BS, stating “If my hamstrings are tight, shouldn’t my hip flexors be loose?”

My answer was “I don’t think your hamstrings are tight.”  At this point, he was about ready to leave the session, thinking I was the craziest person in the world, stating “but I can’t touch my toes?!?”

 

How Tight Hip Flexors Can Cause Tight Hamstrings

I bet you’ve had clients like this in the past.  They know just enough to be dangerous.  The answer to my riddle is more semantics than anything else.  Yes, hamstring tightness can limit your ability to touch your toes, but that isn’t the only cause.

We have actually done a great job understanding this concept over the last several years.  People like Gray Cook, Lee Burton, Brett Jones, and others have done wonders teaching many people that sometimes there are other reasons why you can have a limited toe-touch, specifically because of poor motor control and core stabilization.

However, hip flexor tightness can be a contributor as well, as backwards as that seems.  Again, it comes down to semantics.  I am actually talking about anterior pelvic tilt limiting your ability to touch your toes.

Here is an interesting an example.  Which hamstring is shorter in the below image?

hip flexor hamstring tightness

If you answered the left leg, you are guessing!  Without a comprehensive exam, you are just guessing.  What if his left pelvis was anterior tilted?  This would cause the proximal attachment of the hamstring to move superiorly and look just like a tight hamstring, such as in this example:

tight hamstring anterior pelvic tilt

Whenever someone appears to have tight hamstrings or can not touch their toes, I look first at pelvic alignment to see if they are in excessive anterior tilt.  Everything revolves around assessing your starting point.

As you can see in the example below, if you are starting in a large anterior pelvic tilt, then you are theoretically starting with the hamstrings long.  I used the simple math numbers of 45 degrees and 90 degrees, which is pretty excessive, but you see what I mean.  In a large anterior pelvic tilt, your normal starting position in this example would already be close to 45 degrees!

Anterior Pelvic Tilt

So, can having tight hip flexors cause tight hamstrings?  I’m not sure about that.  But I know that being in anterior pelvic tilt can limit your ability to touch your toes.  Again, it always comes down to:

Functional-Stability-Training-Lower-Body

Assess, Don’t Assume

This is one of my major concepts from the Functional Stability Training for the Lower Body program.  Assess alignment before you just start treating.  Resist the urge to just foam rolling, massaging, and stretching your hamstrings without truly assessing if this is the reason why you can’t touch your toes.  Sometime having tight hip flexors and an anterior pelvic tilt can limit your ability to touch your toes just as much.

How to Get the Most Out of the Start of Your Baseball Offseason Training

It’s been a long summer of baseball and it is time to start thinking about your offseason training program!

Some people think of the offseason as a time to rest, or to get away from baseball, or to do everything they can to dominate again next season. I’ve seen every spectrum of player, from the player that wants to just sit in a tree stand until February to the player that comes in to train the first day of the offseason.

Offseason training programs in baseball are now standard.  Believe it or not, this was not the case 20 years ago.  However, I think there is another golden opportunity that many players do not take advantage of at the start of the offseason.  Think of it as setting the foundation to prepare your body to get the most out of your offseason training.

Here is what I recommend and do with all my athletes at this time of year to get the most out of the start of your baseball offseason training.

 

Take Time Off From Throwing and Baseball

baseball offseason

Photo by Steve Garner

One of the most important aspects to the start of the baseball offseason is to take a step back and get away from baseball.  While this may seem counterintuitive, I do believe it is critical to your long term success.

For professional baseball pitchers in MLB, the start of the offseason means spending time with family, golfing, hunting, fishing, and probably taking a well deserved vacation to somewhere tropical.  It’s a long season, both physically and mentally.

I wouldn’t say that a summer of baseball is much easier for the younger baseball players, either.  Between traveling teams, tournaments, showcases, and grinding away at practice, the summer is almost as busy as the pro players!  I actually joke with some of my high school and college baseball pitchers that they can’t wait to go back to school to take a vacation from their summer baseball travel schedule!

But there are important physical benefits of taking time off as well.  Throwing a baseball is hard on your body and creates cumulative stress.  Furthermore, several studies have been published showing that the more your pitch, the greater your chances of injury:

  • Pitching for greater than 8 months out of the year results in 5x as many injuries (Olsen AJSM 06)
  • Pitching greater than 100 innings in one year results in 3x as many injuries (Fleisig AJSM 2011)
  • Pitching in showcases and travel leagues significantly correlated to increased injuries (Register-Mahlick JAT 12, Olsen AJSM 06)

I have found that my younger athletes that play a sport like soccer in the fall, tend to look better to me over time.  Sure, that is purely anecdotal.  But specializing in a very unilateral sport may actually limit some of your athletic potential, especially when you are in the certain younger age ranges where athletic development occurs.  Everything is baseball tends to be to one side.  Righties always rotate to the left when throwing and swinging, heck everyone even runs to the left around the bases!

There is plenty of time to get ready for next spring.  Take some time off in the fall and let your body heal up.  You aren’t going to forget how to pitch or lose your release point or feel.  You’ll come back stronger next season.

