Back to School, Back to Awful Mobility

It’s back to school time which means it’s time to sit at a desk for long periods of time shortening your hip flexors and putting yourself into a kyphotic posture; ever so slightly changing you into Quasimodo. This is mainly for my high school kids who think that this unnatural posture is an inevitability rather than something they can fix. I’m reminded of the weirdness of Steve Reed when I think about sitting for long periods of time. For those of you who don’t know, and sorry Stevo for putting you on blast, but Steve does the majority of office work at a local coffee shop. Steve has set a reminder on his computer that lets him know when he has been sitting for too long. Once this reminder goes off he proceeds to do a series of exercises to counteract his kyphotic upper back position and his shortened hip flexor position, think band pullaparts and spider-mans with overhead reaches. I remember when Stevo first told me he did this and I thought what a weirdo. But is it really that weird? Or is it weirder that we are forced to be in this unnatural position all day long? Is the sky really blue or do we just perceive it to be that way? What if reality is a dream and our dreams are reality? Whoa, sorry about that; my inner Mike Boyle came out of me on that one. Anyways back to my point, I think Stevo is on to something here and I think it’s something our high school kids should consider, embrace the weirdness in between periods. Do these same type of exercises in between your periods throughout the day in order to stay long and strong. In fact because I’m so generous I’ll give you a workout you can do twice a day. Do the following workout after your first period of the day and then one more time after another period of your choice.

A1) No Money’s against Locker

1-2x6, hold 2 seconds

A2) Half-kneeling Hip Flexor Mob

1-2x5/side, hold 3 seconds

A3) Standing Y’s (thumbs face away)

1-2x8

A4) Spiderman with OH Reach

1-2x3/side

There you go something quick and easy to counteract the horrible posture of the day.  As a side note to this don’t be “that guy/girl” and cause a big scene when you do this.  The last thing I want or need is for an administrator to call me and tell me you all made a big spectacle out of yourself between 5th and 6th period.  And let this be a lesson to all of us, just when you think Stevo is being weird for the sake of being weird he’s actually just being smart!

Lying Knee-to-Knee Mob on Wall for a Better Squat and Improved Running Mechanics

I was recently reminded of this drill as, last week, I tested my hip internal rotation and found it to be woefully lacking, compared to just twelve months ago (pulling SUMO five days a week, along with already possessing extremely overused and stiff external rotators, will certainly have this effect....) While I've been much more diligent at working on my hip extension patterning, I've admittedly fallen by the wayside when it comes to fighting against the loss of hip internal rotation (IR). As such, I began to toss this drill in at the end of my training sessions again and thought I would share it with those of you who may be interested.

Do you care about sound positioning in the bottom of your squat (this = pwnage of heavy weights, by the way), improved running mechanics, or lessened risk of back pain? Do this:

What's it for?

To improve hip IR.  Specifically: a loss of hip IR caused by muscular restrictions (as opposed to passive restrictions such as labrums, minisci, bone, etc.). A couple notes

1. I'd recommend doing this after you've already pulverized your external rotators with a lacrosse ball or other means of soft tissue work.
2. Don't force range-of-motion here, just gently mobilize the knees in and out. You shouldn't feel any sensation of impingement and stop if something feels "off."
3. If you're a female, I wouldn't jump the gun on this one.  A lot of females already tend to have a fair amount of hip internal rotation, due to their hip structure (wider hip bones and thus larger knee valgus at rest).
4. This can be performed before a training session (especially if you're squatting that day, as you'll notice significantly improved hip mobility as you descend into the bottom).  It can also be used at the end of a lifting session or athletic event (especially if you're a baseball pitcher, or partake in a rotational sport) or training session.  This will help loosen up the external rotators of the hip that tend to tighten up over time.
5. This drill can also be done with the feet on the floor (a valid option), but I personally prefer to have the feet on the wall as it tends to be a bit more low-back friendly.

Incorporate this into your routine for improved squatting and running mechanics.

Get a Massage: Research Backs it Up!

My amazing spouse surprised me with a short getaway this past weekend. He coordinated everything: Arabella’s weekend care, room at the Gaylord in the National Harbor, meals, and – what I want to focus on – a massage. It’s been a while since I had a really good massage. My last one was also a pregnancy massage, which I thought was a bit too light – I mean, just cause I’m pregnant, doesn’t mean I’m not training. So, I was pleasantly surprised when this therapist really started digging into the muscle adhesions.

She effectively addressed my trouble areas: upper back, lower back, and calves. Plus, found an unexpected problem area in my lateral deltoids.

Ryan’s therapist attacked the root of his elbow tendonitis by working on his forearms and, hopefully, reiterated (in his mind) the importance of soft-tissue care for this type of ailment.

This experience got me thinking about all the benefits that have been proven to be associated with massage:

Are you an athlete with athsma? If so, read this… a little massage will likely improve your pulmonary function (and, bonus alert, feel amazing):

Pulmonary Functions of Children with Asthma Improve Following Massage Therapy. Objectives: This study aimed at evaluating the effect of massage therapy on the pulmonary functions of stable Egyptian children with asthma. Design: This study was an open, randomized, controlled trial. Settings/location: The study was conducted in pediatric allergy and chest unit of the New Children's Hospital of Cairo University, Egypt. Subjects and interventions: Sixty (60) children with asthma were divided randomly into two equal groups: massage therapy group and control group. Subjects in the massage therapy group received a 20-minute massage therapy by their parents at home before bedtime every night for 5 weeks in addition to the standard asthma treatment. The control group received the standard asthma treatment alone for 5 weeks. Outcome measures: Spirometry was performed for all children on the first and last days of the study. Forced expiratory flow in first second (FEV1), forced vital capacity (FVC), FEV1/FVC and peak expiratory flow (PEF) were recorded. Results: At the end of the study, mean FEV1 of the massage therapy group was significantly higher than controls (2.3±0.8 L versus 1.9±0.9 L, p=0.04). There was no significant difference in FVC (2.5±0.8 L versus 2.7±0.7 L, p=0.43). However, FEV1/FVC ratio showed a significant improvement in the massage therapy group (92.3±21.5 versus 69.5±17, p<0.01). PEF difference was not significant (263.5±39.6 L/minute versus 245.9±32 L/minute, p=0.06). Conclusions: A beneficial role for massage therapy in pediatric asthma is suggested. It improved the key pulmonary functions of the children, namely, FEV1 and FEV1/FVC ratio. However, further research on a larger scale is warranted.

No, asthma? Just a regular ol’ person? This study indicates all kinds of great biologic effects:

A Preliminary Study of the Effects of a Single Session of Swedish Massage on Hypothalamic-Pituitary-Adrenal and Immune Function in Normal Individuals. Objectives: Massage therapy is a multi-billion dollar industry in the United States with 8.7% of adults receiving at least one massage within the last year; yet, little is known about the physiologic effects of a single session of massage in healthy individuals. The purpose of this study was to determine effects of a single session of Swedish massage on neuroendocrine and immune function. It was hypothesized that Swedish Massage Therapy would increase oxytocin (OT) levels, which would lead to a decrease in hypothalamic-pituitary-adrenal (HPA) activity and enhanced immune function. Design: The study design was a head-to-head, single-session comparison of Swedish Massage Therapy with a light touch control condition. Serial measurements were performed to determine OT, arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocytes markers, and mitogen-stimulated cytokine production. Setting: This research was conducted in an outpatient research unit in an academic medical center. Subjects: Medically and psychiatrically healthy adults, 18-45 years old, participated in this study. Intervention: The intervention tested was 45 minutes of Swedish Massage Therapy versus a light touch control condition, using highly specified and identical protocols. Outcome measures: The standardized mean difference was calculated between Swedish Massage Therapy versus light touch on pre- to postintervention change in levels of OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels. Results: Compared to light touch, Swedish Massage Therapy caused a large effect size decrease in AVP, and a small effect size decrease in CORT, but these findings were not mediated by OT. Massage increased the number of circulating lymphocytes, CD 25+ lymphocytes, CD 56+ lymphocytes, CD4 + lymphocytes, and CD8+ lymphocytes (effect sizes from 0.14 to 0.43). Mitogen-stimulated levels of interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, and IFN-? decreased for subjects receiving Swedish Massage Therapy versus light touch (effect sizes from ?0.22 to ?0.63). Swedish Massage Therapy decreased IL-4, IL-5, IL-10, and IL-13 levels relative to baseline measures. Conclusions: Preliminary data suggest that a single session of Swedish Massage Therapy produces measurable biologic effects. If replicated, these findings may have implications for managing inflammatory and autoimmune conditions.

