Category — Video Blogs

Thanks to my friend and colleague, Keats Snideman, for informing me that some new Dan Pfaff videos have been uploaded to youtube.

Dan Pfaff is a guy I really enjoy listening to.  He brings a lot of wisdom and experience to the table and always seems to boil it down into a very practical manner.

Enjoy!

Patrick
patrick@optimumsportsperformance.com

Soft tissue therapy and training of the shoulder has grown in leaps and bounds over the past decade.  While some may still be limiting their treatments to isolated soft tissue techniques at the site of pain and theraband exercises for internal and external rotation most have moved on to include a more holistic and full body approach.

The role of the scapula and thoracic spine are always discussed in the movement of the glenohumeral joint as limitations in movement here will translate to aberrant shoulder movement.  It is commonly talked about now that the thoracic spine needs to have its mobility restored so that the scapula can display optimal stability thus allowing the glenohumeral joint to produce safe and efficient mobility.

The Sternoclavicular Joint

One joint that seems to constantly get overlooked in the equation is the sternoclavicular (SC) joint.  The SC-joint is a true joint and is formed by the articulation between the sternum and the clavicle.  The distal end of the clavicle is where the acromioclavicular (AC) joint is formed, a union between the acromion process and the clavicle.  The AC-joint , while often discussed in the same sentence as shoulder impingement where structures are being compressed underneath the subacromial space, also is required to move during elevation of the upper extremity.  Thus, the movement at the distal end of the clavicle via the AC-joint during shoulder elevation causes a necessary movement of the clavicle and the SC-joint which, if not present can create issues with overall shoulder mobility.

Assessment of Clavicular Movement

The SC-joint should be assessed for both resisted abduction, which also produces a posterior rotation of the clavicle, and posterior movement during horizontal flexion of the shoulder.

Assessment of Abduction

With the client either seated or supine lying, place your index fingers on the superior aspect of the medial clavicle.  Ask the client to perform a shrugging movement while maintaining palpation of the clavicle and evaluate for caudad movement.  Failure of the SC-joint to move in a caudad direction during abduction would indicate a possible restriction.

Assessment of Horizontal Flexion

With the client supine lying, ask them to straighten their arms out toward the ceiling and place their palms together (like a prayer).  Again, palpate both SC-joints with your index fingers and ask the client to push their hands toward the ceiling simultaneously (shoulder protraction).  Assess the joint for movement in a posterior direction, moving toward the table.  Failure of the SC-joint to make this posterior movement during horizontal flexion would indicate a possible restriction.

Treatment of a restricted SC-joint

Depending on your level of training and scope of practice some therapists may choose to perform a high velocity maneuver to improve SC-joint function and shoulder function.  However, being a licensed massage therapist does not afford me this option however I have found the muscle energy techniques (post isometric relaxation) for this joint to be effective.  The client is asked to use their own muscular effort as we, the therapist, apply gentle stretching.  Another thing I like about these techniques is that they are pain free techniques and should not be performed if they produce any sort of pain or discomfort.

Restricted Abduction

• With the client seated stand to the side of the restricted SC-joint
• Place the thenar eminence of the hand closest to them on the superior aspect of the medial clavicle
• With your other arm, gasp the client’s elbow and abduct their arm to about 90 degrees with the shoulder externally rotated.
• Instruct the client to apply gentle adduction (approximately 20% effort) into your hand for 5-7seconds
• Upon relaxation of the muscular effort passively abduct their arm to the next barrier of resistance while simultaneously maintaining a firm (pain-free) pressure on the medial aspect of their clavicle with your thenar eminence
• Repeat this process until freedom of movement is attained at the SC-joint

Restricted Horizontal Flexion

• With the client supine lying stand to the side opposite that of the SC-joint you have to treat
• Place the hypothenar eminence of the hand furthest from the table over the medial end of their clavicle applying firm (pain-free) pressure towards the floor
• Place the hand closest to the table underneath their shoulder gently grasping their scapula
• Ask the client to place their arm around the back of your neck or shoulder
• With their arm behind your neck or shoulder gently lean back to take out the slack of their extended arm while simultaneously lifting the scapula gently from the table
• Ask the client to then attempt to pull you towards them – pulling against your neck or shoulder – with an effort of approximately 20% of muscular force and maintain that resistance for 5-7seconds
• Upon relaxation of the muscular effort, repeat the process of leaning back and lifting the scapula gently off the table to take out more of the slack while simultaneously maintaining pressure on the medial aspect of the scapula
• Repeat this process until freedom of movement is attained at the SC-joint

Patrick Ward
patrick@optimumsportsperformance.com

Joe Heiler at Sports Rehab Expert asked me if I could do a short video on soft tissue treatment of the popliteus.  The popliteus is an often overlooked muscle in soft tissue therapy, so I thought it would be a great idea.

