Meniscus Repair Rehabilitation: Why Are We Still Stuck in the 90’s?

Meniscus injuries within the knee are a common occurrence.  In fact, the National Center for Health Statistics reports that meniscus surgery is the most frequent surgical procedure performed by orthopedic surgeons in the United States, with more than 50% of the procedures performed in patients 45 years of age or older.

Despite this high occurrence, many inconsistencies continue to exist in the rehabilitation of a patient following meniscus repair surgery, particularly involving the rate of weightbearing and range of motion.

I’m still shocked by this and wanted to discuss the recent research that is lending to a more progressive approach to return people safely back to their prior level of function.

Rehabilitation Follow Meniscus Repair

meniscus repair surgery weightbearingRehabilitation after surgical debridement of the meniscus is pretty straightforward. We return the patient’s range of motion, strength and function per their symptoms and let pain and swelling guide the rehab process (a very general guide but one often employed by many rehabilitation specialists).

However, when the meniscus is actually repaired and not just debrided, there are other factors to consider.  When a meniscus is repaired, the tear is approximated using stitches to allow the tear to heal.  

Rehabilitation following a meniscus repair has to be more conservative, however, despite research saying otherwise, there are still many rehabilitation protocols floating around the orthopaedic and sports medicine world that recommend limiting weight-bearing and range of motion after a meniscal repair.  We continue to ignore the literature because of fear that the ‘stress’ on the meniscus with walking and range of motion may be too high.

Unfortunately, many of these commonly used protocols are from the 1990’s. (The current protocols we use can be found at RehabilitationProtocols.com)

So if we’re going to talk 90’s protocols, take a look at these studies from way back when from Shelbourne  and Barber  that showed excellent results in patients undergoing a combined ACL-meniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated ACL reconstruction.

Recent studies from VanderHave and Lind on isolated meniscus repairs have shown similar results using an “aggressive” program of immediate weightbearing compared to a more conservative approach.

I certainly wouldn’t consider these “aggressive” programs, they simply used immediate weightbearing and range of motion.

Again, these studies show meniscal repair outcomes are no different while using restricted weightbearing and range of motion versus an “aggressive” protocol of immediate weight-bearing and unlimited range of motion.

Early Weightbearing After Meniscus Repair

meniscus repair surgery range of motionBut what about the exact mechanisms that many are still fearful of allowing early in the process, like early walking and range of motion? Won’t that put the repair in a position to fail?

We typically immobilize people in full extension during weightbearing, locked in a brace for 4-6 weeks after meniscal repair surgery.

So, if immobilized in extension, why do we limit weightbearing?

During weightbearing, compressive forces are loaded across the menisci. These tensile forces create ‘hoop stresses’, which expand the menisci in extension. These hoop stresses are thought to be helping the healing process in many tears by approximating the tissue.

Furthermore, the compressive loads applied while weightbearing in full extension following a vertical, longitudinal repair or bucket-handle repair have been shown to reduce the meniscus and stabilize the tear, as noted by Rodeo  and more recently by McCulloch.

Early Range of Motion After Meniscus Repair

What about early range of motion?

There is very limited literature on the influences of range of motion on meniscal movement. Thompson showed that during flexion, the posterior excursion of the medial meniscus was 5.1 mm, while that of the lateral meniscus was 11.2 mm.

Looking at meniscal movement as the knee flexes in weightbearing and non-weightbearing you can see there’s less motion, although I really don’t think we know how much motion is detrimental. The motion has been shown to help improve blood flow to the area. This is huge and may aid in the healing process!meniscus biomechanics

What Do We Recommend?

Anecdotally, I can say we have handled meniscal repairs to allow weightbearing and range of motion to tolerance for many years.  Some of the top orthopedic surgeons in the world that I have worked with currently handle a meniscal repair the same as an ACL reconstruction with a meniscal repair .

For an isolated meniscal repair, I prefer the knee continue to be immobilized in full extension for 4-6 weeks but allowed full weightbearing immediately (if a longitudinal repair). For complex repairs, I would recommend limiting weightbearing to partial but understand that the hoop stresses could aid in healing and are arguably helpful and necessary.  For both cases, I would recommend passive range of motion to tolerance.

Trust me, I respect the healing meniscus and continually monitor patients as I progress their range of motion and weight-bearing activities. Things like new joint line pain along the site of the repair, new swelling or a change in pain patterns, and even clicking (although most people have this) are all signs that I may want to further assess and modify my progression.

Based off of this, I continue to stand by my rehab guidelines of full, pain free passive range of motion and immediate weightbearing after a vertical longitudinal meniscal repair. The literature is screaming this same thing at us but we continue to ignore their calls and revert to the 90’s!

What do the surgeons that you work with recommend?  Are any of them still recommending rehab guidelines based on outdated research?  Comment below and let me know, I want to hear what the rest of the country is seeing!

Learn How I Evaluate and Treat the Knee

If you want to learn even more about meniscus rehabilitation, we discuss all of this this and much more in our online knee course at OnlineKneeSeminar.com where we teach you exactly how we evaluate and treat the knee.  Click below to learn more:

What the Top Fitness and Rehab Experts are Doing Differently This Year

At the end of each year, I love to reflect back on the year.  I look through my calendar and tasks lists to see all the things that I accomplished and then plan the upcoming year accordingly.  But in addition to this, one of the things I do each year is look back at what I have learned and what I am doing differently.

This is something I recommend everyone also perform.  If you can’t think of anything you are doing different, you aren’t growing.  Make that your priority for the upcoming year.

This year, I want to share a little bit about what I am doing differently, but more importantly, I decided to ask a bunch of my friends in the fitness and rehab industries the same question.

Notice the underlying themes below.  Plus, notice how many of the people you look up to and would consider “experts” have done so much growing this year.  If they are always pushing to learn and grow, you should be too.

Before we get into what they are doing, I have personally put a lot of emphasis on personal productivity.  We are putting together systems at Champion for almost every aspect of the company.  From the behind the scenes admin work to our actual clinical techniques.

There are two books that I read this year that I thought were outstanding and impactful:

  • Ego is the Enemy – This book blew me away and really made me re-think a lot of what I do.  “Ego” doesn’t have to be a negative thing, don’t take it that way, but prioritizing what you do in life by the outcome has been very helpful.  There are many things we do because of our egos, this book really helps.  I wish I read this book 20 years ago.  This is now something I tell all young people to read ASAP.
  • 15 Secrets Successful People Know About Time Management: The Productivity Habits of 7 Billionaires, 13 Olympic Athletes, 29 Straight-A Students, and 239 Entrepreneurs: I read a lot of productivity books and websites.  This book nailed it.  The advice given is some of the best I have ever read and in a quick and easy format.  If you want to make the most our of your year, start here.  People always ask me how I get so much done.  Besides just simply working hard, this book summarizes many of my techniques.

