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How to Assess Thoracic Mobility

The latest Inner Circle webinar recording on How to Assess Thoracic Mobility is now available.

How to Assess Thoracic Mobility

how to assess thoracic mobilityThis month’s Inner Circle webinar is on How to Assess Thoracic Mobility.  In this presentation, I’m going to show you how I assess thoracic mobility from multiple perspectives.  Many people have thoracic mobility restrictions and just blindly throwing thoracic mobility drills at them is going to be suboptimal without an accurate assessment.  Some need to focus on extension, some rotation, and others can move well, they just don’t!

This webinar will cover:

  • The key things I look at to assess thoracic mobility
  • How to integrate posture, thoracic movements, and functional movements
  • How to assess for compensation elsewhere when the thoracic spine is limited

To access this webinar:

How to Stabilize the Scapula During Shoulder Elevation

One of the most common compensations we see with people with limited overhead shoulder elevation is lateral winging of the scapula.  Anytime you have limited glenohumeral joint mobility, your scapulothoracic joint is going to try to pick up the slack to raise your arm overhead.

This is common in postoperative patients, but also anyone with limited shoulder elevation.

Stabilizing the scapula during range of motion is often recommended to focus your mobility more on the shoulder than the scapula.  As with everything else, as simple as this seems, there is right way, a wrong way, and a better way to stabilize the scapula during shoulder elevation.

In this video, I demonstrate the correct way to stabilize the scapula, and show some common errors that I often see.

 

How to Stabilize the Scapula During Shoulder Elevation

 

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An Easy Drill to Enhance Thoracic Extension

Thoracic mobility drills are commonly given to people to enhance mobility.  I have shown some common thoracic mobility drills in the past, and recently showed a newer muscle energy technique I have been using.  If you haven’t seen these yet, you should check them out:

One of my big principles of rehabilitation and corrective exercises is that you follow up mobility drills with some sort of activation or strengthening drill.  You want to use the body in this newly gained mobility.

For some reason, I feel like this is often ignored with thoracic mobility.

I would actually argue that a very common reason for having limited thoracic mobility is poor endurance into thoracic extension.  The muscles can’t maintain an extended posture and resort to the path of least resistance, a slouched posture.

If you are going to spend time working on thoracic extension mobility, you should follow that up by working on thoracic extension endurance.

In the video below I show an extremely easy way to start working on thoracic extension endurance.  Certainly not groundbreaking, but an important drill that is often overlooked.

An Easy Drill to Enhance Thoracic Extension

Learn How I Enhance Thoracic Mobility

If you want to learn more about how I enhance thoracic mobility, I have a presentation on Enhancing Thoracic Mobility.  I review some of the self mobility and manual therapy techniques I use to enhance thoracic mobility. This webinar will cover:

  • The importance of thoracic mobility
  • Manual therapy techniques to improve thoracic mobility
  • My favorite self mobility drills to improve thoracic mobility on your own
  • Correct exercises to enhance movement after gaining thoracic mobility
  • How to put it all together to maximize outcomes

To access this presentation:

Enhancing Thoracic Mobility

enhancing thoracic mobilityLimited mobility of the thoracic spine is a common finding and something that tends to get worse over time.  To me, it’s one of those “use it or lose it” types of mobility in the body.  Several issues can occur from limited thoracic mobility, such as shoulder, neck, and even low back pain.

Thoracic mobility drills are common, but only part of the puzzle.  I have a new presentation where I’ll be reviewing some of the self mobility, manual therapy techniques, and corrective exercises I use to enhance thoracic mobility.

Enhancing Thoracic Mobility

This presentation will cover:

  • The importance of thoracic mobility
  • Manual therapy techniques to improve thoracic mobility
  • My favorite self mobility drills to improve thoracic mobility on your own
  • Correct exercises to enhance movement after gaining thoracic mobility
  • How to put it all together to maximize outcomes

Access the Presentation

You can purchase access to this presentation for only $10, or join my online Inner Circle Mentorship program for only $10/month and gain access to this and ALL my past presentations, product discounts, exclusive content, member only forum, and more!

Thoracic Mobility Muscle Energy Technique

Have you ever worked with someone that never seemed to improve their thoracic mobility, especially thoracic rotation?

I work with the occasional person that doesn’t respond to many of the common thoracic mobility drills.  Sometimes their daily posture, especially if working a desk job for years, needs more than the simple drills.  Sometimes I feel that thoracic mobility limitations can be true mobility restrictions, but other times I also feel there may be some tone or guarding involved.

A common technique that can be used to enhance mobility drills, especially when tone is involved, is muscle energy technique, or MET.  Muscle energy is commonly used to enhance mobility in other areas of the body, like the shoulder or hamstring, but less frequently used for thoracic mobility for some reason.

In the video below I show a very easy muscle energy technique that you can use to enhance thoracic mobility into rotation.  This is very easy to perform on your own too.

Give it a try and let me know what you think, I’ve been pretty amazed at how much more mobility I can achieve in a short amount of time using this muscle energy technique, especially for those stubborn thoracic mobility limitations.

 

Thoracic Mobility Muscle Energy Technique

 

Learn How I Enhance Thoracic Mobility

If you want to learn more about how I enhance thoracic mobility, I have a presentation on Enhancing Thoracic Mobility.  I review some of the self mobility and manual therapy techniques I use to enhance thoracic mobility. This webinar will cover:

  • The importance of thoracic mobility
  • Manual therapy techniques to improve thoracic mobility
  • My favorite self mobility drills to improve thoracic mobility on your own
  • Correct exercises to enhance movement after gaining thoracic mobility
  • How to put it all together to maximize outcomes

To access this presentation:

 

The Best and Easiest Way to Restore Knee Extension

One of the most common complications following a knee injury or surgery is not restoring full knee extension.  Losing knee extension causes a lot of issues, ranging from anterior knee pain, to altered movement patterns, to even difficulty when walking.

It’s super important to assure you restore full knee extension.

In this video below, Lenny Macrina, my co-owner of Champion and co-author of OnlineKneeSeminar.com, shares what he considers the best way to restore full knee extension.  Luckily, it’s not only the best in our minds but also the easiest to perform!  More importantly, he discusses why he doesn’t like one of the most common exercises that people tend to use.

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Is GIRD Really the Reason Why Baseball Pitchers Get Hurt?

Today’s guest post comes from Lenny Macrina, my good friend and co-owner of Champion PT and Performance.  We work with a lot of baseball players at Champion, which makes us really understand one thing – baseball pitchers are unique!  Many of our athletes come to us after going elsewhere for care but not making the progress they want.  I don’t think we are special, we just see a lot of baseball injuries, so we know what to look for in these athletes.  

Lenny does a great job here discussing a very common misconception about pitching injuries and GIRD.  Honestly, GIRD is kind of outdated.  

Lenny has conducted a ton of research on this topic and wanted to share his results.  You MUST understand the science and not get caught up in all the hype on the internet!  Read below and learn more!


 

Baseball pitchers tend to have unique amounts of mobility of their shoulders. Because of this, throwing generates tremendous forces on the shoulder.  This is important to consider when evaluating and treating baseball injuries.

All of this fancy talk basically says that throwing a baseball is technically bad for your body, and many times we see baseball pitchers with hurt shoulders and elbows.

But why?

We believe there are many reasons, but as physical therapists who have to assess and treat these baseball players, we must be aware of their unique presentation and act accordingly.

It has been well established in the literature that pitchers exhibit adaptations to their shoulder mobility from the act of throwing.   Generally, the thrower’s shoulder exhibits less internal rotation but greater external rotation compared to non-throwing side. There are many proposed reasons for these shoulder mobility changes, including bony adaptations, muscular tightness, shoulder blade position, and capsular restrictions.

This loss of internal rotation has received a lot of attention and has even been referred to as glenohumeral joint internal rotation deficit (GIRD).

 

Is GIRD really the reason why baseball pitchers get hurt?

Several authors have stated that GIRD may increase the risk of shoulder injuries in baseball pitchers. This has caused everyone to assume this and treat accordingly.

Our initial research, that we published in 2011, showed pitchers with GIRD had a 1.8 times increased risk of shoulder injury. But it was NOT statistically significant. Since then, we have published more data that shows similar trends, specifically in our paper looking at 8 consecutive seasons of injury data.

While pitchers with measured GIRD had a slightly higher rate of shoulder injury during that season, the relationship was not statistically significant and GIRD did not correlate with shoulder injuries.

Essentially, we have not shown that GIRD correlates to pitching injuries.

 

Total Motion May Be More of the Issue

Perhaps the issue really isn’t GIRD?  A more important measurement to consider in the overhead thrower is total rotational range of motion. Total rotation is defined as the sum of external rotation and internal rotation.

 

Total Rotational Range of Motion

Rather than look at internal rotation by itself, it may be more valuable to look at the combined total rotational motion of both external and internal rotation together.

In fact, we showed that pitchers with greater than a 5 degree deficit in total rotational range of motion displayed a greater risk of injury. In one study, this was a statistically significant 2.6 times increased risk of shoulder injury.

 

What About External Rotation and Shoulder Injuries?

Does GIRD Cause Baseball Pitching InjuriesCuriously enough, we also have shown a relationship between loss of external rotation mobility and shoulder injuries.  Pitchers with external rotation insufficiency were more likely to undergo surgery, 2.2 times more likely be placed on the DL for a shoulder injury, and 4.0 times more likely to undergo shoulder surgery.

Wow!  At first you would think, let’s stretch these guys out and gain external rotation. But hold on one second and let’s get a grip!

If you remember our study from 2011, we showed a high preponderance for shoulder injuries especially in the pitchers whose total motion was greater than 187 degrees.  You don’t want too little or too much motion!

So, as I always tell my students, athletes and fellow clinicians: We’re always walking a fine line between too much and not enough mobility.

 

What About Shoulder Flexion?

While internal and external rotation get all the exposure, shoulder flexion may actually be an area we see tight the most.

I think one interesting finding of our recent research has been the relationship between the shoulder flexion deficit and injury.  Pitchers with a deficit of greater than or equal to 5° in shoulder flexion of the throwing shoulder had a 2.8 times greater risk for elbow injury.

The correlation between shoulder flexion deficit and elbow injury may represent a lack of tissue mobility and overall flexibility (possibly to the latissimus dorsi) in injury-prone subjects.

The baseball pitcher has a unique mobility of the arm.  We need to be careful assuming that these abnormalities and asymmetries correlate to injury.  They often do not.

The challenge is figuring this out and keeping up with the research…as it is always evolving!  The more you work with baseball pitchers the more you appreciate these subtleties.  These are the subtleties that make them unique, and effective as athletes.

 

So, what does all of this mean?

  • Assess motion
  • GIRD not necessarily bad (actually pretty normal)
  • Lacking ER may increase risk of injury
  • Total range of motion deficits increase risk of injury
  • Shoulder flexion deficits increased elbow injury risks
  • Assess and never assume!

GIRD is not as evil as everyone makes it out to be.  Treating them unnecessarily and trying to gain internal rotation may actually make them worse.  Don’t treat without thoroughly assessing, and don’t assume GIRD is the reason why baseball pitchers get injured.

 

 

Assessing the Shoulder Shrug Sign

The latest Inner Circle webinar recording on Assessing the Shoulder Shrug Sign is now available.

Assessing the Shoulder Shrug Sign

Assessing_the_Shoulder_Shrug_SignIn this inservice recording, I overview the two main types of shoulder shrug signs that I see.  The classic shrug sign typically involves either a rotator cuff injury or significant capsular hypomobility.  However, we also see shrugs in people that have poor overhead mobility.

This webinar will cover:

  • What are the different types of shoulder shrug signs?
  • How to tell if you have a mobility or motor control issue
  • The sequence I follow to determine what to choose for my treatments

To access this webinar: