The Body Mechanic

Daniel MacLean

Body Mechanic The Self-Help Guide to

Correcting Movement Deviations

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Body Mechanic The

Self-Help Guide to

Correcting Movement Deviations by Daniel MacLean

art/Design/creative

biloba-creative.com art/design/creative

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Table of Contents About The Author

p 3

Introduction p 4 Methodology p 6 Functional Test p 8 Screening Tests p 14 Corrective Exercises p 18 -Ankle p 19

-Hip Mobility (Flexion)

p 23

-Hip Mobility (Internal Rotation)

p 28

-Hip Mobility (Extension)

p 30

-Hip Stability (Phase 1)

p 34

-Hip Stability (Phase 2)

p 38

-Lumbar Stability (Phase 1)

p 42

-Lumbar Stability (Phase 2)

p 46

-Thoracic Mobility p 50 -Shoulder Stability p 55 Corrective Exercises Gone Wrong

p 61

Putting It All Together

p 62

References p 65

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About Me - Daniel MacLean, MPT, CSCS, FMS-CM, USAW-L1 My athletic background is comprised of soccer and basketball. Initially, soccer was my first love; but, after suffering an ankle injury that kept me sidelined for six months, I transitioned to basketball for the rest of my high school career. It was through the recovery and rehabilitation process for my injury that my interest in the field of physical therapy began. I was able to return to full basketball competition as well as to collegiate competition at both Solano Community College and San Francisco State University, where I earned a B.S. in Kinesiology with an emphasis in Exercise Science. While finishing my undergraduate degree, I worked at an outpatient sports medicine physical therapy clinic as an aide where my knowledge of therapy and exercise continued to expand. I eventually attended physical therapy school at Sacramento State University, where I received a Master’s of Physical Therapy. My philosophy towards rehabilitation and performance training solidified as I performed a long–term internship at Athlete Performance in Pensacola, Florida, where we worked directly with the Andrews Institute. APFL helped me develop a strong understanding of the Functional Movement Screen (FMS), Selective Functional Movement Assessment (SFMA), the corrective exercises to address movement dysfunction, and numerous manual therapy techniques to address soft tissue limitations. After I graduated from physical therapy school, I felt a need to further enhance my manual therapy skills, which led me to the Long–Term Folsom Manual Therapy course. This yearlong training was focused on manual therapy techniques to address soft tissue dysfunction throughout the body, with an emphasis on the spine. This manual therapy course gave me insight into appropriate treatment for the body based on different phases of healing. I am currently the Director of Rehabilitation at Results Physical Therapy & Training Center in Sacramento, California. I have been extremely fortunate to be mentored by some of the leaders in sports physical therapy over my two- year span at Results, which has helped me develop a systematic approach to bridging the gap between the physical therapy treatment table and sporting competition. I have also obtained my Certified Strength and Conditioning Specialist Certification (CSCS), USAW Level 1 Certification, and I am a Certified Functional Movement Screen member. All of these life experiences have contributed to the development of a well-rounded approach to assessment and treatment of movement dysfunction.

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Introduction Due to the rising popularity of CrossFit and Olympic lifting over the past decade, there has been a steady rise in sports-related injuries within the population. As a physical therapist, I have seen many athletes in the clinic with similar types of pathologies over the past three years. The observation of these injuries among my patients has sparked an interest into why these pathologies continue to show up day in and day out in the clinic. While the increase in injuries between the CrossFit and Olympic lifting population is not surprising given the fact that the popularity of these activities has steadily increased over the past 10 years, what is surprising is the commonality within this community of participants when talking about injuries. The most common injuries in these sports continue to involve the shoulder, knee, hip, and lumbar spine. With any sport that requires maximum effort there is going to be an increased risk for injury. As the body becomes fatigued, performance decreases, movement becomes compromised, and injuries tend to occur; but what if there was a guide as to how to manage/enhance your body’s performance while also decreasing your risk for injury? What if you had a guide to help self-diagnose movement impairments in the body that are putting you at increased risk for micro trauma and injury? The goal of this guide is not only to empower the athlete to be proactive with his or her body as far as injury prevention, but also to serve as a building block for future success and a foundation for performance enhancement. We constantly hear about the importance of balancing the body and making sure the body is symmetrical from side to side. That is for good reason. When there are differences from side to side in the muscular system, we not only put ourselves at an increased risk for injury, but we also cannot be as efficient/powerful with our movement patterns. When there is deviation in the muscular system, energy is lost as our body compensates to produce movement. I often compare the human body to a finely tuned automobile when discussing the concept of balancing the body. A car produces speed from the engine transmitting power through the axle and wheels. A car can only go as fast as the wheel can rotate on the axle. When a wheel is not equally balanced compared to the opposite side, we get a wobbly wheel (deviation). A wheel that does not rotate efficiently greatly impacts the ability of the car to reach maximum speeds. Every time the tire turns energy is lost, and the tire is eventually going to prematurely wear down. The same can be said for the human body. For example, if we have a hip that is not rotating well in its socket, the body will lose energy through that joint while performing deep squats or lunges, causing a decrease in power output through that structure.

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Introduction, continued This guide will give you the power to maintain proper alignment throughout your body, thus putting stress through structures that are intended to produce power. Currently, in the CrossFit and Olympic lifting community there is a plethora of information concerning exercises and stretches to perform. How does one choose the appropriate corrective exercise? Let me tell you what most people do. If an athlete feels the need to strengthen his or her legs, they will perform exercises they are familiar with or exercises they have seen online somewhere. The problem with this strategy is that they might be performing the incorrect exercise for the deviation they are currently experiencing. No two individuals are the same, and, therefore, no two individuals have the same issue. Let’s take the knee for example. The knee is a common site for pain in the lower extremity, and, consequently, many people attempt to strengthen the knee in order to increase leg strength or to correct movement deviations. The question is: What if impairment in the hip or ankle is the cause of the knee deviation or pain in their movement? Many times the knee is not the cause of lower extremity deviation; it is simply the aftermath of poor movement in the hip or ankle. This guide will help you determine where your deviation is originating from, which exercises will correct the deviation, when you should perform these exercises, how often you should perform these exercises, and, most importantly, the reason for performing these exercises. By utilizing this guide, you will be equipped with all the tools necessary to accomplish your goals, whatever they may be.

Disclaimer: This guide is not meant to diagnose or treat any pathology, nor should this guide be used to rehabilitate from any type of surgical procedure. If you are recovering from an injury or surgical procedure, make sure to contact your local healthcare provider prior to beginning any exercise or training regimen. All movements listed within this guide are performed at one’s own risk. Neither Juggernaut Publishing nor Daniel MacLean is responsible for any injury which may occur while performing movements listed in this guide.

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Methodology When attempting to determine limitations in your body, it is important to look from global to specific: for example, looking at a global movement such as the squat and then determining what point in the squat a deviation occurs. Once we know where a deviation occurs, we can then find the culprit. If you squat and your knees rotate inward, we can then get more specific and look at the joints above and below the knee to determine what the cause of the deviation is. Looking at one joint at a time can be tricky and misleading. Looking at one joint at a time will provide some information, but might not target the actual cause of the deviation; i.e., addressing the deviation, (the knee), but not addressing the cause of the deviation, (the hip or ankle). The result of focusing on one joint at a time will be short-term relief with continued movement deviation, which is, effectively, putting a bandage over the problem. It will not fix the problem; it will only cause further deterioration and risk for further injury. Bottom line, looking at a global movement and breaking the movement down will yield better results and a longer–lasting effect on your body’s performance. This mindset is represented in The Joint-By-Joint Approach, as coined by Gray Cook & Michael Boyle, for rehabilitation and performance enhancement. The joint-by-joint approach links all the joints in the body and categorizes them into joints which are in need of mobility (flexibility) and/or joints that are in need of stability (strength). As we move from the ankle up to the neck, we will focus on the joints which are most commonly involved with the CrossFit and Olympic lifting community. The ankle is most commonly in need of mobility. In general, if the ankle does not move well, increased force will be distributed through the knee or arch of the foot during athletic competition. The knee is most commonly in need of stability and is a common source of pain when there are impairments in the hip or ankle. The hip is most commonly in need of mobility. A lack of mobility will cause increased force through the lumbar spine and knee when attempting deep squatting movements. The hip is unique because a lack of stability may also lead to the knee acquiring compromising positions, which increases the risk to the patella or ligamentous structures of the knee. The lumbar spine is most commonly in need of stability. When there is a lack of stability, the spine may bend or extend beyond its neutral position, causing damage to the structures of the spine. The thoracic spine is most commonly in need of mobility and will cause the lumbar spine, as well as the shoulder joints, to move excessively if the thoracic spine is too stiff.

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Methodology continued The shoulder joint and scapular/thoracic joint is most commonly in need of stability. When the joint is unstable, overhead motions may cause micro trauma, leading to more substantial injuries in the future. In general, men present with mobility issues and females present with stability issues. Again, these are very general guidelines and are not true to every person. These are simply commonalities seen in the clinic. The goal is to address impairments before pathology hits. Okay. We now know a general rule of thumb for each joint of the body. Now, the big questions are: What do we do with this information? How do you find out if you have good stability or mobility in each joint? This next section will show multiple screening tests for the joints in question and how to choose the appropriate corrective exercise to address specific limitations. The most important functional test for CrossFit and Olympic lifting athletes alike is the overhead squat. This position combines deep squatting with overhead pressing, a common training and competition position for our population. Studies are beginning to show that if an individual scores poorly on the Overhead Squat Functional Test (FMS) there is an increased risk for injury (when combined with other functional tests), and an individual will not significantly increase their performance over the next year. Both of these statements are very powerful and are the reasons we will use this as our only functional test. While performing the overhead squat, it is important to wear shoes you will utilize for training. If you train in a high-heeled shoe, I would recommend screening in a neutral shoe or barefoot. A high-heeled shoe (common in Olympic lifting) will eliminate a dorsiflexion mobility issue in the ankle. (Be consistent in footwear for pre- and post-test comparisons). I also recommend using a video camera or smartphone to record your overhead squat and other screening tests as it will be extremely difficult to perform the test and self-assess at the same time.

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Functional Test Overhead Squat (Record video from front & side) Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place a dowel on your head and hold it so that your elbows are at a 90-degree angle. Press the dowel directly overhead, extend both elbows, and squat down as deep as you can comfortably go. The overhead squat is going to provide a lot of information. My goal for you is that you will be able to clearly see a deviation. Below are some visual examples of the most common deviations we see in the clinic. Let’s start from the ground up.

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Assessment (Front view) i. Ankle: 1. Does the arch of your foot collapse? (Ankle Mobility) 2. Does your foot remain pointing forward? (Ankle/Hip Mobility)

ii. Knee: 1. Do your knees remain in line with your toes and hip? (Out-Hip Mobility/In-Hip Stability)

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Assessment (Front view) continued iii. Hip: 1. Do you shift towards one side? (Hip Stability) 2. Does your hip hike on one side? (Hip Mobility)

iv. Elbow 1. Does your elbow bend? (Thoracic Mobility/Shoulder Stability) v. Dowel: 1. Does the dowel stay parallel to the ground? (Lower side—Thoracic Mobility or Shoulder Stability)

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Assessment (Side view): i. Ankle: 1. Does your heel lift off the ground? (Ankle Mobility)

ii. Lumbar Spine: 1. Hyperextended? (Lumbar Stability/Thoracic Mobility) 2. Rounded? (Hip Mobility/Lumbar Stability)