But more importantly, let’s hear from everyone else.  I simply emailed all these people with one easy question: “What are you doing differently this year?”  Their answers were outstanding.

Thanks to everyone that participated!

 

What the Top Fitness and Rehab Experts are Doing Differently This Year

Greg Robins

greg_robinsOn the training front, I am spending a lot more time having youth athletes build up a work capacity before writing more traditional programming for them. I have found that 3/4 kids I assess would most benefit from 30-40 min of glorified manual labor 3-4x per week.

With more specialization, more technology, more home work, etc., they never move.  Every day is the same. The kids are vastly ill prepared day 1 to see progress with basic weight lifting.

Furthermore, the last thing I want to introduce is more black and white structure. Move it, drag it, carry it, throw it, have fun.

Greg Robins

Strength Coach, Cressey Sports Performance


Dean Somerset

More semi-private training options compared to a couple of years ago. Many people don’t need me counting or correcting every single rep for them, especially if they’ve worked with me for a couple of years, plus the group dynamic tends to push people more than I ever could. Everyone is still working on their own individual program, but just in a group with me running the show.

Dean Somerset

Strength Coach, DeanSomerset.com

 


Tony Gentilcore

tony_gentilcoreNow that I’m on my own and officially a business owner, I’ve become more aware of what it really means to be client-centered and not coaching-centered. I’ve become better at not defaulting to my own biases.

It’s never about me. It’s about the client/athlete. What are their goals? And, does my programming reflect that? To be specific, something I have always been cognizant of, but am now much more aware of is the notion of respecting people’s differences; namely their anatomy.

No one has to deadlift with a straight bar from the floor. No one has to back squat or use a low-bar position or maintain a symmetrical stance. Everyone is different, with acetabulums pointing this way and that, femoral necks with different lengths and angulation, not to mention other things like femur and torso lengths.

Being more aware of not marrying myself to ONE way of doing anything because a textbook told me so has been a nice revelation on my end.

Tony Gentilcore

Strength Coach, CORE


Erson Religioso

erson_religiosoHere is what I’m doing different lately:

In the clinic

  • Using more isometrics and PNF to enhance movement patterns and in many cases restore pain free end range without the need for more complicated manual therapies. Also messing around with blood flow restriction training

Social Media

  • Posting regularly to instagram, one of the last social networks where all of your followers see all of your posts, very different than facebook’s “curated” timeline. Facebook’s reach is at an all time low and bottom line, it’s great for advertising, but not so great for organic reach. Also started a media company with some podcasts, Therapy Insiders, and short form Podcast, Untold Physio Stories. Lastly, my blog posts are A LOT shorter, mostly shorter videos, instead of 5-7 minute videos.

Learning

  • Listening to more podcasts, Health Fit Biz, #AskMikeReinold. Still using feedly to keep up with my regularly read blogs.

Business

Teaching

Erson Religioso

Physical Therapist, TheManualTherapist.com


Erwin Valencia

erwin_valenciaOnce described as “A Google Guy trapped in a Sports Medicine Body” by a fellow Major League Baseball Athletic Trainer, I’ve now added the word “Spiritual” to that phrase, as I began my third year in the NBA.

I’m grateful everyday for the opportunity to run my truly “whole-listic” platform here in New York, thanks to the unwavering support of my idol, my guru, and my team’s president, The Zen Master himself, Phil Jackson.

As an organization, we’ve been at the forefront of innovation in realm of Sports Science in the US for almost a decade, without needing public accolades or press to validate what we do. With that being a status quo for us, we’ve added other elements to our sports performance algorithm, this time enhancing more than just the 5 senses of each of our athletes, allowing them to truly be the best versions of themselves, Mind, Body, and Spirit.

Erwin Valencia

Director of Training and Conditioning, New York Knicks


Pete Dupuis

pete_dupuisI don’t know if I’d call it different, per se, but I’m getting back to my roots a little bit and scheduling routine “fitness tourism” so that I can have an ongoing feel for what’s working elsewhere. I tell almost every consulting client I work with to get out and see other facilities in action, but tend to forget that this information applies to me as well.

Just because CSP is attracting a ton of observational guests doesn’t mean that I can stop taking my own advice and seeing others do their thing.

Pete Dupuis

Co-Owner, Cressey Sports Performance


Ken Crenshaw

ken_crenshawWe have continued to evolve our understanding of PRI / DNS / FRC methods for muscle activation / inhibition based off individual assessment.  We have added in manual therapy options  (FDM-Fascial Distortion Method and FM-Fascial Manipulation per Stecco) to aide in finding balanced posture and movement.

We have been using Blood Flow Restriction units in extremity rehab which seems to have some good promise.

Tim Brown has given us some really nice options for using kinesiotaping to help function.

Our Performance staff has had the luxury of being in association with the ALTIS  training center in Phoenix, this has given us some great movement training.

One of our biggest pushes has been personal development / team development / communication. The Landmark Seminars for personal development have helped several of our staff members. Leadership development is always one of our foundations and the article link below may give some insight on our philosophy behind it.

http://pbats.com/the-culture-of-outstanding-leadership/

Ken Crenshaw

Head Athletic Trainer, Arizona Diamondbacks


Pat Rigsby

pat_rigsbyThis year what I’ve done differently…

  • I’ve spent my first full year in my ‘new’ business after selling my stake in a number of other ventures. During this time I’ve really narrowed my focus to ‘helping entrepreneurs build their ideal business’ rather than just helping people grow businesses. While it may not sound like much of a difference – it’s given me a lot of clarity on who I’m trying to serve and how I’m trying to serve them. From my perspective (and hopefully from the outside) it feels much more like being a specialist versus a generalist.
  • I’ve also enforced pretty rigid guardrails as far as my business is concerned, saying ‘no’ to more things that ever before. What I’ve come to find is that the more things that are a wrong fit that I say ‘no’ to, the more opportunities that seem ‘right’ tend to come my way. Whether it’s the length / amount of travel or the type of client I take on, selecting the right fit has actually caused me to be more creative in how I reach my professional goals – yielding really good results.
  • Along those same lines – I’ve narrow what I do to: coaching, connecting, creating, strategic planning and idea creation. Everything else gets outsourced to people who are better at those respective things. By rough estimate, I’ve spent about 85-90% of my professional time doing things I really enjoy – a much higher percentage than in any year previous.
  • From a tactical perspective, I’ve worked a lot on growing my platform. I’ve written one book and have two others that should be complete by March at the latest. I launched a podcast. I (continue to) email my audience daily. I’ve spoken at a few new events this year and done more varied  ‘list building stuff’ than in any year previous.
  • I added another layer to my coaching offerings – which grow the enrollment by about 75 clients while being a real success by any measure.
  • Finally – after kind of mailing it in from late March – mid July as far as work goes (working about 15 hours a week most weeks), I created what I called a 100 Day Sprint where I mapped out about a dozen pretty aggressive goals spanning every fact of my business from revenue growth to writing progress. I just wrapped it up on 11/4 and hit 11 of 12 goals…with many being exceeded by a significant margin. Now I’m going to turn the whole process into a course.

Pat Rigsby

Business Consultant, PatRigsby.com


Dave Tilley

dave_tilleyHere is what I have been doing a lot differently

  • On the clinical side, one thing I have been doing is playing devils advocate with myself a lot in regards to newer concepts/research. I saw in myself that that my pendulum was shining way too far between topics and just like many others I don’t want to get carried away. Finding the mid ground in contrasting areas like include “functional” approaches vs importance of isolation/basics, neurological vs biomechanical/histological approaches, set movement patterns vs motor variability, and so on. I find it really helps me map out my approach but also keeps me on my toes when reading new research. I’m spending a ton of time in hip micro instability research and treatment, so having this opposing sides view is really interesting to develop new ideas.
  • I have really been trying to build up my strength and conditioning knowledge and apply to my whole rehab approach. I have always felt decent in this area, but in working more with high level gymnasts/Olympic Weightlifters, I found that I was dropping the ball a bit for advanced rehab. I’ve been reading a ton of newer strength books and energy systems training research to get up to speed, but also approaching my rehabilitation through more formal strength and periodization models, even with the acute or post op patients.
  • More for myself, a lot more reading in personal development this year. Reading books like Ego is The Enemy, Legacy, and Extreme Leadership we eye opening to some personality flaws I didn’t even pick up in myself. Swallowing some tough pills was necessary, but ultimately I think it’s helping make my job and life better. Also has allowed me to make some really large positive changes in trying to change a sport so stubborn as gymnastics. Another personal note, I’ve also been way more disciplined about following my calendar weekly to stay on track.
  • Definitely writing a lot shorter, more concise blog posts for my company SHIFT Movement Science  I put out more content based articles less often, but make them full of relevant points and get right to the point. It’s been really helpful for me to deload but readers enjoy it much more. Moving more to educational products and items people can utilize to learn on their own vs my pumping out regular articles.

Dave Tilley

Physical Therapist, Champion PT and Performance


Dan Lorenz

dan_lorenzThings I’m Doing Differently:

  • Been inviting local physicians to our monthly journal clubs and “co-author” blogs on my website.  Has been a great addition and really surprised how many have expressed interest.  I had not done that previously.
  • Inviting more local physicians in to do inservices for my staff.  Surprised how many actually pull themselves away and want to do it.  Been great for education and interaction.  
  • I meet once a week w/ my clinicians that are 0-2 years out of PT school to review their cases.  Fridays, noon over lunch.  They go over struggles, the others put in their two cents, then I swoop in at the end and tell ’em they’re all full of s**t. Lol.  Just kidding, just help them round out their plans.  They rave about it and I know in the end, I “lose to win.”
  • Clinically – using BFR more, but I find I have more questions than answers.  Also using dry needling as an adjunct.
  • I have tried really hard to stop arguing with idiots on social media. After a while, it’s hard to tell the difference.
  • I have decided that I’m not that important.  My clinics will be fine.  So will my patients and they’ll find a way to see me.  I go in to work a little later to take my son to school and leave two days early to pick him up.  That matters way more than an extra visit or two.  
  • Agree w/ Pat Rigsby big time – taking stuff off my plate and saying “no” a little more often.  It’s a struggle because I have a tremendous passion for my profession, but have to make sure everything else doesn’t suffer.

Things I Wish I Did Differently:

  • Now that I’m not involved formally in pro and college sports like I used to, although I still see elite athletes, I don’t have all the cool toys so many of you get to use.  Sigh…maybe someday.  Love to tinker with innovative tech products. 

Things I Haven’t Changed a Bit:

  • Read a ton.  Research guides practice. I can’t get enough. I love this stuff.  
  • Engage with people that are on lists like this.  Seek people that have earned trust,  Seek people who walk the walk.  
  • Be an expert at the basics.  For all the fluff and different approaches, I make sure stuff is mobile, stable, and strong like freaking bull.  Everything else – power, reactive strength and speed – follows nicely.

Dan Lorenz

Physical Therapist, SSOR


Michael Boyle

michael_boyleMy first thought was ” I haven’t done much different”. However, after reading everyone’s responses I was moved to write.

Most of what I’m changing has already been alluded too

  • Giving more responsibility to my staff. My goal is to make myself non essential.
  • Putting more thought and energy into staff development. I have established this as my ” one thing” from a business standpoint.
  • Trying to work less and be a better dad and husband. This is a never ending battle.
  • Also learning to say no. I coach who I want to, when I want too. I refer a lot of speaking options to staff members.
  • Taking advice from Alistair McCaw and focusing on 20 minutes of thoughtfulness every day. Also a 20 min nap.

Michael Boyle

Strength Coach, Mike Boyle Strength and Conditioning


Wil Fleming

wil_flemingPrioritizing things. As a coach and business owner things can get out of whack.

For me the ranking is 1) family, 2) business, 3) coaching.

Family: Making sure I am raising my son the way I want to. He’s only 18 months old, but getting out everyday to play with him for at least an hour of completely undirected free play (per good LTAD guidelines), keeping the TV off at all times, and making sure that I spend each morning with him before hitting the gym. It also means being a better husband and spending equal time on developing that relationship as I do my business and coaching.

Business: Re-vamped our core values this year to reflect what I truly believe (they were outdated when my former business partner left). We are in the relationship business and I wanted the core values to reflect as much. Just updating these has been so impactful to my business.

Coaching: Getting better at programming, I am good at seeing complex movements and breaking them down. The question I asked myself this year was “am I applying these stresses in the most optimal way?” When the answer came up, maybe, then I decided I needed to look again at what we have been doing.

On that note, I have been trying to look at different sources for more knowledge on programming, less to the traditional guru’s and more towards people that are putting up results with similar populations. Do you have the best collegiate weightlifters? Then I’m going to look at what you’re doing. Do you produce really good high school baseball players? Then I’m going to look at what you’re doing. Surprise, surprise, these people don’t have the most instagram followers, because they are out there actually coaching people.

Wil Fleming

Strength Coach, Force Fitness


Regan Wong

regan_wongAs previously stated amongst the group, balancing being a father/husband with a successful career has been something to continue to work on. As a father of 3, it has been somewhat challenging for me to do so in the past but I have made it a priority this past year to do so. I will continue to work on it. One of this funniest activities I enjoy getting my kids into is rock climbing and tae kwon do. I have found great motor development patterns develop from the rock climbing and great kinesthetic awareness/balance/proprioception in all my kids…especially in my middle son who is deaf in one year and was just “clumsy”  as toddler.  Great to see the confidence and single limb balance develop from his martial arts.

At work, I have identified and trained 2 staff clinicians to take on more managerial roles so that I didn’t have to feel like I had to be in the place 12 hours a day and be afraid the clinic would fall apart. Working on implementing the culture and systems in place to have the business run while the head guy wasn’t on the floor was a strategy to allow professional growth amongst select staff and allow me more time to spend with family etc. It also allows us to identify leaders in our clinic to eventually open and run satellite clinics when we are ready to do so from a business prospective.

I have taken the time professionally to learn the ins/outs of running a Motion Analysis lab for our pitcher biomechanical analysis to give me more of an understanding of the whole process, interpretation of the data, and provide feedback to the pitchers and coaches. Baseball medicine is always evolving as we try to tackle and decrease the pitcher injuries of the elbow/shoulder. I am currently doing research between simple balance and core tests using the LevelBelt app and comparing to the biomechanical data of the lab on pitchers that have come through the lab.

I have used the KAATSU blood flow restriction training and have seen some pretty good results with regaining quad strength and hypertrophy in post-op conditions that were limited weight bearing for initial 6 weeks post-op. Seems to be promising.

Regan Wong

Physical Therapist, TMI


Jon Goodman

jon_goodmanMy business has achieved monumental growth this year and it came as the result of an unlikely reason: I relinquished control. This year I became more comfortable establishing systems, operations, and guidelines for operating aspects of my business and handing off those elements to skilled members of the team in full trust. Instead of working in my business every day, I spend all of my time visualizing how I want it to grow and finding the people, developing the systems, and setting the wheels in motion to make it happen. As a business, my team and I have grown faster, built better stuff, made more, impacted more, and had more fun all at the same time.

Jon Goodman

Owner, ThePTDC.com


Patrick Ward

patrick_wardI think what I have been trying to do differently — mainly over the past several years, really — is attempting to use mathematics and statistics to understand some of the processes that we go through with our athletes. This could from a training, rehabilitation, or performance standpoint.

There are lots of approaches out there that people take but understanding how they work, what is meaningful, what types of changes/improvements are actually real versus random biological variation, etc. That is really the challenging part. At the end of the day, we deal with people’s health and my thoughts over the past several years have been towards trying to understand if what we are doing is truly making an impact and what the magnitude of that impact is.

Patrick Ward

Strength Coach, Optimum Sports Performance


Lenny Macrina

lenny_macrinaI’m working on time management…calendar reminders to plan my life have helped guide my ‘to do’ list despite a 9 month old that has little routine

Learning the basics of powerlifting and olympic lifting. It’s a new world but an important one to understand for the clients that we see.

Trying to enjoy family life and dedicate time to baby/wife.

Continue to improve my stock buying/selling strategies and not always going for the ‘big one’ that will give a big pop… being slightly more conservative despite the fun of the big hit!

Easy to get complacent after 12+ years of being a PT…trying to fight that complacency and stay engaged.

Lenny Macrina

Co-Owner, Champion PT and Performance


Charlie Weingroff

charlie_weingroffThings I am doing differently:

  • Always trying to understand the psychology of “what motivates a man” and understanding why others do what they do, particularly using methods and techniques that are incomplete and inferior to best practice.
  • Reconciling buckets of techniques based on their earnest physiology and neurology.
  • Reverse engineering thought process of successful individuals.
  • Continuing to find common targets of physiology and neurology that link the methods that are typically classified as training and/or rehabilitation.
  • Developing scalability of methodology allowing clinicians to maintain their individuality using models that have already proven to be successful
  • Studying links of the 5 W’s of athletic performance across long-term time frame

Charlie Weingroff

Physical Therapist, Drive 495


Jeff Blum

jeff_blumOne thing I’ve been trying to do is take as much time with my kids as possible. They are getting older fast (or so it seems) and so am I.

Trying to make sure that I spend time with my wife in what she wants to do.

From a professional standpoint, we’ve been increasing our knowledge about the neuro aspects of the body and the best ways to effect it. Affecting fascia, Parasymp/symp, central nervous system, peripheral nervous system.

Using blood flow restriction training (KAATSU), US imaging, cryochamber, hyperbaric chamber. Looking into neuro “priming” for our rehab (Halo Neuroscience).

Trying to make a concerted effort to really start to grasp volume for our players. Sleep, nutrition, exercise, stress, hydration, and its cumulative effects.

Every once in awhile, just pulling back and making sure we are still looking at the basics and not getting to wrapped up in the “new” gadgets. Making sure we are looking at how the whole body is moving, if the joint is supposed to be more mobility or stability, fascial lines and how they are moving, etc…

Jeff Blum

Director of Rehabilitation, Kansas City Royals

What Are You Doing Differently?

Lets keep it rolling, reply below and comment on what you are doing differently.  I’d love to hear, I’m always looking for new ways to grow!

 

 

Sorry, Sitting Isn’t Really Bad for You

Over the last several years, the health concerns surrounding sitting have really been highlighted by the health and fitness crowds, as well as the mainstream media.  In fact, there have been entire books published on this topic.  I’ve seen articles with titles such as “Sitting is Evil,” “Sitting is the New Smoking,” and even “Sitting will kill you.”

Wow, those seem pretty aggressive.  We’ve been sitting since the beginning of time!  I’m going to really shock the world with this comment…

Sorry, sitting isn’t really bad for you.

Yup.  There is nothing wrong with sitting.  I’m actually doing it right now as I write this article.  You probably are too.  Don’t get me wrong, sedentary lifestyles are not healthy, but let’s get one thing straight:

It’s not sitting that is evil, it’s NEVER moving that is evil. [Click to Tweet]

By putting all the blame on sitting, we lose focus on the real issue, which is lack of exercise.  So we see a shift in people switching to standing desks at work, still not exercising, but thinking that they are now making healthy choices.  

This is so backwards it boggles my mind.

The body adapts amazingly well to the forces and stress that we apply to it throughout the day.  If you sit all day, your body will adapt.  Your body will lose mobility to areas like your hips, hamstrings, and thoracic spine.  Your core is essentially not needed while sitting so thinks it’s not needed anymore during other activities.  And several muscles groups get used less frequently while sitting and weaken over time, like your glutes, scapular retractors, and posterior rotator cuff.

Unfortunately, when all you do is sit all day, and you never reverse this posture or exercise, your body adapts to this stress to make you the most efficient sitter.  That’s right, you get really good at sitting.

For example, think about what happens to the core when you sit all day.  One of the functions of your core is to maintain good posture and essentially to keep the bones of your skeleton from crashing to the floor.  The core is engaged at a low level of EMG activity throughout the day for postural needs.  

The problem with sitting is that the chair also serves this function, so your core isn’t needed to keep you upright, the chair serves this function. If sitting is all you do, then when you stand up, your core essentially isn’t used to providing this postural support so you rock back onto your static stabilizers by doing things like standing with a large anterior pelvic tilt and lumbar extension.  

sitting isnt bad for you

Unfortunately, this becomes the path of least resistance, and most energy efficient, for your body.  Your core gets used to relying on the chair to function, then when you need it, gets lazy.

It’s OK to sit all day, as long as you are reversing this posture at some point.  This can be as specific as exercises designed to combat sitting and as general as simply taking a walk in the evening.

 

3 Strategies to Combat Sitting All Day

I want to share the 3 things that I often discuss with my patients and clients.  You can apply these yourself or use them to discuss with your clients as well.  But if you sit all day, you really should:

  1. Move, Often
  2. Reverse your posture
  3. Exercise

But the real first step is to stop blaming sitting and calling a spade a spade.  It’s lack of movement and exercise that is the real concern, not sitting.

 

Move, Often

The first step to combatting sitting all day is to move around often.  The body needs movement variability or it will simply adapt to what it does all day.  

I get it, we all work long days, and sitting is often required in many of our jobs.  But the easiest way to minimize the effects of sitting all day is to figure out ways to get up and move throughout the day.

This doesn’t need to be 10 minutes of exercise, it could simply be things like getting up to fill up a water bottle or taking quick 2 minute walk around the office.  When I am not in the clinic or gym, I personally tend to work in hour long chunks, so I will get up and walk around in between chunks to get a glass of water, snack, or use the bathroom.  

This works well for me, but you need to find what works for you.  I know of others that use things like Pomodoro timers, or even some of the fitness tracking devices, which can remind you to stand up and move around at set times.

 

Reverse Your Posture

I’ve been talking about the concept of Reverse Posturing for years.  The concept is essentially that we need to reverse the posture that we do the most throughout the day to keep our body balanced and prevent overuse.

Sitting involves a predominantly flexed posture, so doing exercises that promote the posterior chain would be helpful.  These will depend on each person but a basic set of exercises may look like:

Chin Tucks

Shoulder W’s

Thoracic Extension Exercises

View one of my past articles for several more great thoracic mobility drills.

Bridging Exercises

True Hip Flexor Stretch

Perform each of these for 10 reps.  These should take 5 minutes to perform and will make a big impact on how you feel throughout the day.  

I also often tell people to perform the prone press up exercise, cobra yoga poses, or to simply lay on their stomach in the evening while reading or watching TV.  

fig 1 - sitting isnt bad for you

 

Exercise

Remember going back to some of the past concepts above, the body adapts to the stress applied.  To combat this perfectly, a detailed exercise program that is designed specifically for you and comprehensively includes a focus on total body and core control is ideal.  

This will assure that the muscle groups that are not being used while sitting all day get the strength and mobility they need, while the core gets trained to stabilize the trunk during functional movements.

If you want to get the most out of your body and stay optimized, you need to do things like work on your hip and thoracic spine mobility, strengthen your rotator cuff, groove your hinge pattern, and learn how to deadlift and work your glutes.

 

Sitting Isn’t Bad For You, Not Moving Is

As a profession, we need to get away from blaming sitting as the enemy and labeling it evil.  Our society is sitting more and more each generation.  We need to be honest with ourselves and realize that sitting isn’t the problem, it’s not moving enough that is the concern.  We need to stop pointing fingers and get to the root of the problem.  

Go ahead and sit, just move more often and use these 3 strategies to combat sitting all day.

 

 

 

6 Keys to ACL Rehabilitation

The latest Inner Circle webinar recording on 6 Keys to ACL Rehabilitation is now available.

 

6 Keys to ACL Rehabilitation

6 keys to acl rehabilitationThis month’s Inner Circle webinar is on 6 Keys to ACL Rehabilitation.  In this presentation, I’ll go over the 6 key foundational principles that you need to understand to maximize your results with ACL rehab.  There are many surgical and patient variables that may speed up or slow down the standard rehab progression, however, you can build an optimal program by following these 6 principles.

This webinar will cover:

  • The #1 complication after ACL rehab, prolonged weakness, and how to minimize this
  • The two most important things to focus on during the first week of rehabilitation
  • How to develop advanced strength programs and alter periodization schemes in the rehab setting
  • My simple, yet effective, criteria to return to activities

 

To access this webinar:

 

How Pelvic Tilt Influences Hamstring and Spine Mobility

how pelvic tilt influences hamstring and spine mobilityHow many people come to you and complain that they have tight hamstrings?  It seems like an epidemic sometimes, right?  I know it’s pretty common for me, at least.  

Many people just tug away at their hamstrings and aggressively stretch, which may not only be barking up the wrong tree, but also disadvantageous.

I have really gotten away from blindly stretching the hamstrings without a proper assessment, as I feel that pelvic position is often the reason why people think they are tight.  This is pretty easy to miss.

In the video below, I want to explain and help you visualize the how pelvic tilt influences hamstring mobility and spine position.  Often times the hamstrings feel “tight” or “short” when in reality their pelvic position is just giving us this illusion.  I talk about this a lot with clients at Champion and often find myself making these drawings on our whiteboard.

Keep this in mind next time you think someone has tight hamstrings or has too much thoracic kyphosis.  Often times the key is in the hips!

 

How Pelvic Tilt Influences Hamstring and Spine Mobility

 

Strategies for Anterior Pelvic Tilt

If you are interested in learning more, I have a couple of great webinars for my Inner Circle members that you may find helpful:

Hip Variations and Why My Squat Isn’t Your Squat

Today’s article is an AMAZING guest post from my friend Dean Somerset.  I’ve been talking a lot lately about how hip anatomy should change your mechanics and why exercises like squats should be individualized based on each person, but Dean blows this topic out of the water with this article.  If you love this stuff as much as I, check out the link at the bottom for Dean and Tony Gentilcore’s new program, The Complete Shoulder & Hip Blueprint.  This is just the tip of the iceberg of what is covered in the program.

 

Hip Variations and Why My Squat Isn’t Your Squat

In a recent workshop, I had a group of 50 fit and active fitness professionals and asked them all to do their best bodyweight squat with a position that felt good, didn’t produce pain, and was as deep as they could manage. As you can imagine, looking around the room produced 50 different squats. Some were wide, narrow, deep, high, turned out feet or some variation all of the above.

Did these differences mean there was a standard everyone should aim for, and those who weren’t there had to try to improve their mobility or strength or balance in that position? Maybe, but there’s probably a bunch of other reasons as to why 50 people have 50 different squats.

A standard requirement for powerlifting is to squat to a depth that involves having the crease of the hips below the vertical position of the knee. That’s probably the only known requirement for squat depth out there. The universal recommendation of “ass to grass” depth being the best thing since sliced bread may sound nice on paper (or in Instagram videos or Youtube segments), but it might be something that’s relatively difficult for some people to achieve, and for others it could be downright impossible, regardless of how much mobility work or soft tissue attacks they go through. The benefits of a deep squat seem to only be reserved for those who have the ability to express those benefits by accessing that range of motion without some other compensatory issue.

Let’s just consider simple stuff like anthropometric differences between individuals. Someone who is taller will have a bigger range of motion to go through to hit a parallel position than someone who is shorter, and someone with longer femurs in relation to their torso length will have a harder time maintaining balance over their base of support compared to someone who has shorter femurs. A long femur could be any femur that comprises more than 26% of an individual’s’ total height. So someone who is tall and long femured will have trouble getting down to or below parallel due to simply having the limb lengths to allow the bar to stay over the base of support during the squat motion without losing balance one way or the other.

Not as commonly known is the degree of retroversion or anteversion the femoral necks can make. The shaft of the femur doesn’t just always go straight up and insert into the pelvis with a solid 90 degree alignment. On occasion the neck can be angled forward (femoral head is anterior to the shaft) in a position known as anteversion, or angled backward (femoral head is posterior to the shaft) in a position known as retroversion. Zalawadia et al (2010) showed the variances in femoral neck angles could be as much as 24 degrees between samples, which can be a huge difference when it comes to the ability to move a joint through a range of motion.

hip variations squat

The acetabulum could itself be in a position of anteversion or retroversion, and this difference itself could be more than 30 degrees. This means the same shaped acetabulum would give someone who has the most anteverted acetabulum 30 extra degrees of flexion than someone who had the most retroverted acetabulum, but would give them 30 degrees more extension than the anteverted hips.

There’s also the differences in centre-edge angles, or the angle made from the center of the femoral head through the vertical axis and the outer edge of the lateral acetabulum. Laborie et al (2012) measured this angle in 2038 19 year old Norwegians, and found that it ranged from 20.8 degrees to 45.0 degrees with a mean of 32 in males and 31 in females.

hip anatomy squat

Now to throw even another monkey wrench into the problem, there’s the simple fact that your left and right hips can be at different angles from each other! Zalawadia (same guy as before) showed that the angle of anteversion or retroversion of the femur could be significantly different from left to right, sometimes more than 20 degrees worth of difference.

squat anatomy

All of this can have a direct effect on their available range of motion. You can’t easily mobilize bone into bone and create a new range from that interaction, so if one person has hips where the bony alignment and shape doesn’t causes earlier contact in a specific direction compared to someone else who has a different shaped and aligned hip structure, it’s going to show in their overall mobility.

Elson and Aspinal (2008) showed that there can be a massive variation in both passive and active movements of the hip across age ranges and gender differences. They showed a true hip flexion range of between 80-140 degrees (mean of 25)with no lumbar rounding, a strict active straight leg raise with no lumbar rounding range of 30-90 degrees (mean of 70), and active leg raise with lumbar rounding of 50-90 degrees (mean of 86). This means someone in their sample managed to get 60 degrees more hip flexion than someone else in the sample. There was also a range of between 5-40 degrees of hip extension too, and across an age range from 19-89 years old, that’s a notable difference, especially if you work in general populations where everyone walks into the gym and over to the squat rack.

D’Lima et al (2000) found that hip flexion ROM could be as low as 75 degrees with 0 degrees of both acetabular anteversion or femoral anteversion, but as high as 155 degrees, with 30 degrees of both acetabular anteversion or femoral anteversion. An increase in femoral neck diameter of as little as 2mm was able to reduce hip flexion range by 1.5 – 8.5 degrees, depending on the direction of motion.

So essentially, your ability to achieve a specific range of motion is as much up to your unique articular geometry as it is to your strength and mobility. In many cases, it’s entirely independent of your strength and mobility, and no amount of stretching, mashing, crushing, or stripping will improve it. In many cases, trying to achieve that range of motion that’s outside of your joints ability to achieve will cause less desirable results, like bone to bone contact and irritation (potentially leading to things like femoroacetabular impingement), or compensatory movement from other joints like the SI joint or lumbar spine.

So with as much involved with the structure as I’ve presented here, and how impactful it can be to the end result of total motion of the hips during exercises, how can you determine whether it’s a limiting factor or not? If you happen to have X-ray vision you can do a good job of this, but you’d likely be charging a heck of a lot more money than you are right now for your services.

What we have available is a detailed assessment that focuses on a combination of features.

Involving a passive assessment to assume a theoretically available range of motion and shape of movement capability, an active assessment to see how they can use that range and whether there’s a difference between the two, and then determining strength or motor pattern aptitudes for the movements can be the best tools we have at our disposal, and then coaching the movement until their face sweats blood.

By using multiple approaches to assessing available and usable range of motion, you can get multiple views into a room that can paint a broader picture of what’s available. If the person has the ability to easily let their knee drop to their chest on your treatment table and squat to the floor, there’s obviously no restriction to their range of motion. If they have trouble breaking 90 degrees, even if they move wider through abduction and external rotation, their active range is limited through multiple tests, and their ability to show you a squat shows a lumbar flexion at around 90 degrees of hip flexion as well, the odds of you mobilizing that tissue to produce a significantly bigger range may be limited.

 

Passive Assessment of Hip Structure

 

Active Hip Flexion Capability Against Gravity

 

Active Rockback for Hip Flexion without Gravity Influence

 

Supported Squat Assessment


If all of these tests show a specific limitation to the range of motion consistently across all situations, it could be assumed that there would be a structural limitation versus passive insufficiency, weakness or other considerations. If active testing is limited but passive or supported assessments are fine, there could be a strength or motor pattern limitation holding the movement back.

Now sure, there’s a lot of brakes that could be restricting that range, from things like scar tissue to guarding and some soft tissue restrictions. Doing some work to help reduce that can help improve overall range of motion, but in some cases will be limited to just minimal gains. In some situations, trainers or therapists may work on improving range of motion for weeks or months and see no improvement, and in many cases the deck would be stacked against them seeing any improvement at all.

customized squat pattern

As mentioned earlier, there could also be an asymmetric structural element at play, which may necessitate an asymmetric setup for the movement where one foot is either turned out more, held slightly forward or back, or even turned into something like a one-heel elevated squat. The difference between this and a lunge is merely how far back that elevated foot is relative to the other foot, but again it’s taking advantage of potential asymmetries in structure and allowing an asymmetric set up to be more congruent with the individual.

Another way to think of it is if we have a potentially asymmetric structure yet force a symmetric set up on it, we may be creating an imbalance or compensative element in our training versus preventing it.

The Complete Hip and Shoulder Blueprint

complere shoulder and hip blueprintThese and many more elements are discussed in Complete Shoulder & Hip Blueprint, a new continuing education resource from Tony Gentilcore and Dean Somerset. This digital video product is 11 hours of lecture and hands on where they break down pertinent anatomy, considerations for program design, and delve into assessments, corrective options, and training considerations for these 2 highly involved complex structures.

