The latest webinar recording for Inner Circle members is now available below.
Muscle Energy Techniques
This month’s Inner Circle webinars shifted gears a little bit. Rather than talk about a specific injury or treatment focus, we discussed a general technique, muscle energy techniques. I liked this approach as I think there are a lot of immediate clinical implications that will allow you to start using muscle energy techniques right away. Here is just a few of the things we covered:
The history and background of muscle energy techniques from both the physical therapy and osteopathic fields
The effects and efficacy of muscle energy techniques
A review of some of the various different methods of using muscle energy techniques
How I use muscle energy techniques to increase motion, decrease guarding, reduce hypertonicity, perform joint mobilizations, and teach self-stretches
How you can start integrating muscle energy techniques into your current skill set.
To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.
Limitations in ankle dorsiflexion can cause quite a few functional and athletic limitations, leading to the desire to perform ankle mobility exercises. These types of mobility drills have become popular over the last several years and are often important components of corrective exercise and movement prep programming. Considering our postural adaptations and terrible shoe wear habits (especially if high heels), it’s no wonder that so many people have ankle mobility issues.
Several studies have been published that shown that limited dorsiflexion impacts the squat, single leg squat, step down activities, and even landing from a jump. These are all building blocks to functional movement patterns, so the importance of designing exercises to enhance dorsiflexion can not be ignored. While I will openly admit that I believe that the hip has a large influence on ankle position and mobility, it is still important to perform ankle mobility exercises. I will discuss the hip component in a future post.
There are many great ideas on the internet on how to improve dorsiflexion with ankle mobility exercise, but I wanted to accumulate some of my favorite in one place. Below, I will share my system for assessing ankle mobility and then addressing limitations. I use a combined approach including self-myofascial exercises, stretching, and ankle mobility drills.
How to Assess Your Ankle Mobility
Before we discuss strategies to improve ankle mobility, it’s worth discussing how to assess ankle mobility. I am a big fan of standardizing a test that can provide reliable results. One test that is popular in the FMS and SFMA world is the half-kneeling dorsiflexion test.
In this test, you kneel on the ground and assume a position similar to stretching your hip flexors, with your knee on the floor. Your lead foot that you are testing should be lined up 5″ from the wall. This is important and the key to standardizing the test.
From this position you lean in, keeping your heel on the ground. From this position you can measure the actual tibial angle in relationship to the ground or measure the distance of the knee cap from the wall when the heel starts to come up. An alternate method would be to vary the distance your foot is from the wall and measure from the great toe to the wall. I personally prefer to standardize the distance to 5″. If they can touch the wall from 5″, they have pretty good mobility. I should note that my photo below has my client wearing minimus shoes, but barefoot is ideal.
This is a great position to assess your progress, and as you’ll see, I’ll recommend some specific drills you can perform from this position to you can immediately assess and reassess.
Ankle Mobility Exercises to Improve Dorsiflexion
As I mentioned previously, I like to use a 3-step process to maximize my gains when trying to enhance ankle dorsiflexion:
Self-myofascial release for the calf and plantar fasica
Stretching of the calf
Ankle mobility drills
I prefer this order to loosen the soft tissue and maximize pliability before working on specific joint mobility. Also, I should note that I try to go barefoot during my ankle mobility exercises.
Self Myofascial Drills for Ankle Dorsiflexion Mobility
One of the more simple self myofascial release techniques for ankle mobility is foam rolling the calf. This has benefits as you can turn your body side to side and get the medial and lateral aspect of your calf along the full length. I will instruct someone to roll up and down the entire length of the muscle and tendon for up to 30 seconds. If they hit a really tender spot or trigger point, I will also have them pause at the spot for ~8-10 seconds.
What is good about the foam roller is that you can also add active ankle movements during the rolling, such as actively dorsiflexing the foot or performing ankle circles. This gives a nice release as well. Don’t forget to roll the bottom of your foot with a ball, as well, to lengthen the posterior chain tissue even further. There is a direct connect between the plantar fascia and Achilles tendon.
Some people do not feel that the foam roller gives them enough of a release as it is hard to place a lot of bodyweight through the foam roller in this position. That is why I often use one of the massage sticks to work the area in addition. You can use a massage stick in a similar fashion to roll the length of the area and pause at tender spots. I often add mobility in the half kneeling position as well, which gives this technique an added bonus.
Stretches for Ankle Dorsiflexion Mobility
Once you are done rolling, I like to stretch the muscle. If moderate to severe restrictions exist, I will hold the stretch for about 30 seconds, but often just do a few reps of 10 seconds for most people. The classic wall lean stretch is shown below. This is a decent basic exercises, however, I have found that you need to be pretty tight to get a decent stretch in this position.
I usually prefer placing your foot up on a wall or step instead, as seen in the second part of my video below. The added benefit here is that you can control the intensity of the stretch by how close you are to the wall and how much you lean your body in. I also like that it extends my toes, which gives a stretch of the plantar fascia as well. For both of these stretches, be sure to not turn your foot outward. You should be neutral to point your toe in slightly (no more than an hour on a clock).
Simple Ankle Mobility Exercises
I like to break down my ankle mobility exercises into basic and advanced, depending on the extent of your motion restriction. There are several basic drills that you can incorporate into your movement prep or corrective exercise strategies.
The first drill involves simple standing with your toes on a slight incline and moving into dorsiflexion by breaking your knees. Eric Cressey shows us this quick and easy drill that you can quickly perform:
Tony Gentilcore shows another simple ankle mobility drill, which is essentially just a dynamic warmup version of the ankle mobility test we described above:
Kevin Neeld shows a great progression of this exercise that incorporates both the toes up on the wall, essentially making it more of a mobility challenge and stretch. If you look closely, you’ll see that he is also mobilizing in three planes, straight neutral, inward, and outward:
Advanced Ankle Mobility Exercises
Jeff Cubos shares a video of the half kneeling mobilization with a dowel. The dowel is an important part of the ankle mobility drill. You begin by half kneeling, then placing a dowel on the outside of your foot at the height of your fifth toe. Now, when you lean into dorsiflexion, make sure your knee goes outside of the dowel. You can add the dowel to many of the variations of drills we are discussing:
Chris Johnson shared a nice video using a Voodoo Floss band to assist with the myofascial release and position the tibia into internal rotation:
For those that have a “pinch” in the front of the ankle of tight joint restrictions of the ankle in general, Erson Religioso shows us some Mulligan mobilizations with movement (MWM) using a band. In this video, he has his patient put the band under his opposite knee, however you could easily tie this around something behind you. In this position you step out to create tension on the band, which will move your talus posteriorly as you move forward into dorsiflexion:
As you progress along with your mobility, you may find that variations of these drills may be more effective for you. You can combine many of these approaches into one drill, such as Matt Siniscalchi shows us here, combining the MWM with the dowel in the half kneeling position:
As you can see, there are many different variations of drills you can perform based on what is specifically tight or limited. You may have to play around a little but to find what works best for each person, however these are a bunch of great examples of ankle mobility exercises you can choose to perform when trying to improve your dorsiflexion.
Ah, it’s that time of the year again, time for New Year’s resolutions! While many people will be taking the plunge and dedicating some time and energy to fitness goals, the real challenge is sticking to these New Year’s resolutions for more than a month! There are many reasons why people don’t stick to their workouts and fitness New Year’s Resolutions. Some of them are just facts of life, such as time commitments, financial concerns, and lofty expectations.
Two common reasons for not sticking to your fitness resolutions that I have observed are soreness from the initiation of a new program and plateaus in your progress. These are much more manageable and something that I think are sometimes related to mobility issues that can be addressed.
For the person just beginning a fitness program, muscle soreness and tightness after performing new exercises is essentially expected. But there are some ways to reduce this soreness and get over the initial hump a little easier. Movement and massage are two prime examples. For the person that has some workout experience but aren’t working with a qualified professional, they often have some muscle imbalances and movement restrictions because someone isn’t helping them address their weaknesses. Everyone wants to work on their strengths, right?
These are both obvious reasons as to why you want to work with a qualified strength and conditioning coach or personal trainer that can help identify and address your mobility concerns. But what if you don’t have the access to a great coach and just want to start a home workout program or buy a generic gym membership?
Here are 3 tools that I recommend for you to get more out of your programs. For a small amount of money, you can start your own package of tools that you can use at home between workouts. Use these tools daily for 10 minutes and you’ll move and feel better between workouts, which will allow you to get more from your programs.
Foam rollers are a staple for many people and certainly not anything new. While foam rollers are popular at the gym before a workout, having one at home to use between workouts is a must as well. Many people consider a foam roller a “self-myofascial release” tool. I’m not sure if we are making any significant fascial changes when we foam roll, but the combination of the compression on the tissue and movement associated with foam rolling likely has a positive effect on neuromodulating tissue soreness and tightness. What does this mean for you? You’ll feel better and move better when you are done!
How to Use a Foam Roller
I recommend two uses for foam rollers – 1) as a generalized full body program, and 2) on specific sore muscles. I would recommend rolling out the major hot sports of the body, such as:
I essentially recommend 5-10 full length rolls of each area, performed in a slow and controlled pace each day. If specific muscles are sore after a workout, I would emphasize these and perform another 5-10 reps, however, if you find a specific point of discomfort, you can pause at that spot for 10 seconds. Take a few deep breaths and try to relax. I would also recommend performing a few thoracic spine extensions while rolling the mid back. Here is a great video demonstration from Eric Cressey. He hits a few different areas, however, the general concepts are the same and these are great examples. There are also a few trigger point ball examples towards the end, but more on that later:
What Foam Roller to Buy?
I currently recommend two foam rollers, one for beginners that are just looking to incorporate foam rolling and another for more advanced uses that don’t mid spending a little more.
For Advanced Users: The Grid Foam Roller. When you are ready to step up to a more firm roller, the Grid is by far the best on the market. I don’t really think all those ridges and nubs do anything, but this is a great firm and durable roller that will last you a lifetime. It’s a bit pricier between $30 and $40, but worth it.
While foam rollers are great, they aren’t perfect for every body part. Essentially, if you can’t put a lot of weight through the foam roller, it doesn’t feel like you are doing much. If you notice the above list of muscle areas does not include the entire body. To hit more specific areas, a massage stick is a great tool and essentially a foam roller with handles! You can use your hands to put more pressure into the movement when body weight isn’t available. I see a foam roller and massage stick as complementary, and a massage stick is great for:
Outer side of lower leg
As you can see, pretty important areas, and spots that foam rollers really don’t hit well. Not only do these areas get sore, but limitations often result in poor performance when training.
How to Use a Massage Stick
I use a massage stick just like a foam roller, with about 5 full length rolls on each area. If sports are sore, which is pretty common in the calf and upper trap, I will pause there for about 10 seconds. Here is a demonstration I have used in the past on how I use massage sticks for the forearm:
What Massage Stick to Buy?
I have used several massage sticks in the past and must say that there is only one I would currently recommend as it is by far superior to the others:
TheraBand Roller Massager+. I was skeptical when I first used this massage stick, assuming that the ridges were just a way of separating themselves from the rest of the market. However, the combination of the ridges and the material of the roller makes for a great combo and the best roller on the market! The material grabs the skin well and the ridges create a drag sensation in addition to the compression.
Trigger Point Ball
We have progressed from a foam roller, to a massage stick, and now to a trigger point ball, the third component of a great self-help tool package! Even with a roller and a stick, there are still some areas that are just too hard to get to. As you can see, we are getting more specific with each tool. Here is what I use trigger point balls for:
Specific trigger points in the glutes and hips
Upper and middle trap areas
Posterior rotator cuff
If these are areas of concern for you, you’ll want to get some sort of trigger point ball to hit these spots with ease.
How to Use a Trigger Point Ball
Using a trigger point ball is a little different from a roller or a stick, I usually don’t recommend rolling the body on the ball, but rather just stick to a trigger point release. These balls can get to a small specific spot, so you can hit multiple points in each area, holding each for about 10 seconds. Here is an example of using a trigger point ball on the posterior shoulder:
What Trigger Point Ball to Buy?
I typically use a couple of different trigger point balls, depending on how firm I want the ball to be. I would recommend the softer balls for beginners and firmer for advanced users. I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas. Here is what I recommend:
For Beginners: Trigger Point Therapy Massage Ball. These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like. This is a good starting point, but if you weigh a lot or plan on using it exclusively for the glutes, the brand new Trigger Point Therapy X-Factor Ball is a little larger and more firm. I use these a lot.
For Advanced Users: SKLZ Reaction Ball. You know those little yellow reaction balls that you drop and bounce all over the place? A friend just recently turned me on to these as trigger point tools! They work great! They are firm and have great little nubs to really get in to the tissue. Plus you can usually find them for under $10.
By combining these 3 tools, you’ll have a perfect home kit to help you move better and feel better between workouts, which means you’ll get more out of your programs and hopefully stick to those New Year’s resolutions!
I wanted to show a quick video of a technique I use for self-myofascial release of the forearm. Obviously, this is a hard area to get with a foam roll and some of the techniques I have seen using the various trigger point balls don’t seem to apply enough pressure for me. Here is a quick clip demonstrating:
The video uses the new Thera-Band Roller Massager+. Obviously you can use you stick of choice, like the original Massage Stick or Tiger Tail, however I must admit that the Thera-Band stick is my current go-to massage stick device. I was a little skeptical at first about the ridges, thinking it was just a way to differentiate itself from the competition, but it really does feel better than the other sticks. The rubber surface with the ridges makes for a nice combination of compression and superficial drag.
Self Myofascial Release for the Forearm
In the video above you’ll notice a few things:
I position the stick at an ~45 degree angle and really wedge it into a firm surface. This gives me a nice rigid platform to roll on.
I use this just like a foam roll. I start with simply rolling back and forth the length of the muscle groups, then stop on any trigger points that I find and hold for a sustained released, then I progress to include multidirection movements that include fascial release techniques.
For the flexor and pronator group, I start with the wrist flexed and pronated and as I roll I extend and supinate.
This is reverse for the extensor and supinator group, I start with the wrist extended and supinated and as I roll I flex and pronate
This is a great warm-up for the forearm and also a great technique to include in home exercise programs for those with injuries such as medial epicondylitis and lateral epicondylitis. Try it and let me know what you think about this or if you have any other self-myofascial release techniques for the forearm that you find to be helpful.
Leon Chaitow recently posted a great article on his website discussing the use of isometric contractions in pain management. In this post he discusses many topics including trigger points and muscle energy techniques. This is a must read article to truly get the most out of your trigger point work and muscle energy techniques.
I was going to include this article in last week’s stuff you should read article, but I really thought this was worth it’s own post.
Here are some tidbits of info that I really liked:
Long, low level isometric contractions are best at reducing pain – Leon tells you a few possible mechanisms as to why this works
All techniques, included isometric contractions and other methods of trigger point release, should be followed up with gentle stretching to lengthen the muscle
This has many implications for trigger point releases and muscle energy techniques
Combining everything Leon discuss, muscle energy techniques are simple and potentially very effective treatments to perform. This makes muscle energy a no-brainer to include in your tool belt – potentially large bank for your buck with minimal investment
It is no secret that I am not a huge fan of the sleeper stretch, I have written about why I don’t use the sleeper stretch that often in the past. While I do realize that there is a need for it at times if you know how to perform the sleeper stretch correctly, I also think there are alternatives to the sleeper stretch that may be safer and even more effective.
To begin, let me ask the question – what is it we are trying to achieve by performing the sleeper stretch? It is probably to work on shoulder internal rotation or cross body horizontal adduction mobility (we’ll refer to the later as posterior shoulder mobility). So let’s explore what else we can do to work on those areas.
Alternatives to the Sleeper Stretch
A recent study in JOSPT compared the sleeper stretch and simple cross body horizontal adduction stretching. The results were pretty interested. The authors report that the cross body horizontal adduction stretch was significantly better at restoring internal rotation of the shoulder in comparison to the sleeper stretch.
It appears that the simple cross body horizontal adduction stretch is actually a better stretch than the sleeper stretch.
Another study from JOSPT also evaluated the use of muscle energy technique (MET) during the cross body horizontal adduction stretch and found that MET was able to show an immediate increase in both horizontal adduction and internal rotation range of motion.
In both studies, the cross body horizontal adduction stretch improved posterior shoulder AND internal rotation mobility.
So, if we consider some of the disadvantageous of the sleep stretch in addition to the proven benefits of the cross body horizontal adduction stretch, I think we can see a nice alternative to the sleeper stretch.
Let’s break this down into two groups, manual and self stretching. I realize that many different people will be reading this so here are some options to help work on people but also to help perform yourself if you are the one looking for an alternative to the sleeper stretch.
I tend to perform a variety of manual techniques in addition to simple cross body horizontal adduction stretching if someone needs a little extra work or has a deficit in internal rotation, including muscle energy techniques and pin and stretch techniques. Both are really effective in my hands and show an immediate and noticeable increase in motion. Here are some photos below but I am putting together a presentation on manual therapy techniques for the shoulder that I will try to present as a webinar over the next few months.
The below photos show me performing cross body horizontal adduction stretching with muscle energy and then adding a pin and stretch technique. Simple and effective without being aggressive.
To perform these stretches yourself, it is best to stand in a doorway so that the wall can help block your scapula from moving. You can place the border of your shoulder blade against the wall and perform the cross body stretch. Here is a video demonstration:
I have also used TriggerPoint balls to provide both a trigger point release and pin and stretch to the posterior shoulder as well, they really tend to work great. You can use something like a tennis ball, racquet ball, lacrosse ball etc. if you have them lying around the house, but I still find the TriggerPoint balls to be superior for techniques like this. Just the right amount of give and the little nub on the ball is great for trigger points. If you are serious about doing these stretches yourself buy one of these, you’ll be happy. Here is a video demonstration:
Don’t forget to catch up and read my past articles:
Mike is the President and Co-Founder of Champion Physical Therapy and Performance, located in Boston, MA. Champion offers an integrated approach to elite level physical therapy, personal training, and sports performance.
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