 

Regen Your Body

baseball regen

Photo by Niko Paix

Tough travel schedule, long hours in a car, bus, or  plane, cheap hotels, bad food, lack of sleep, inconsistent schedule.  Sound familiar?  That is a baseball season.  It’s tougher than you would think on your body.

All of these factors, and more, wear down your body and it’s ability to regenerate.  The constant stress to your body is a grind that drains your energy, increases your fatigue and soreness after an outing, and lengthens the time your body needs to fully recover between outings.

In order to get all that you can out of your off season training, you need to regen your body first.  This begins with the first principle above and taking time away from throwing, but there are also other things you can do to reset and regenerate your body.  You body needs to heal and sleep and nutrition are two great things to focus on at the start of the offseason.  Here are  a few things I recommend:

  • Get on a consistent sleep schedule
  • Sleep at least 8 hours a night
  • Eat a clean diet while avoiding fast food and processed foods
  • Hydrate, hydrate, hydrate

Think of it as allowing your body to get back to neutral so you can start building on a solid foundation during the offseason.  You don’t want to start your offseason training with your body worn down.

 

Clean Up Any Past or Lingering Injuries

baseball offseason trainingI’m always amazed at the amount of people that limp through a baseball season and think that taking some downtime after the season is going to cure all their aches and pains.  What happens many times is that they take time off and then start training or preparing for next season and find out they may feel better but they didn’t address their past injuries.  They still have deficits.  If you wait until you start throwing again to find this out, it’s too late.

All my athletes start the offseason out with a thorough assessment that looks at all past areas of injury, regardless of whether or not they are currently symptomatic.

Many times, strength deficits, scar tissue, fibrosis, and several imbalances are still present after an injury, even if your are playing without concern.  Your body is really good at adapting and compensating.  It will find a way to perform.  This is likely one of the reasons that the number one predictor of future injury is past injury, meaning if you strain your hamstring, you are more likely to strain it again.  You probably never adequately addressed the concern.

You have to dig deep and find the root cause of the injury as well as clean up the mess created from the injury itself.  Remember, many injuries occur due to deficits elsewhere in the body.  Sometimes that elbow soreness is coming from your shoulder, for example.  Resting at the start of the offseason is great for the elbow, but you didn’t address the cause of your elbow symptoms.

 

Rebalance Your Portfolio

baseball assessmentIn the financial world, the concept of rebalancing your portfolio is one of the cornerstones of sound investing.  Essentially at periodic intervals you should assess your current portfolio balance and adjust based on the performance of your assets.  As some of your stocks go up and others potentially go down, your top performers are probably taking up a very large percentage of your portfolio and skewing your balance.

By rebalancing your portfolio at the end of the year, you assure that you redistribute your assets evenly and minimize your risk.

This same concept is important for baseball training.

After a long season of wear and tear you no doubt are going to have imbalances.  This happens even if you get through the season injury-free.  I say this often, but throwing a baseball is not natural for your body.  You’ll have areas of tightness and looseness, you’ll have areas of strength and weakness.  You’ll have imbalances and asymmetries.

In my studies on professional baseball pitchers (you can find some of my published data here and here), and an article on baseball shoulder adaptations), I have found many things:

  • You will lose shoulder internal rotation (if you don’t manage this during the season)
  • Your will gain external rotation, which isn’t necessarily a good thing and needs to be addressed!
  • You will lose elbow extension
  • You will lose shoulder and scapular strength
  • You will lose overall body strength and power
  • Your posture and alignment will change

One of the most powerful things I can recommend for any baseball pitcher is that you get a thorough assessment at the end of the season.  This serves as the most important day to me in your offseason program and the cornerstone of what I do with my athletes.  We need to find out exactly how your body handled the season and adjusted over the way.  Everyone responds differently.

Without this knowledge, your just throwing a program together and hoping everything works out.  This may work one year, but it’s going to catch up to you eventually.  Probably right in the middle of next season!

 

Set a Foundation for the Start of Your Baseball Offseason Training

What is the purpose of all this?  Simply taking time off after a season isn’t enough anymore.  Simply jumping into an offseason baseball training program isn’t enough anymore.  Simply performing a baseball long toss program isn’t enough anymore.

You need to actively put yourself in the best position to succeed.  Offseason training is the norm now a days.  You used to be able to gain a competitive advantage by training your tail off all offseason, but your peers are doing this too.  You can set yourself apart by setting a strong foundation BEFORE your offseason training.  This is not as common and one of the biggest mistakes I see amateur baseball players make each offseason.

Set yourself apart by starting your offseason on the right path.  Take some time off, regen your body, get your past injuries evaluated, and go through a thorough assessment to find ways to maximize your bodies potential.  Do this before the start of your offseason training so you set a fantastic foundation to build upon.

Ready to get started?  Learn more about what we do for baseball offseason performance training at Champion Physical Therapy and Performance.

Champion Physical Therapy and Performance

 

 

The Dale Carnegie Approach to Assessments

We are often guilty of making a big mistake when we are performing assessments.  This applies to both rehabilitation and fitness specialists.