The series is currently on a launch sale pricing, and the entire package is available for only $137 versus the regular pricing of $177. The sale is on from November 1 through 5, so act quickly to get your copy.  Click below to learn more or check out the below preview video!

large-learn-more

 

large-learn-more

Shoulder Impingement – 3 Keys to Assessment and Treatment

Shoulder impingement really is a pretty broad term that most of us likely take for granted.  It has become such a junk term, such as “patellofemoral pain,” especially with physicians.  It seems as if any pain originated from around the shoulder could be labeled as “shoulder impingement” for some reason, as if that diagnosis is helpful to determine the treatment process.

Unfortunately, There is no magical “shoulder impingement protocol” that you can pull out of your notebook and apply to a specific person. [Click to Tweet]

I wish it were the simple.

A thorough examination is still needed.  Each person will likely present differently, which will require a variations on how you approach their rehabilitation.

But the real challenge when working with someone with shoulder impingement isn’t figuring out they have shoulder pain, that’s fairly obviously.  It’s figuring out why they have shoulder pain.

 

 

Shoulder Impingement: 3 Keys to Assessment and Treatment

To make the treatment process a little more simple, there are three things that I typically consider to classify and differentiate shoulder impingement.

  1. Location of impingement
  2. Structures involved
  3. Cause of impingement

Each of these can significantly vary the treatment approach and how successful you are helping each person.

 

Location of Impingement

The first thing to consider when evaluating someone with shoulder impingement is the location of impingement.  This is generally in reference to the side of the rotator cuff that the impingement is located, either the bursal side or articular side.

shoulder impingement assessment and treatment

See the photo of a shoulder MRI above.  The bursal side is the outside of the rotator cuff, shown with the red arrow.  This is probably your “standard” subacromial impingement that everyone refers to when simply stating “shoulder impingement.”  The green arrow shows the inside, or articular surface, of the rotator cuff.  Impingement on this side is termed “internal impingement.”

The two are different in terms of cause, evaluation, and treatment, so this first distinction is important.  More about these later when we get into the evaluation and treatment treatment.

 

Impinging Structures

To me, this is more for the bursal sided, or subacromial, impingement and refers to what structure the rotator cuff is impinging against.  As you can see in the pictures below (both side views), your subacromial space is pretty small without a lot if room for error.  In fact, there really isn’t a “space”, there are many structures running in this area including your rotator cuff and subacromial bursa.

Shoulder impingement

You actually “impinge” every time you move your arm.  Impingement itself is normal and happens in all of us, it is when it becomes excessive or abnormal that pathology occurs.

I try to differentiate between acromial and coracoacromial arch impingement, which can happen in combination or isolation.  There are fairly similar in regard to assessment and treatment, but I would make a couple of mild modifications for coracoacromial impingement, which we will discuss below.

 

Cause of Impingement

The next thing to look at is the actual reason why the person is experiencing shoulder impingement.  There are two main classifications of causes, that I refer to as “primary” or “secondary”shoulder  impingement.

Primary impingement means that the impingement is the main problem with the person.  A good example of this is someone that has impingement due to anatomical considerations, with a hooked tip of the acromion like this in the picture below.  Many acromions are flat or curved, but some have a hook or even a spur attached to the tip (drawn in red):

shoulder impingement

 

Secondary impingement means that something is causing impingement, perhaps their activities, posture, lack of dynamic stability, or muscle imbalances are causing the humeral head to shift in it’s center of rotation and cause impingement.  The most simply example of this is weakness of the rotator cuff.

The rotator cuff and larger muscle groups, like the deltoid, work together to move your arm in space.  The rotator cuff works to steer the ship by keeping the humeral head centered within the glenoid.  The deltoid and larger muscles power the ship and move the arm.

Both muscles groups need to work together.  If rotator cuff weakness is present, the cuff may lose it’s ability to keep the humeral head centered.  In this scenario, the deltoid will overpower the cuff and cause the humeral head to migrate superiorly, thus impinging the cuff between the humeral head and the acromion:

evaluation and treatment of shoulder impingement

 

Other common reasons for secondary impingement include mobility restrictions of the shoulder, scapula, and even thoracic spine.  We see this a lot at Champion.  In the person below, you can see that they do not have full overhead mobility, yet they are trying to overhead press and other activities in the gym, flaring up their shoulder.

shoulder impingement mobility

If all we did with this person was treat the location of the pain in his anterior shoulder, our success will be limited.  He’ll return to gym and start the process all over if we don’t restore this mobility restriction.

The funny thing about this is that people are almost never aware that they even have this limitation until you show them.

 

 

Differentiating Between the Types of Shoulder Impingement

In my online program on the Evidence Based Evaluation and Treatment of the Shoulder, I talk about different ways to assess shoulder impingement that may impact your rehab or training.  There are specific tests to assess each type of impingement we discussed above.

The two most popular tests for shoulder impingement are the Neer test and the Hawkins test.  In the Neer test (below left), the examiner stabilizes the scapula while passively elevating the shoulder, in effect jamming the humeral head into the acromion.  In the Hawkins test (below right) the examiner elevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff under the subacromial arch.

Shoulder impingement tests

You can alter these tests slightly to see if they elicit different symptoms that would be more indicative to the coracoacromial arch type of subacromial impingement.  This would involve the cuff impingement more anteriorly so the tests below attempt to simulate this area of vulnerability.

The Hawkins test (below left) can be modified and performed in a more horizontally adducted position.  Another shoulder impingement test (below right) can be performed by asking the patient to grasp their opposite shoulder and to actively elevate the shoulder.

how to assess shoulder impingement

There is a good chance that many patients with subacromial impingement may be symptomatic with all of the above tests, but you may be able to detect the location of subacromial impingement (acromial versus coracoacromial arch) by watching for subtle changes in symptoms with the above four tests.

Internal impingement is a different beast.

This type of impingement, which is most commonly seen in overhead athletes, is typically the result of some hyperlaxity in the anterior direction.  As the athlete comes into full external rotation, such as the position of baseball pitch, tennis serve, etc., the humeral head slides anterior slightly causing the undersurface of the cuff to impingement on the inside against the posterior-superior glenoid rim and labrum.  This is what you hear of when baseball players have “partial thickness rotator cuff tears” the majority of time.

shoulder internal impingement

 

 

The test for this is simple and is exactly the same as an anterior apprehension test.  The examiner externally rotates the arm at 90 degrees abduction and watches for symptoms.  Unlike the shoulder instability patient, someone with internal impingement will not feel apprehension or anterior symptoms.  Rather, they will have a very specific point of tenderness in the posterosuperior aspect of the shoulder (below left).  Ween the examiner relocates the shoulder by giving a slight posterior glide of the humeral head, the posterosuperior pain diminishes (below right).

how to assess shoulder internal impingement

 

3 Keys to Treating Shoulder Impingement – How Does Treatment Vary?

There are three main keys from the above information that you can use to alter your treatment and training programs based on the type of impingement exhibited:

Subacromial Impingement Treatment

To properly treat, you should differentiate between acromial and coracoacromial impingement.  Treatment is essentially the same between these two types of subacromial impingement, however, with coracoacromial arch impingement, you need to be cautious with horizontal adduction movements and stretching.  This is unfortunate as the posterior soft tissue typically needs to be stretched in these patients, but you can not work through a pinch with impingement!

A “pinch” is impingement of an inflamed structure!

Also, I would avoid elevation in the sagittal plane or horizontal adduction exercises.

 

Primary Versus Secondary Shoulder Impingement

This is an important one and often a source of frustration in young clinicians.  If you are dealing with secondary impingement, you can treat the persons symptoms all you want, but they will come back if you do not address the route of the pathology!

I do treat their symptoms, that is why they have come to see me.  I want to reduce inflammation.  However, this should not be the primary focus if you want longer term success.

This is where a more global look at the patient, their posture, muscle imbalances, and movement dysfunction all come into play.  Break through and see patients in this light and you will see much better outcomes.

A good discussion of the activities that are causing their symptoms may also shed some light on why they are having shoulder pain.  Again, using the example above, if you don’t have full mobility and try to force the shoulder through this tightness you are going to likely cause some issues.  This is especially true if you add speed, loading, and repetition to elevation, such as during many exercises.

 

Internal Impingement

One thing to realize with internal impingement is that this is pretty much a secondary issue.  It is going to occur with any cuff weakness, fatigue, or loss of the ability to dynamically stabilize.   The athlete will show some hyperlaxity in this athletic “lay back” shoulder position.  Treat the cuff weakness and it’s ability to dynamically stabilize to relieve the impingement.  How to treat internal impingement is a huge topic that I cover in a webinar for my Inner Circle members.

 

Learn Exactly How I Evaluate and Treat the Shoulder

If you are interested in mastering your understanding of the shoulder, I have my acclaiming online program teaching you exactly how I evaluate and treat the shoulder at ShoulderSeminar.com!

The online program at takes you through an online 8-week program with new content added every week.  You can learn at your own pace in the comfort of your own home.  You’ll learn exactly how I approach:

  • shoulder seminarThe evaluation of the shoulder
  • Selecting exercises for the shoulder
  • Manual resistance and dynamic stabilization drills for the shoulder
  • Nonoperative and postoperative rehabilitation
  • Rotator cuff injuries
  • Shoulder instability
  • SLAP lesions
  • The stiff shoulder
  • Manual therapy for the shoulder

The program offers 21 CEU hours for the NATA and APTA of MA and 20 CEU hours through the NSCA.

Click below to learn more!

large-learn-more

 

Should Everyone Deadlift?

Many people have called the deadlift, “the king of all exercises.”  And rightfully so, as there may not be a bigger bang-for-your-buck exercise out there.

In my opinion, the deadlift is the most underutilized exercise in rehabilitation.  Perhaps the move is intimidating?  Perhaps people are afraid of barbells?  Perhaps people are worried patients may hurt their backs?  Perhaps rehab professionals don’t know enough about strength and conditioning?

I always say that I am a much better physical therapist because I am also a strength coach, and always keep learning from many great strength coaches.

As the gap between rehab and performance continues to narrow, the deadlift may be the final exercise to cross the chasm.  We shouldn’t be afraid of the deadlift, however, we also need to understand the the conventional deadlift is not for everyone.

 

Why Everyone Should Deadlift

should everyone deadliftOne of the most important trends in rehabilitation and strength and conditioning over the last decade or two has been the move away from muscle-based exercises and shift towards movement-based exercises.  Rather than work on quad strength, work on squatting, for example.  (Photo credit by the man, the myth, and the deadlift legend Tony Gentilcore)

The deadlift is essentially a hip hinge pattern, which is extremely functional and equally elusive for many people.

Put simply, people can’t hinge anymore!  It’s amazing.

As our society changes and relies more on poor posture patterns, prolonged seated periods, and things like excessive use of smartphones, I’m amazed how it seems even kids can’t touch their toes anymore.

Working on a poor hip hinge pattern is extremely helpful for so many different issues that I see every day.  From back pain, to knee pain, to even poor sport performance.

We have become so anterior chain dominant.  Luckily, the deadlift hits the entire posterior chain in one big lift.  

So the the deadlift really helps with the hip hinge pattern, but there are so many other benefits including working on better posture, glute development, lower extremity power development, a stronger core, stronger lats, and even enhanced grip strength.  

You can see why it’s such a big bang-for-your-buck exercise.

 

Why Everyone Shouldn’t Deadlift

Wait a minute…

I just spent the first half talking about how beneficial the deadlift is for so many people.  Why shouldn’t everyone perform a deadlift?

Let me clarify – I’m talking about the conventional barbell deadlift.

Take a step back and remember that we are more concerned about movements, than muscles, right?  So luckily there are many variations of hinging, and even deadlifts, that can be utilized to achieve all the above great goals.

Perhaps the deadlift is so underutilized in the rehab setting because everyone just looks at the conventional barbell deadlift.  That’s like going straight to the top, saying that there is no way you can perform that exercise, then just scrapping all forms of deadlifts and hip hinge exercises.

Most people that walk into the door at Champion have no chance at being successful at a conventional barbell deadlift.  Among other things, you need:

  • Good mobility
  • An understanding of the hinge pattern neuromuscular pattern
  • The ability to load, essentially lift a weight with intent

Most people don’t have at least 2-3 of these qualities.

We’ll try to get them there with the right blend of mobility drills, corrective exercises, and manual therapy, but that doesn’t mean we have to wait to start deadlifting.  We just need to start at a more regressed level.

So, don’t immediately scrap the deadlift, find a way to incorporate it.  Work within your mobility and limited range, try a variation using a kettlebell or sumo stance, and use submaximal loads until you can groove a proper hip hinge pattern.

deadlift variations

One of my favorite resources on deadlift technique and variations is this excellent article by Mike Robertson.

As you improve, you can incorporate more advanced forms of the deadlift, but don’t simply scrap the deadlift until then, modify!

 

3 Ways to Modify a Deadlift so Anyone Can Perform

If you want to learn more, I have an Inner Circle webinar on 3 Ways to Modify the Deadlift so Anyone Can Perform.  In this presentation, I break down the 3 most common reasons why people often don’t perform a deadlift, the inability to load, poor hinge patterns, and altered hip anatomy.  Deadlifts are great, and really underutilized in rehab, but with these 3 modifications, anyone should be able to perform them.

To access this webinar:

Thanks for sharing! Follow me online for even more great content!

Send this to friend