Improving Shoulder Capsule Mobility
Key Points: Manual Therapy – Standing Shoulder Capsule Mobilization
1) Patient instruction: Reach hand behind the low back, grab onto a door frame. Make sure the hand does not reach beyond the midline of the body.
2) Practitioner instructions:
– Position the shoulder complex in a “neutral” position by placing one hand on the inferior lateral angle of the scapula, and the other hand on the anterior shoulder. The forearm of the hand placed on the inferior lateral angle should block the patient’s elbow from “winging out” as the shoulder is pushed into a neutral position.
– Ask patient to look up – the scapula naturally tilts forward in this motion. To create opposing forces and a stretch, tilt the scapula backwards. Repeat 3 times.
– Ask patient to drive their hips to the right (assuming we are working on the left shoulder) – the scapula naturally rotates downwards in this motion. To create opposing forces and a stretch, rotate the scapula upwards. Repeat 3 times.
– Ask patient to look over their right shoulder – the scapula internally rotates in this motion. To create opposing forces and a stretch, rotate the shoulder externally. Repeat 3 times.
3) If pain is present during this exercise, have patients lower their hand further down their backs.
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4 Exercises to Improve Hip, Pelvic and Low Back Mobility
This post draws inspiration from my guy Michael Mash, PT @barbellrehabHe posted a great video that was geared towards "opening up the hips and SI joint prior to squats and lunges". It's what I would call a 'runners lunge' in Yoga, & think this is one of the best movement combinations to enhance hip & thoracic mobility. Squatting requires thoracic extension along w hip motion. Lack of thoracic extension r/i too much low back/hip motion (ie back pain w squatting)The top left video demonstrates a runners lunge/updog<>downdog movement. It utilizes both a hip driver and chest/head driver. In a downdog position, my verbal que is to push the heart to the knees, and when we enter the runners lunge, I "drive the chest forward and up" to create a chain reaction of cervical/thoracic extension. The top right is a the same, but regressed bc I'm giving my hips & tspine more room to go through motion by positioning hands on a step. remember, if you can't get motion, position out of the movement to be able to go through the movement..Extension is achieved at both ends of the spectrum here. Bottom Left is a progression the first two, b/c a dynamic motion is added. The movement sequence is downdog>runners lunge>high lunge (reach up to the ceiling, try & sync the breath for another progression)>downdog. This motion because it requires more core stability to be able to move and not be wiggly. The bottom right is another progression/variation. this takes a runners lunge & adds an arm driver in the frontal and transverse planes. This drives even more thoracic motion/extension with hip motion. I also like it because there is an element of shoulder complex stability by having one arm planted & the other reaching in space. The t-spine is a money area of the body, along with the hips. Anytime I can stretch/strengthen/mobilize/stabilize them together I do. Thanks Mike, for the inspiration! and if you're not checking out @barbellrehab instagram account, do yourself a favor and follow it.
Posted by Adam Wolf PT on Wednesday, March 15, 2017
This post draws inspiration from my guy Michael Mash, PT. Thanks Mike, for the inspiration! If you’re not already following his Instagram account: @barbellrehab, do yourself a favor and follow it.
Mike posted a great video about “opening up the hips prior to squats and lunges”. It’s what I would call a ‘runners lunge’ in yoga – I think this is one of the best movement combinations to enhance hip and thoracic mobility simultaneously. Squatting requires thoracic extension along with hip motion. Lack of thoracic extension results in too much low back/hip motion.
Top left:
This video demonstrates a runners lunge and updog to downdog movement. It utilizes both a hip driver and chest/head driver. In the downdog position, a verbal cue I use is to “push the heart to the knees”. When we enter the runners lunge, I think of “driving the chest forward and up” to create a chain reaction of cervical/thoracic extension.
Top right:
This video is a regression of the top left video as I’m giving my hips and t-spine more room to go through motion by positioning hands on a step. Remember, if you can’t get motion, try position out of the movement to be able to go through the movement. Extension is achieved at both ends of the spectrum here.
Bottom left:
This video demonstrates a progression because a dynamic motion (high lunge) is added to the movement. This increases the amount of core stability needed to maintain balance. The movement sequence is as follows:
Downdog > runners lunge > high lunge (reach up to the ceiling, try & sync the breath for another progression) > downdog
Bottom right:
This video demonstrates yet another progression. I add an arm driver in the frontal and transverse planes to the runners lunge. This drives even more thoracic motion/extension with hip motion. I also like it because there is an element of shoulder complex stability by having one arm planted and the other reaching in space.
In conclusion, the t-spine is a money area of the body, along with the hips. I aim to stretch/strengthen/mobilize/stabilize them together at any opportunity I get.
Progressive Strategies: Loading Knee Valgus
Yesterday, knee valgus was the topic of dissucssion. knee valgus isn't bad, lack of control of knee valgus is bad. Tradition teaches to avoid it, yet injury occurs when forces are presented that the body can't handle. Knee valgus is normal & happens as the foot loads into the ground. Therefore it should be trained to prevent injury! More importantly, if the motion is ugly, figuring out what is making it ugly is important. check the foot? hip? thoracic spine? this video illustrates 4 progressive strategies load knee valgusing. Of course, working at the individual threshold is imperative! If any of these motions looked ugly, I simply wouldn't do it. in order:top left: utilizes a band to create more knee valgus, combined with a transverse pivot squat. top right: a lunge plus hand drivers to create thoracic type 1 & 2 to load the stepping knee.bottom left: step down from step, plus hand reaches to increase ground forcesbottom right: locomotor patters (anterior shuffle with hand reaches) to load kneeI mentioned thoracic Type 1 vs. 2 motions. the thoracic spine a a criminal to many areas of the body…..especially the knee. lack of thoracic motion contributes to knee, low back, shoulder and neck injuries. both are important for optimal knee function, and tomorrow will describe the difference, and a quick assessment strategy.
Posted by Adam Wolf PT on Monday, October 3, 2016
In my previous blog, we discussed why I believe knee valgus isn’t bad, rather not controlling knee valgus is bad. Tradition teaches to avoid it, yet injury occurs when forces are presented that the body can’t handle. Knee valgus is normal and happens as the foot loads into the ground. Therefore, it should be trained to prevent injury!
The video above illustrates 4 progressive strategies that load the knee valgus motion. Of course, working at the individual threshold is imperative! If any of these motions looked poor, I simply wouldn’t do it. More importantly, if the motion is poor, figuring out what is making it poor is important. Places I usually check on include the foot, hip and thoracic spine – a lack of motion in any of these regions usually results in the system being unable to lengthen appropriately.
Key points
Top left: Utilize a band to create more knee valgus, combined with a transverse pivot squat.
Top right: A lunge with hand drivers to create Thoracic Type 1 & 2 Motions to load the stepping knee.
Bottom left: Step down from step, with hand reaches to increase ground forces
Bottom right: Locomotor patterns (anterior shuffle with hand reaches) to load knee