Imagine this scenario, your throat hurts so you go see your doctor.  Your doctor takes pride in being thorough and “getting to the root of your dysfunction.”  Over the course of the next 30-minutes you find out you have high blood pressure, are technically obese, maybe pre-diabetic, have psoriasis on your scalp, and maybe even a little athlete’s foot.

Your next question has to be, “but what about my throat?”  Your doctor responds, “Oh it’s nothing, probably a little post-nasal drip from seasonal allergies.”  Do you leave the doctor’s office happy that you don’t have strep throat or are you depressed that your throat is fine but that your health is a ticking time bomb?

Now I am obviously a fan of thoroughness and preventative medicine, however sometimes we are guilty of overloading our clients with everything that is “wrong” with them.  How many times do you think we do this in our professions?

How many times has a shoulder patient come to you and you find 40 things wrong with their arm, spine, and legs?  How many times has a fat loss client come to you and you are focused on their poor rotary stability and shoulder mobility?

The problem with these three scenarios is not your thoroughness or your findings from the assessments, it is with your delivery.  We recently were all guilty of this when we all discussed my article on assessing overhead arm elevation.  We found a lot of flaws but not a lot of positive findings!

 

The Dale Carnegie Approach to Assessments

dale carnegie approach to assessmentsI started to teach the concept of what I call the Dale Carnegie approach to assessments (If you don’t get the reference, you have some reading to do).  I mentioned this briefly during the lumbopelvic assessment I perform in my Functional Stability Training of the Lower Body program but wanted to expand on this topic.  (photo from Wikipedia)

Here are a couple of key principles of how I implement the Dale Carnegie approach to assessments.

 

Sandwich The Negatives with Positives

Next time you are assessing someone, try this simple task – start and end with something positive.  Try to avoid just bombarding your client with all their flaws, which is really easy to do.  Let’s be honest, we are trained to see the negatives, and you are probably really good at it, right?  Your assessment should not be about finding everything that is wrong with your client to show off your intelligence.  There need to be some positives as well.

What about someone who really has a lot of flaws?  In this case, perform your thorough assessment, take detailed notes, but try to limit what you share with your client to what is only needed to 1) help them reach their goal, and 2) allow you to perform your job as best as you can.

If you can’t find any positives (you really should…), compliment them on their haircut, new sneakers, or anything else, but find something!

I also try to explain that no one is perfect and talk about some of my own flaws.  This seems to relieve a little tension, but your client is still going to focus on themselves.  So try to give them some positive to shift their focus.

 

Arouse in the Other Person an Eager Want

A little earlier in this article we mentioned the fat loss client.  My friend Pat Rigsby and I were talking recently and he asked an interesting question, “Do you think someone who comes to you for fat loss really cares about their shoulder mobility?”  This was a pretty great thought.  I think we sometimes get a little caught up in what “we” want to do with our clients instead of what our clients want.

Again, this doesn’t mean to avoid assessing their shoulder mobility, but rather, talk in terms of your clients’ interests.  You need to connect the dots, as Ryan Ketchum likes to say, and help your client see how addressing your assessment findings are going to help them achieve their goals.

Taking this another step, don’t forget more classic Carnegie wisdom by using encouragement and praising any improvement.  This is important for each session and during re-evaluation periods.  If your clients are seeing gains in “their” goals and “your” assessment, they are going to make the correlation.

 

Next time you have a new client, try using my Dale Carnegie approach to assessments and see what happens – Let me know in the comments below!

 

 

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A Quick and Easy Way to Assess Pelvic Alignment

One of the aspects of the Functional Stability Training programs that I discuss is alignment.

We have really progressed our understanding of functional movement in recent years, however, you may be missing the boat if you assume that we are symmetrical and neutral.  I am a believer that we need to assess and address our alignment before we can properly look at our movement patterns and restrictions.

Some of the more basic tests for alignment, like posture assessment and pelvic palpation, have many flaws and ultimately low reliability and validity.  However, I feel that this is the case when assess in isolation.  I prefer to take clients through a detailed assessment that looks at many different aspects of alignment and mobility.  What you start to see is that patterns emerge.  When several alignment tests are all pointing in the same direction, I start to feel more comfortable about the reliability and validity of my assessment.

I talk about this a lot in FST for the Lower Body and even go through an assessment process where we put the pieces of a puzzle together for one individual.  Below is a quick clip showing a really quick and easy way to assess pelvic alignment.  Next time you assess hamstring length, look down and see what position the leg is in.  Is it rotated?  abducted or adducted?

Because we force the motion and raise the leg in the sagittal plane, if there is any pelvic obliquity, there is going to be a subsequent re-alignment of the lower extremity.

 

How to Assess Alignment by Looking at the Hamstrings

 

This is just a quick clip of one little aspect of the process, and really not very useful in isolation, but a nice little clip to get you thinking when you are stretching or assessing hamstring length on your next client!  Take this into consideration with a full assessment and it’s results may be more useful to you.

 

Functional Stability Training Lower BodyLearn More About Functional Stability Training

If you want to really learn more about these concepts, you should check out Eric Cressey and I’s Functional Stability Training for the Lower Body.  The video above is from this program.  If you’re serious about starting to integrate functional rehab and training, Eric and I’s system will show you what we do.