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Assessment (Side view) continued iii. Torso: 1. Is your torso parallel to your shinbone? (Thoracic Mobility/Lumbar Stability)

iv. Dowel: 1. Is the dowel forward from your toes? (Thoracic Mobility/Lumbar Stability) 2. Is the dowel symmetrical from end to end? (End forward-Thoracic Mobility / Shoulder stability)

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Assessment (Perfect form) i. Front View:

ii. Side View:

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Screening Tests From the Functional Overhead Squat test, we can narrow our screening tests. The screening tests are intended to direct you towards the area with the greatest amount of deviation. Again, we move from global to more specific with our testing to direct us to the appropriate area of need. It is simple: If you saw a large deviation in the hip during the overhead squat, you would then choose the appropriate screening tests for the hip. If the screening test is positive, you will choose the appropriate corrective exercises. If you have many deviations on the overhead squat, a good rule of thumb is to start from the ankle and work your way up the kinetic chain towards the shoulder.

1. DF ROM (No video necessary) a. Positioning: Half kneel. b. Test: Move your knee forward and in line with your second toe as far as you can without raising your heel. Place a dowel vertically, touching your front knee. Measure the distance from your great toe to the dowel. c. Normal: 4” from your toe or symmetrical to your opposite side.

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Screening Tests continued 2. Hip Mobility (Flexion - Video from side & head/down) a. Positioning: Lie on your back. b. Test: Pull one knee towards your chest while keeping a slight curvature in your spine. If your knee begins to rotate outward (hip external rotation), the test is over and measure from that point. You should not feel your lower spine flat against the ground. c. Normal: Symmetrical to your opposite side. Leg does not rotate outward (externally rotate).

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Screening Tests continued 3. Hip Mobility (Internal Rotation - Video from foot/up) a. Positioning: Lie on your back with the test knee bent to 90 degrees. b. Test: Keeping your knee at 90 degrees, move your knee inwards towards the ground while keeping your target knee aligned with your target hip. Maintain a flat lumbar spine against the ground. c. Normal: Symmetrical to your opposite side.

4. Hip Mobility (Extension - Video from side) a. Positioning: Sit at the edge of a table. Rock onto your back cradling both knees to your chest. b. Test: Grab one knee with both hands while letting the opposite leg fall down towards the ground. Keep your lower back flat to the table at all times. c. Normal: Thigh bone falls down in contact with the table, knee flexion ROM >80 degrees.

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Screening Tests continued 5. Thoracic Mobility (Video from behind) a. Positioning: Sit at the edge of a table or chair. Squeeze a foam roller between your knees. Place a dowel horizontally across your chest. b. Test: Rotate moving in a slow and controlled fashion. Rotate to one side as far as you can while maintaining original positioning. Return back to center and test the opposite side.

c.

Normal: 50 degrees (~halfway to 90 degree angle)

You may have realized that all of the screening tests are also mobility tests. There are two reasons for this. The first reason is, in order for any movement to be completed without deviation, the entire kinetic chain must have sufficient mobility. If sufficient mobility cannot be acquired, joints above and/or below will be forced to work harder to obtain the correct movement position, thus making a mobility issue appear as a stability issue in a neighboring joint. The second reason the screening tests are all mobility tests is because it is extremely difficult to self-assess a stability issue through screening tests. There is far too much room for error. Therefore, we will be determining a stability issue through a (-) finding on the mobility screening tests. The chart below will direct you to the appropriate corrective exercise given (-) findings through the screening tests: DF ROM (-): Perform Hip Stability Correctives. Hip Mobility Flexion/IR/Extension (-): Perform Hip Stability &/or Lumbar Stability Correctives. Thoracic Mobility (-): Perform Shoulder &/or Lumbar Stability Correctives.

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Corrective Exercises Now we get to the meat and potatoes of the guide and what everyone wants to know: Give me the exercises that will correct my deviations, decrease my risk for injury, and increase my performance. I will tell you that there is no secret recipe behind the exercises you are about to see. This list may be full of exercises you have already seen or performed. The goal is to perform the CORRECT exercises for your limitations and to perform the exercises the CORRECT way. What I tell my patients/clients all the time is, ìIt is easy to do the exercises wrong; it is hard to do them right.î Meaning, if you are performing the exercises the correct way, they should be challenging. If an exercise is not a challenge, check your form or move on to the next phase. While performing these corrective exercises, I want you to understand where you are feeling either the stretch or muscle work. If you are feeling the stretch or muscle work in a different area than indicated, you need to re-check your form or concentrate more specifically on the target area. There are three types of corrective exercises which we will perform to correct your movement deviations. Each exercise has a purpose and should be performed with optimal form. If form is being compromised, the exercise should be stopped because poor movement patterns are compensating for lack of mobility or stability. The first type of corrective exercise is mobility. Mobility exercises are intended to increase ROM of the joint or flexibility of the joint musculature. As described above, limited mobility will limit the depth or form of the overhead squat. The second type of corrective exercise is stability. Stability exercises are intended to ensure the normal alignment/roll/glide of each joint is optimal. When a joint is stable, the prime movers of the joint can produce max strength and power during the overhead squat. The third type of corrective exercise is neuromuscular re-education. Neuromuscular reeducation is used to correct poor movement patterns when mobility and stability issues have been addressed. Neuromuscular re-education exercises are used with a resistance band and are intended to force certain muscles to engage when there is difficulty consciously contracting muscles on one’s own. Neuromuscular re-education exercises help facilitate proper movement patterns and should be performed last in a corrective exercise session.

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ANKLE- DF ROM 1. Kneeling Dorsiflexion Stretch (2x10reps, 5 sec hold) a.

Positioning: Half-kneeling with target ankle in front, position a dowel vertical to the ground on the outside portion of target foot.

b.

Perform: Bring knee forward over the outside portion of the dowel until your heel begins to rise. Hold there for 5 seconds. Bring back to starting position and repeat.

You should feel: A pull in your Achilles/lower calf.

c.

*If you feel a pinch/pressure in the front of your ankle, choose (Alternate).

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ANKLE– DF ROM continued 2. (Alternate) Kneeling Dorsiflexion Stretch w/belt (2x10reps, 5sec hold) a.

Positioning: Begin in a half kneeling position with target ankle in front. Place a belt/band slightly below your ankle crease. Attach to a pole directly behind and lower than ankle level (see picture if pole is not available).

b. c.

Perform: Bring knee forward over the outside portion of the dowel until your heel begins to rise. Hold there for 5 seconds. Bring back to starting position and repeat. You should feel: A pull in your Achilles/lower calf.

Explanation: The pinch you feel in the front of the ankle may not be a stretch. It may be some form of impingement in the front of the ankle. The belt is meant to mobilize the joint, eliminate the pinch, and allow for the appropriate stretch. If you are still experiencing a pinch in the ankle, do not attempt to stretch through it as this may cause damage within the joint. Schedule an appointment to see your healthcare provider if a pinch is limiting movement (MD or Physical Therapist).

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ANKLE- DF ROM continued 3. Standing Calf Stretch (2x30sec) a.

Positioning: Stand next to a wall arm’s length away. Keeping your feet together, incline your body at roughly a 45-degree angle against the wall with your forearms bearing your weight. Bring your non-targeted foot halfway towards the wall.

b.

Perform: Keeping your target foot straight and heel down, lean your hips closer to the wall.

You should feel: A pull in your upper calf.

c.

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ANKLE- DF ROM continued 4. Assisted Squat w/dowel (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. With a dowel directly in front of you, grab the dowel with both hands.

b.

Perform: Keeping your torso erect, squat down as deep as you can go while maintaining vertical dowel position. Ensure heels remain in contact with the floor.

You should feel: A pull in your ankles, outer hips, upper back, and shoulders.

c.

Relevance: performing these exercises will increase your ankle mobility, thus allowing the knee and hip to perform optimally during deep squatting movements such as: squat, overhead squat, and deadlift. When there is inadequate mobility in the ankle, the foot arch can collapse thus causing the knee to fall inward during the above listed movements. Lack of ankle mobility may also cause increased force distributed through the patella-femoral joint, resulting in micro trauma to this structure.

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HIP MOBILITY (Flexion) 1. Single knee to chest w/belt (2x10, 5sec hold) a. Positioning: Lying on your back, pull target knee to chest. Place a belt/band in the target hip crease, other end of belt/band around opposite foot. b. Perform: Pull your target knee towards your chest, not allowing your knee to fall outwards, and hold for 5 seconds. Return to starting positioning and repeat.

c.

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You should feel: A pull in your buttock/hamstring.

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HIP MOBILITY (Flexion) continued 2. Glute/Piriformis Stretch (2x30sec) a. Positioning: Begin in quadruped position. Rotate target foot under the opposite shinbone. b.

Perform: Bring the top leg back and across the rotated foot, maintain level hip alignment, and keep your lumbar spine slightly arched as you stretch.

You should feel: A pull in your outside hip/glute.

c.

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HIP MOBILITY (Flexion) continued 3. Adductor Stretch (2x10, 5sec hold) a. b.

Positioning: Begin in a quadruped position. Slowly move your knees apart from each other until a light stretch is felt in the groin.

You should feel: A pull in your inner thighs.

c.

Perform: Maintaining a slight arch in your lower back, lightly bring your buttock towards your heels to increase the intensity of the stretch.

*If you feel a pinch/pressure in the front of your hip, choose (Alternate).

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HIP MOBILITY (Flexion) continued 4. (Alternate) Adductor Stretch w/belt (2x10, 5sec hold) a.

Positioning: Begin in a quadruped position. Place a belt/band high in the groin of the target hip and other end of belt/band around a pole directly to the side of target hip. Slowly move your body laterally away from the pole to feel a traction force in the hip. Slowly move your knees apart from each other until a light stretch is felt in the groin.

b.

Perform: Maintaining a slight arch in your lower back, lightly bring your buttock towards your heels to increase the intensity of the stretch.

You should feel: A pull in your inner thighs.

c.

Explanation: The pinch you feel in the front of the hip may not be a stretch. It may be some form of impingement in the front of the hip. The belt is meant to mobilize the joint, eliminate the pinch, and allow for the appropriate stretch in the musculature. If you are still experiencing a pinch in the hip, do not attempt to stretch through it as this may cause damage within the joint. Schedule an appointment to see your healthcare provider if a pinch is limiting movement (MD or Physical Therapist).

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HIP MOBILITY (Flexion) continued 5. Assisted Squat w/dowel (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. With a dowel directly in front of you, grab the dowel with both hands.

b.

Perform: Keeping your torso erect, squat down as deep as you can go while maintaining vertical dowel position. Ensure feet remain pointed forward.

You should feel: A pull in your ankles, outer hips, upper back, and shoulders.

c.

Relevance: performing these exercises will increase your hip mobility into forward bending, thus allowing the spine to remain straight during the bottom portion of movements such as: deep squat, deadlift, snatch. When the spine flexes, or hips “tuck under” during the bottom portion of these movements, energy is lost through the spine thus decreasing maximum power output and/or increasing risk for injury to the lumbar spine.

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HIP MOBILITY (Internal Rotation) continued 1. Hip Internal Rotation Stretch (2x30sec)

a.

Positioning: Lie on your back. Bend one knee up to 90 degrees.

b.

Perform: Keeping your abdominals contracted and back flat against the ground, rotate your knee inward towards the ground. For increased stretch, bring the opposite foot over and rest it on the target limb’s knee.

You should feel: A pull in the outside of your hip.

c.

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HIP MOBILITY (internal Rotation) 2.

Squat Neuro Re-education Hip internal Rotation (x10)

a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place tubing/mini band slightly above your knees. Place a dowel on your head and hold it so that your elbows are at a 90-degree angle. Extend both elbows to press the dowel directly overhead.

b.

Perform: Push your knees out against the band and squat down as deep as you can comfortably go.

You should feel: A pull in your outer hips.

c.

Relevance: performing these exercises will increase your hip mobility into forward bending, thus allowing the spine to remain straight during the bottom portion of movements such as: deep squat, deadlift, snatch. When the spine flexes, or hip “tuck under” during the bottom portion of these movements, energy is lost through the spine thus decreasing maximum power output or increasing risk for injury to the lumbar spine.

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HIP MOBILITY (Extension) 1. Prone Quad Stretch With Rope (2x30sec) a.

Positioning: Make a loop in the rope at one end. Hook it around the target limb’s foot. Lie on the table with the target limb up and the opposite limb down, down foot far forward towards the shoulder.

b.

Perform: Pull the rope overhead.

c.

You should feel: A pull in the front of your target limb’s thigh.

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HIP MOBILITY (Extension) continued 2. Anterior Chain Wall Stretch (2x30sec) a.

Positioning: Place a pad on the ground ~ 4 inches from a wall or bench. Obtain a half-kneeling position with target limb knee down on pad. Slowly move backward towards the wall to bring the target limb foot up the wall.

b.

Perform: Tighten your abdominals and make your trunk erect. Bring your hips forward until you feel a stretch.

You should feel: A pull in the front of your hip.

c.

*If you feel a pinch/pressure in the front of your hip, choose (Alternate).

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HIP MOBILITY (Extension) continued 3. (Alternate) Anterior Chain Wall Stretch with belt (2x30sec) a.

Positioning: Place a pad on the ground ~ 4 inches from a wall or bench. Obtain a half-kneeling position with target limb knee down on pad. Slowly move backward towards the wall to bring the target limb foot up the wall. Secure a belt around the back of your target limb thigh directly below your gluteal fold. Make sure you maintain a tall posture.

b.

Perform: Slowly slide your knee backward to tighten the belt. Rock forward and back to perform small oscillations within the joint.

You should feel: A pull in the front of your hip.

c.

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HIP MOBILITY (Extension) 4. Squat Neuro Re-education Hip External Rotation (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place tubing/mini band slightly above your knees. Place a dowel on y our head and hold it so that your elbows are at a 90-degree angle. Extend both elbows to press the dowel directly overhead.

b.



c.

Relevance: performing these exercises will increase your hip mobility into full extension. When we do not have full hip extension, it is difficult to maximally contract the abdominals and glutes. The abdominals and glutes help to stabilize the spine during power movements, thus allowing the quads, hamstrings and glutes to produce power during the “pulling or pushing” phases of the snatch or clean and jerk respectively.

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HIP STABILITY (Phase 1) 1. Side-lying Clam With Band (2x10) a.

Positioning: Place the band slightly above your knees. Lie on your side with your target limb on top. Bend your knees to 90 degrees with your feet in line with your trunk.

b.

Perform: Keeping your feet together, lift your knee as high as you can without your hip rolling backwards. Hold at the top for 2 seconds and slowly return to starting position.

You should feel: A pull in the back/outside of your hip.

c.

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HIP STABILITY (Phase 1) continued 2. Bridge On Ball With Band (2x10) a.

Positioning: Lie with your upper back placed on a physioball and the band slightly above your knees. With your feet hip-width apart, bring your hips up so that you obtain a neutral spine position.

b. Perform: Slowly lower your hips to the ground, tap the ground, and bring your hips back up to the starting position, squeezing your glutes to perform the movement.

c.

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You should feel: A pull in your glutes and upper hamstring.

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HIP STABILITY (Phase 1) continued 3. Band Walks (2x20steps: forward, backward, sideways) a.

Positioning: Place the band slightly above your knees. Keeping your knees hip-width apart, perform a mini squat to obtain the starting position. Lean your trunk forward at a 30-degree angle at the hip.

b.

Perform: Keeping your feet and knees hip-width apart, take a half step forward with one foot and repeat with the other. Repeat for backwards and sideways directions as well. Make sure your ankle/knee/hip complex remains a straight line (that is your knee does not rotate inward).


c.

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HIP STABILITY (Phase 1) continued 4. Squat Neuro Re-education Hip External Rotation (x10) a.


b.



c.

Relevance: performing these exercises will increase your hip stability as well as increase the speed at which your glutes fire during power movements. The glutes are largely responsible for producing power during hip extension movements such as: snatch, clean, and the transition from downward/upward motion of the squat.

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HIP STABILITY (Phase 2) 1. Reverse Mountain Climber (2x6-8 each leg) a. Positioning: Place your elbows on a table, holding your body in a reverse plank position. Ideal alignment is a straight line from your ankle through the shoulders. b. c.

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Perform: Squeeze your abdominals and glutes, press your elbows into the table, slowly lift and bend one knee to 90 degrees, while maintaining the plank position in the down limb. You should feel: A pull in the back/outside of your hip.

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HIP STABILITY (Phase 2) continued 2. Single Leg Deadlift (2x10) a.

Positioning: Stand on one leg. Place the dowel vertical along your spine with one hand behind your neck and the other hand behind your lower back. The stick should maintain contact with your head, upper back, and tailbone as you perform the movement.

b. Perform: Maintain slight knee flexion as you tip your torso forward, hinging from the hip, spine straight. Keep your moving limb straight and in line with your torso.

c.

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HIP STABILITY (Phase 2) continued 3. Single Leg Bridge on ball (2x10) a.

Positioning: Lie with your upper back placed on a physioball and neck supported, buttocks resting on the ground. Bend your right knee towards your chest and hold it with your left arm. Place your right hand on the ground for balance.

b.

Perform: Slowly raise your buttocks, keeping your hips squared and squeezing your left buttock until your hips are shoulder level in height and your torso is neutral.

You should feel: A pull in your glutes and upper hamstring.

c.

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HIP STABILITY (Phase 2) continued 4. Squat Neuro Re-education Hip External Rotation (x10) a.


b.



c.

Relevance: performing these exercises will increase your hip stability as well as increase the speed at which your glutes fire during power movements. The glutes are largely responsible for producing power during hip extension movements such as: snatch, clean, and the transition from downward/upward motion of the squat.

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LUMBAR STABILITY (Phase 1) 1. Plank w/Alternating Leg Lifts (2x20 total) a. Positioning: Position your body in a plank with your elbows directly under your shoulders and bent to 90 degrees straight line from your ankle to your shoulders. b.

Perform: Press your elbows into the ground to push your shoulder blades away from each other. Squeeze your glutes, abdominals, and quads.

Keeping your leg straight, lift one leg off the ground 2-4”. Hold for 3 seconds and repeat on other side.

You should feel: Work in the abdominals, glutes, and shoulder blades.

c.

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LUMBAR STABILITY (Phase 1) continued 2. Prone on Ball (2x15) a.

Positioning: Position your body in a plank position on an exercise ball contacting your upper abdominals. Feet should be against a wall with your knees fully extended.

b.

Perform: Squeeze your glutes, abdominals. Tucking your hips into the ball, keeping your body straight as a board, reach forward and out with both arms together as if you are holding a small dumbbell.

You should feel: Work in the abdominals, glutes, low back, and shoulder blades.

c.

*Rotate your feet outward against the wall to increase your glute contraction. Increase difficulty by holding a small dumbbell weight in your hands.

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LUMBAR STABILITY (Phase 1) continued 3. Shoulder Taps (2x20 total) a.

Positioning: Position your body in a push-up position with your hands on a countertop/bench/ground. Feet should be at least hip-width apart.

b.

Perform: Squeeze your glutes and abdominals. Without rotating your trunk, lift one arm up and touch the opposite shoulder in a controlled manner. Return and repeat on opposite side.

You should feel: Work in the abdominals, obliques, and glutes.

c.

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LUMBAR STABILITY (Phase 1) continued 4. Squat Neuro Re-education Trunk Extension (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place the tubing around your upper back, wrapped underneath your armpits, with the tubing secured around a pole directly in front of your body.

b.

Perform: Lightly pressing your torso against the tubing, squat down as deep as you can comfortably go.

You should feel: A pull in your lumbar spine, abdominals, and glutes.

c.

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LUMBAR STABILITY (Phase 2) 1. Glute/Ham Trunk Extensions (2x15) a.

Positioning: Position your body on the glute/ham machine with the pressure on your upper thighs.

b.

Perform: Squeeze your glutes and abdominals maintaining a neutral spine as you hinge from your hip down and up. There should be no movement in the lumbar spine during the repetition.

You should feel: Work in the abdominals, glutes, and hamstrings.

c.

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LUMBAR STABILITY (Phase 2) continued 2. Push-outs/Short rotations (2x10) a.

Positioning: Stand in a mini squat position with a neutral spine. Grab the tubing with both hands and keep close to chest.

b.

Perform: Push-outs — slowly straighten your arms until they are fully extended, hold for 2 seconds, and return to chest.

Short rotations - while your arms are fully extended, with no movement in the hips, rotate your upper body and move your hands from one shoulder to the other for one repetition.

You should feel: Work in the abdominals, obliques, and glutes.

c.

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LUMBAR STABILITY (Phase 2) continued 3. V-ups (2x15)

a.

Positioning: Lie on your back with your arms extended overhead.

b.

Perform: Squeeze your abdominals to flatten your back against the ground. Lift your arms and legs up towards the ceiling until your hands touch your feet.

Return arms and legs back towards the ground and repeat. Spine should remain flat against the ground the entire time.

You should feel: Work in the abdominals.

c.

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LUMBAR STABILITY (Phase 2) continued 4. Squat Neuro Re-education Trunk Extension (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place the tubing around your upper back, wrapped underneath your armpits, with the tubing secured around a pole directly in front of your body.

b.

Perform: Lightly pressing your torso against the tubing, squat down as deep as you can comfortably go.

You should feel: A pull in your lumbar spine, abdominals, and glutes.

c.

Relevance: performing these exercises will increase your lumbar stability. When lumbar stability is adequate, the spine can remain neutral during movements such as: squat, deadlift, snatch, and clean and jerk. When the spine can remain neutral during these movements, we can ensure that energy is not lost through the spine, and the hips are able to produce maximum force. These exercises will ensure your spine does not excessively flex or extend during these movements.

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THORACIC MOBILITY 1. Upper Thoracic Rotation Stretch (2x5, 5sec holds) a.

Positioning: Lie on one side, bottom leg straight and in line with your trunk, upper knee bent, and flex hip to at least 90 degrees, knee touching the roller, both hands out in front of you, and hands together like you are clapping.

b. c.

Perform: Take a breath in and, as you exhale, rotate your top hand as far as you can in the opposite direction, attempting to touch the shoulder to the ground. Lift the bottom hand and reach towards the ceiling.

Body Mechanic

You should feel: A pull in the upper back.

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THORACIC MOBILITY continued 2. Quadruped Thoracic Spine Rotations (2x10) a.

Positioning: Begin in a quadruped position, knees directly under hips, hands directly under shoulders. Position one hand around the back of your neck, opposite hand pressing into the ground to engage the shoulder girdle.

b. c.

Perform: Imagine a pole straight down your spine. Take the arm behind the head and attempt to rotate your elbow as far as you can towards the ceiling, keeping the opposite hand pressing into the ground.

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THORACIC MOBILITY continued 3. Seated Thoracic Spine Extension (2x10, 5sec holds) a.

Positioning: Sit in a chair with feet together and placed on a small box to round your lower back. Position hands together and locked behind neck with elbows touching.

b.

Perform: Keeping your low back slightly rounded, lift your elbows up towards the ceiling, attempting to extend from your upper back.

c.


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THORACIC MOBILITY continued 4. Latissimus Dorsi Stretch (2x5, 5sec holds) a.

Positioning: Begin in child’s pose position. Place a foam roller under your hands with your palms facing towards the ceiling.

b.

Perform: Lightly roll the foam roller away from your body and sit on your heels.

c.

You should feel: A pull in the upper back and under arm.

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THORACIC MOBILITY continued 5. Squat Neuro Re-education Shoulder Extension (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place the tubing handles in each hand with the tubing secured around a pole directly in front of your body. Extend both hands above head in the overhead squat position.

b.

Perform: Keeping the arms extended overhead, squat down as deep as you can comfortably go.

c.

You should feel: A pull in your thoracic spine and shoulder girdles.

Relevance: performing these exercises will increase your thoracic spine mobility. Have adequate thoracic spine mobility is extremely important in the “catching” phase of the snatch and clean and jerk. A lack of adequate thoracic spine mobility causes compensations in the catching phase, thus putting excessive stress through the shoulder joint. When the shoulder joint has excessive stress through it during the catching phase, it will be difficult to “lock out” the weight overhead, and possibly cause overuse to the joint.

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SHOULDER STABILITY (Scapular strengthening routine) 1. Scapular Retraction w/band (x10) a. Positioning: Sitting with good posture, grab a small towel/band and extend your arms straight in front of you so that your wrists and elbows are shoulder-width apart. b.

Perform: Give light pressure outward to the towel/band. Squeeze your shoulder blades down and back as you pull your elbows to 90 degrees and in line with your body.

You should feel: A pull between the shoulder blades.

c.

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SHOULDER STABILITY (Scapular strengthening routine) continued 2. 90/90 External Rotation w/band (x10) a.

Positioning: Sitting with good posture, grab a small towel/band and bend your elbows to 90 degrees with your elbows in line with your body.

b.

Perform: Give light pressure outward to the towel/band. Squeeze your shoulder blades down and back as you rotate the towel to your forehead and return to beginning position.


c.

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SHOULDER STABILITY (Scapular strengthening routine) continued 3. Prone “T’s” (x10) a.

Positioning: Lie with your chest on an exercise ball, arms straight with thumbs rotated outward maximally.

b.

Perform: Lift your arms up and out to the side as you squeeze your shoulder blades down and back.


c.

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SHOULDER STABILITY (Scapular strengthening routine) continued 4. Prone Y’s (x10) a.

Positioning: Lie with your chest on an exercise ball, arms straight with thumbs rotated up towards the ceiling.

b.

Perform: Lift your arms up in a Y formation, keeping your shoulder blades down and back.

c.


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SHOULDER STABILITY (Scapular strengthening routine) continued 5. Prone 90/90 External Rotation (x10)

a.

Positioning: Lie with your chest on an exercise ball, elbows bent to 90 degrees.

b.

Perform: Lift your elbows up to body level while squeezing your shoulder blades together. Rotate your hands up towards the ceiling until your hands are in line with your elbows.

You should feel: A pull between the shoulder blades and back of shoulder.

c.

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SHOULDER STABILITY (Scapular strengthening routine) continued 6. Squat Neuro Re-education Shoulder Extension (x10) a.

Positioning: Stand with your toes pointing forward and feet shoulder-width apart. Place the tubing handles in each hand with the tubing secured around a pole directly in front of your body. Extend both hands above head in the overhead squat position.

b.

Perform: Keeping the arms extended overhead, squat down as deep as you can comfortably go.

You should feel: A pull in your thoracic spine and shoulder girdles.

c.

Relevance: performing these exercises will increase your shoulder stability. When shoulder stability is adequate, it will make initial pulling much more powerful during movements such as: deadlift, snatch, clean and jerk. Adequate shoulder stability also increases the ease of stabilizing the bar overhead during the catching phase of movements such as: snatch and clean and jerk. These are my favorite corrective exercises for each of the movement deviations that have been discussed. It is important to note that performing these corrective exercises alone will give moderate success. In order to get the most significant improvement in your overhead squat position, you must perform the overhead squat after your corrective exercise session. The neuromuscular re-education exercise at the end of each corrective exercise session will integrate the newly attained mobility and stability into the overhead squat movement.

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Corrective Exercises Gone Wrong Though I would love to tell you this guide would help anyone who follows the aforementioned procedures, I cannot. The reality is 80 percent of athletes who use this guide will benefit greatly from this information, 10 percent will get moderate results, and the other 10 percent will not benefit at all. This guide is not meant to diagnose any structural pathology, nor is it intended to treat pathology. If you are recovering from any type of structural tear (ligamentous, labral, disc, etc.), I would advise seeing a healthcare professional who can develop a treatment plan specific for your needs. If you are rehabbing from a postsurgical procedure (ACL, meniscus, SLAP, discectomy, etc.), I would advise following your current treatment plan until cleared by an orthopedic specialist. This guide is merely intended to treat general movement dysfunction while empowering you to be proactive in your training program. It is extremely important to note that none of the corrective exercises listed above should cause your body pain. If you are experiencing pain with any of these movements, you should contact your local orthopedic specialist or physical therapist to determine if further assessment and/or treatment are indicated.

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Putting it all together Now that we have a good understanding of some movement deviations and corrective exercises to improve those deviations, when is the best time to implement corrective exercises? The exercise order is extremely important for optimal performance. These corrective exercises are meant to increase mobility or stability in a given joint. In order for mobility or stability improvements to have a lasting effect on our movement patterns, we must practice the movement pattern immediately following the corrective exercise session. The corrective exercises should not be intense enough to fatigue your muscular system before a normal lifting workout session, and, therefore, will be performed prior to your normal lifting schedule for that given day. Corrective exercises need to be performed every day; so set aside 10-15 minutes before your normal session to initiate your corrective exercise session for the day. Your daily routine will consist of the following: 1. a.

Low/moderate intensity cardio (Ex. bike, elliptical, fast walk for 5-10mins) This will increase internal muscular temperature as well as extensibility of the tissue (flexibility potential).

2. a. b.

Foam roll/Trigger Point (2mins per muscle) Self-mobilization of tissue/fascia. Will increase effects of stretching during correctives.

3. a.

Corrective Exercises (10min max) Either ankle, hip, spine, or shoulder exercises listed above.

4. a.

Regular training session. Further utilize newly found mobility or stability in your training session.

Now you have your entire program laid out for you. We have discussed how to determine your specific movement deviations through the Overhead Squat Functional Test as well as screening tests for the ankle, hip, lumbar spine, thoracic spine, and scapula/shoulder joint. We have gone over how to correct these deviations as well as when corrective exercises should be performed. Typically, it takes 2-4 weeks for mobility issues to become symmetrical to the contralateral side if performed daily. Once you have become symmetrical from side to side using the screening tests, specific mobility exercise frequency can be decreased to 2-3x/week in your program. I highly recommend weekly checks of your mobility to ensure that you are remaining balanced after decreasing the frequency of these exercises from your program. The stability exercises outlined in this guide are intended to target specific deep muscular stabilizers in each joint. Deep stabilizers are important to stabilize a joint prior to movement where the larger/prime movers of the joint can produce power; therefore, it would be a good idea to maintain your stability exercises at least 2x/week after 4-6 weeks of performing your corrective exercises every day. The more stability you can maintain in a joint, the greater force production there is to be realized from the prime movers.

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Putting it all together continued Below is a general warm-up routine, which can be maintained once your Overhead Squat Functional Test has no deviations. This general routine will be split up into two training days. The overhead day will be performed prior to a snatch or clean & jerk heavy day. The deep squat day will be performed prior to a heavy squat or deadlift day. Maintenance is key to decreasing injury risk and ensuring continued performance gains. Overhead Training Day 1. 2. 3. 4. 5. 6. 7.

Upper Thoracic Rotation Stretch (x5) Quadruped Thoracic Rotations (x5) Foam Roll Lat Stretch (x5) Glute/Ham Trunk Extension (x10) Prone T’s (x10) Prone Y’s (x10) Squat Neuro Re-education Shoulder Extension (x10)

Deep Squat Training Day 1. 2. 3. 4. 5. 6. 7.

Hip Flexor Stretch (5x5sec hold) Glute/Piriformis Stretch (5x5sec hold) Adductor Stretch (5x5sec hold) SL bridge on Ball (x10) Single Leg Deadlift (x10) Glute/Ham Trunk Extension (x10) Squat Neuro Re-Education Hip External Rotation (x10)

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Putting it all together continued With CrossFit and Olympic lifting becoming ever so popular, it is important to prepare your body for the high demands of deep squatting and large amount of resistance being held overhead. This guide will prepare to correct any impairments/deviations (large or small) in your muscular system, thus enhancing your performance and decreasing your risk for injury. If you are experiencing pain with any lifts, it is important to contact your local healthcare provider to ensure you are not causing irreparable damage to your body. An orthopedic specialist or physical therapist can help determine if you are putting yourself at risk for injury. Please feel free to contact me directly with any questions you may have throughout your quest for symmetry. I would be remiss if I did not acknowledge all of the people who have had an influence on my treatment and training philosophies. Each one of these professionals has had a direct influence on the development of this style of assessment and treatment of movement deviations. Kyle Yamashiro, PT, Results Physical Therapy & Training Center Tony Mikla, PT, Athletes Performance, Arizona Michael Moore, PT, Folsom Physical Therapy Tim McGonigle, PT, Folsom Physical Therapy Steve Smith, PT, Los Angeles Dodgers

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References Bandy, W.D., Irion, J.M (1994). The Effect of Time on Static Stretch on the Flexibility of the Hamstring Muscles. Journal of the American Physical Therapy Association, 74:845-850. Chapman RF, Laymon AS, Arnold T. Functional Movement Scores and Longitudinal Performance Outcomes in Elite Track and Field Athletes. Int J Sports Physiol Perform. 2013 Apr 23. Cook, G. (2010). Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies. Aptos, California: On Target Publications. De Mey K, et al. (2013). Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect of trapezius muscle activation measured by surface electromyography. The Journal of Orthopedic and Sports Physical Therapy. 43(1): 3-10. DePeino, G.M. et al. (2000). Duration of Maintained Hamstring Flexibility After Cessation of an Acute Static Stretching Protocol. Journal of Athletic Training. Jan-Mar; 35(1): 56-59. Escamilla, RF., et al. (2009). Shoulder Muscle Activity and Function in Common Shoulder Rehabilitation Exercises. Journal of Sports Medicine. Vol 39(8): 663-685. Magee, David J. (2008) Orthopedic Physical Assessment, Fifth Edition. St. Louis, Missouri: Saunders Elsevier. Mayer, JM., et al. (1999). Electromyographic activity of the lumbar extensor muscles: Effect of the angle and hand position during Roman Chair Exercise. Archives of Physical Medicine and Rehabilitation, July: 80(7): 751-755. McGonigle, T. (2012). Training The Patient With Low Back Dysfunction. Folsom, Ca. Tim McGonigle and Folsom Physical Therapy. O’Sullivan, K., Murray, E., Sainsbury, D. (2009). The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders. 10:37. Selkowitz, et al. (2013). Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Journal of Orthop Sports Phys Ther, 43(2): 54-64.

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The Body Mechanic

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