Anatomy

The popliteus attaches onto the lateral condyle of the femur and partially into the lateral meniscus, the belly of the muscle passes along the back of the knee, crossing the popliteal fossa, and attaches onto the medial one third of the proximal tibia.

The popliteus is an accessory muscle to knee flexion and helps to rotate the knee medially in the open chain and laterally in the closed chain (when the tibia is fixed).

Indications for treatment

You may want to consider treating the popliteus when the client is experiencing pain in the back of the knee during movement, when tibio-femoral rotation is compromised, or if there is a loss of flexion at the knee.

Precautions

The popliteal fossa contains many neurovascular structures that pass down into the lower leg and foot.  For that reason, the belly of the muscle will be difficult to palpate and treat, so it is advised that you focus your treatment on the attachments of this muscle to influence it.

Patrick
patrick@optimumsportsperformance.com

With everyone talking about barefoot running and getting out of very cushy/supported shoes over the past year, I thought it would be good to review the Janda short foot posture and go over some exercise progressions that we have been using to help re-train the intrinsic muscles of the foot.

What is it?

The Janda short foot posture is a technique that Janda proposed to teach patients to shorten the longitudinal arch of the foot, thus moving the patient out of their flat foot position.  The short foot posture offers a variety of benefits at the foot such as:

- Increased proprioception of the bottom of the foot

- Enhanced joint alignment up the chain at other joints

- Improved stability of the body

- Increased strength of the foot for better locomotion

As you will see in the below video, exercises with the short foot posture should follow similar progressions of any other exercise you would use:

Bilateral stance > Split Stance > Single Leg Stance

Important point

Refrain from curling the toes, excessively flexing them into the floor, or trying to grip the floor with the toes.  The arch should be created with the toes flat on the ground, not overly flexed, and drawing the ball of the big toe toward the heel of the foot.

As you will see in the video, when the client moves to single leg stance, his foot stability is challenged, and his big toe starts to come up off the ground (although he works to correct it right when it happens).  The goal is to perform the movement with a healthy arch and the big toe down on the ground.  Trying to push all your weight to the outside of the foot in order to create an arch is not the same as the short foot posture.

Exercises

In the video we used some single arm cable row progressions, however, there are a variety of exercises we perform to re-train the foot:

- Single leg clocks (some call this single leg excursion or star-balance)

- 1-arm cable chest press/rows

- Single legged deadlifts

- Split Squats

- Step ups

- Medicine ball throws and catches

Again, exercises should follow a logical progression:

Static (very little movement) > Dynamic movement with lower extremity stable > Dynamic movement with lower extremity mobile > Explosive movements

Always ensure that the client can handle one progression before moving to the next!

Where to place it in the workout

We use these movements in one of two places during our training sessions.  Obviously these are not heavily loaded strength exercises, so we use these either as part of our warm up, or later in the training session as an ‘accessory movement’.

Patrick
patrick@optimumsportsperformance.com

Anterior pelvic tilt is a posture characterized by increased tightness of the hip flexors/lumbar erectors and weakened hip extensors/abdominals. This pelvic position is what Dr. Vladimir Janda classified as “lower-crossed syndrome”.

In this video, I offer two techniques for addressing the erector spinae musculature (which act as a force couple with the hip flexors in an anterior tilt). These techniques require the client to be active during the treatment process, which helps them to learn what it feels like to move their pelvis between both anterior and posterior pelvic tilts.

Being able to both anteriorly and posteriorly tilt the pelvis is an essential component of the golf swing and is tested during the “pelvic tilt test” in the Titleist Performance Institute Golf Fitness Assessment.  You may observe many clients who are unable to move out of anterior pelvic tilt, or if they are they do so with what Dr. Greg Rose refers to as a “shake and bake”, where you see their body actually shake as the muscles try and allow this movement to happen.

Hopefully you find these techniques useful!

Patrick
patrick@optimumsportsperformance.com