Thinking about getting a pre-event massage before your next competition? BE CAREFUL with your decision and KNOW yourself!

Psychophysiological effects of preperformance massage before isokinetic exercise. Sports massage provided before an activity is called pre-event massage. The hypothesized effects of pre-event massage include injury prevention, increased performance, and the promotion of a mental state conducive to performance. However, evidence with regard to the effects of pre-event massage is limited and equivocal. The exact manner in which massage produces its hypothesized effects also remains a topic of debate and investigation. This randomized single-blind placebo-controlled crossover design compared the immediate effects of pre-event massage to a sham intervention of detuned ultrasound. Outcome measures included isokinetic peak torque assessments of knee extension and flexion; salivary flow rate, cortisol concentration, and [alpha]-amylase activity; mechanical detection thresholds (MDTs) using Semmes-Weinstein monofilaments and mood state using the Profile of Mood States (POMS) questionnaire. This study showed that massage before activity negatively affected subsequent muscle performance in the sense of decreased isokinetic peak torque at higher speed (p < 0.05). Although the study yielded no significant changes in salivary cortisol concentration and [alpha]-amylase activity, it found a significant increase in salivary flow rate (p = 0.03). With the massage intervention, there was a significant increase in the MDT at both locations tested (p < 0.01). This study also noted a significant decrease in the tension subscale of the POMS for massage as compared to placebo (p = 0.01). Pre-event massage was found to negatively affect muscle performance possibly because of increased parasympathetic nervous system activity and decreased afferent input with resultant decreased motor-unit activation. However, psychological effects may indicate a role for pre-event massage in some sports, specifically in sportspeople prone to excessive pre-event tension.

Outside of these few studies, there are loads of studies supporting massage for everything from improving brain development in preterm babies to care for cancer patients to treating chronic constipation.

Pretty interesting stuff and perhaps something to add to your self-care to-do list.

Tactical Frog Mobilization

Here's a quick video on an excellent hip mobility drill I like to use to open up the hips before training.

Have a frogtastic weekend everyone.

Press Around the Pain

If a bigger bench press is your goal there is a chance that at some point you will experience some type of elbow pain.  This is usually brought on by the intensity, volume, or frequency at which you are bench pressing and most likely the combination of the three.  What results is inflammation of the tendon near the olecranon.  If left untreated the situation could become worse and result in tendinosis. When this problem comes about you have three options: You can take time off and let it recover, you can work through the pain, or you can find ways to work around the pain.  Even though the smartest thing to do is take some time off, most people aren’t going to do this.  Taking time off will reduce the stimulus to the area which will allow inflammation to subside and the area to heal.

Most people, including myself, are stubborn so if you refuse to take time off your next best option is working around the pain. This is what I did and I’m still making gains in my bench press while also reducing my elbow pain.  The following are some of the ways I did that and I encourage you to implement them as well if you don't want to take the time off necessary to recover.

1. Take Out Elbow Dominant Accessory Work

Usually, what you’ll find, is that most elbow pain does not flare up during pressing exercises. Rather, the pain occurs during accessory movements that make the elbow the main point of action.  Accessory movements such as triceps pushdowns, skull crushers, supine triceps extensions, and seated overhead triceps extensions should be avoided.  These types of isolation exercises cause the elbows to take the brunt of the work and cause pain in already irritated elbows.  Try substituting partial range of motion pressing movements, close grip pressing movements, or a combination of the two for your accessory movements.  Things like a 4 board close grip bench press is a great one.  As well as partial pushups to sandbags or to a 4-5 board works great as well.  You’ll find that these movements will cause less elbow pain because the work is no longer completely centered on the elbow but spread out to the chest and shoulders.

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2. Hammer Your SMR and Mobility Work

When engaging in a high volume/high intensity press focused program, it is likely some serious adhesions will build up in your triceps. And if you’re not staying up on your shoulder and t-spine mobility, the problem in your elbows may get even worse.  I learned these two lessons the hard way. Since making them a priority my elbows have gotten better, I still have a long way to go.  Spend 5 minutes on your days off and after hard sessions rolling your triceps and anywhere around the problem area.  I’ve found using the cardboard cylinder from the plastic wrap that athletic trainers use to wrap ice bags with to be an awesome tool to use for SMR.  It’s small which allows for a little more concentrated roll and much more handy and easier to manipulate than an actual foam roller.

As I stated before it’s important to hammer your shoulder and t-spine mobility as well.  Just like knee problems arise from poor hip mobility the same goes for elbow problems and lack of shoulder mobility.  Poor shoulder mobility basically impedes the ability of the triceps to aid in shoulder extension and when coupled with excessive elbow dominant exercises the end result is inflammation and pain.  Take time to work in some static stretching drills for your pecs, lats and rotator cuff.  I found that working this in after your SMR sessions yields the best results.  Be sure to also incorporate some t-spine extensions either on the wall or on a foam roller throughout your sessions as well in order to get that upper back a little more mobile.  Try to accumulate around 5 minutes of total work for your shoulders and t-spine.

3. Use a Thorough Warm-up/Prehab work

In order to help work around your elbow pain, it’s imperative that the area have a good amount of blood flow before you slam it with heavy doubles or high volume accessory work.  The same goes for your warm up and prehab work as it does for your accessory work; lay off the movements that isolate your elbow.  Use full range pushups, band pullaparts, facepulls, rotator cuff circuits, etc. to warm up before pressing.  These will not only get your elbows ready but also your upper back, shoulders and chest as well.  One exercise I just recently started using that is a variation of an exercise I learned from Mark Bell is what I nicknamed the Elbow TKE.  I’ve been using this almost every day for the past couple of weeks to warm up my elbows for not only pressing movements but for squatting, deadlifting, and just general blood flow work as well.  This is an awesome exercise to isolate your triceps without putting direct pressure on the elbow.

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Keep on pressing my friends.

To Overhead Press or Not to Overhead Press

I received this question from a friend of mine who is currently in physical therapy school and thought I'd share my response here. Q. Had a question. I know that at [X clinic he worked at] some of the therapists told me that overhead press was bad to do due to some impingement of the supraspinatus. This is also something we've learned in school but im not sure if this is specifically for those who just aren't strong enough or those recovering from injuries and such. Do you do overhead shoulder press w/ dumbells or BB and what is your take on the subject?

A. As usual, this is a question of contraindicated exercises versus contraindicated people. To make a blanket statement such as "no one should overhead press" would be both remiss and short-sighted. For example, if this is the case, should I avoid taking down and putting up my 5lb container of protein powder on top of my kitchen cabinet each morning? But I digress.

Getting to your the center of your question: Is the overhead press a fantastic exercise? Absolutely! Can the majority of the population perform it safely? Eh, not so much. In fact, this is a very similar subject matter to the back squat. The squat is arguably the greatest exercise to add lean body mass and increase athletic prowess, but may not be the wisest exercise selection depending on the person/situation. Chris actually addressed this very question in THIS post as to why he doesn't back squat the Division 1 baseball players he works with over at George Mason.

First things first: Look, I LOVE the overhead press. In fact, nothing makes me feel more viking-like than pressing something heavy overhead.In my personal opinion, the barbell military press is one of the BEST exercises to develop the deltoids, traps, serratus, and triceps, along with (if performing it correctly) the abdominals, glutes, low back, and upper thighs. HOWEVER, a lot of "stuff" needs to be working correctly in order to safely overhead press:

• Soft Tissue Quality
• Thoracic Mobility (specifically in extension)
• A Strong (and Stable) Rotator Cuff
• Upward Rotation of the Shoulder Blades
• General Ninja-like Status

Improved thoracic extension will positively alter your shoulder kinematics as you press overhead, a strong and stable cuff will help keep the humeral head centered in the glenoid (the shoulder socket) in order to free up that subacromial space (decreasing risk of impingement) , upward rotators will keep the scapulae in proper positioning, and I don't think I need explain how obtaining ninja status will help you overhead press like a champ.

If you can get all the things above up to snuff (via specific drills/exercises), then you're in pretty darn good shape. In reality, this comes down to ensuring you lay down a sound foundation of movement before loading up that very pattern. If the movement patterns and necessary kinematics are there, then chances are you get the green light to overhead press.

However, it doesn't stop there. A few other things need to be taken in to consideration:

1. Training Economy. If you only have X number of hours in the gym and Y capacity to recover, then you need to choose the Z exercises that will give you the most bang for your buck without exceeding your (or your athlete's) capacity to recover. Considering that the "shoulders" already receive tons of work from horizontal pressing movements (on top of horizontal and vertical pulling exercises), I really don't feel that most trainees - especially those that are contraindicated - need to overhead press if the primary goal is to further hypertrophy the deltoids and/or elicit some sort of athletic performance improvement.

2. Injury History. Partial thickness cuff tear? Labral fraying? Congenital factors? All these (and more) will come into play with deciding if overhead pressing will set you up for longevity in the realm of shoulder health.

3. Population. Are you dealing with overhead athletes? They're at much greater risk for the traumas listed in #2, and, not to mention, they already spend a large majority of their day with their arms overhead so you need to consider how mechanically stable (or unstable) their shoulder is, along any symptomatic AND asymptomatic conditions they may possess. Conversely, if you're dealing with a competitive olympic lifter, or an average joe who moves marvelously, then the overhead press may be a fantastic (or even necessary) choice to elicit a desired outcome.

4. Type of Injury. Ex. Those with AC joint issues may actually be able to overhead press pain free due to the lack of humeral extension involved (whereas the extreme humeral extension you'd find in dips or even bench pressing could easily exacerbate AC joint symptoms). Using myself as example, I can actually military press pain free, whereas bench pressing quickly irritates my bum shoulder. I don't have an AC joint issue (as far as I know...), but I've still found that my pain flares up when my humerus goes into deep extension (past neutral) in any press such as a pushup, barbell press, dumbbell press, etc. so the military press actually feels pretty good for me PERSONALLY. With regards to pushups and dumbbell pressing, I can usually do it fine as long as I'm cognizant to avoid anterior humeral glide.

As for pressing overhead with dumbbells vs. barbells, I find that, frequently, it's best to start someone with dumbbell pressing with a NEUTRAL grip (palms facing each other) as this will give your shoulder more room to "breathe" by externally rotating the humerus and lowering risk of subacromial impingement. From there, you can progress to the barbell as long as the items listed in the beginning are in check.

In the end, this comes down to how well you move, your posture, and your individual situation. With technology currently PWNING our society's movement patterns via increased time in cars, sitting in front of our computers, gaming, and overall sedentary lifestyle, we have to fight much harder than our ancestors to turn that "red light" to a "green light" in the sphere of overhead pressing.

Note: to conclude, feel free to watch the video below by Martin Rooney. Hopefully, you can read the central message portrayed: