🙌🙌🙌🙌 word. Coaches be careful with your knees out cues. I’ve been treating lots more injuries from this and have been teaching my clients better alternatives for a few years now. (Via Lauren Beasley Shanaphy)
I have been struggling with upper back and upper chest pain, accompanied with dizziness, for over 30 years. I have seen many doctors over the years and have tried many different ways to solve the problem, and at the very least, get some relief. Unfortunately I have never been given a clear diagnosis and no treatment plan to this point has been effective. I started seeing Dimitry 2 months ago and for the first time I am seeing some real changes in the way I am feeling and the way my body is moving. For each of my sessions Dimitry looks at how my body is functioning, and in my case, how it is not functioning properly. I feel that for the entire session I am working with someone who is an expert on how the body should be working and more importantly, knows how to correct problems when he sees them.
If anyone suffers from chronic pain, they know how hopeless you can feel at times as no matter what you do nothing seems to work. You start to ask the question “I am always in pain, what is going to make tomorrow any different?”. Well, I have been very fortunate to meet Dimitry as he has completely restored my hope as I am clearly feeling much better and also understanding why. As he works with me he shows me how my body is no longer functioning as optimally as it should and by making very small adjustments, the body can move properly and repair. This has been a very tough journey for me but at this point I know I am finally on the path to heal. I am very willing to do the work needed to get better, I just needed to find someone to set up the proper plan for me and I did.
How do I thank a man who in four months transformed me from being barely mobile to moving freely and without pain?
I’ll start by extolling Dimitry Polyakov’s mind-blowing understanding of the musculoskeletal system and the rare, individual attention he gives his patients.
Dimitry is a miracle worker for those who are struggling to return to action after an injury or surgery. I know because I was recovering from both in June 2015, when I first came to Total Physical Therapy. That was about 10 weeks after knee-replacement surgery and four weeks after a subsequent patella-tendon tear — an injury I suffered during a rehab session at a physical-therapy chain whose factory approach is the polar opposite of Dimitry’s one-on-one care.
The results speak for themselves. Less than three months after I started working with Dimitry, I set off on an 11-day trip to Northern Europe, where I was able to walk 6-8 miles a day. I’m now back to cycling and daily rigorous workouts, and I’m about to return to the golf course. Most importantly, I’ve learned from Dimitry how to move safely and soundly in order to avoid future injury.
Throughout my rehab process, Dimitry is keenly aware that major injuries and surgery can lead to other pain and imbalances as the body compensates, and he uses his leading-edge muscle-assessment technique to quickly address minor setbacks.
Dimitry recognized at the outset that I had serious doubts about the future of my mobility, and he refused to let me cling to negative thoughts. Instead, he assured me repeatedly that I’d achieve my goals — and I’m forever grateful that he delivered on his promise.
Total-PT and Dimitry Polyakov has been the most comprehensive, knowledgeable and practical problem solver I have ever been to. I have multiple low back/pelvic problems and other issues that have been treated by: The Hospital for Special Surgery and other facilities in New York for interventions ranging from 10 steroidal injections, 50 Acupuncture sessions, YEARS of standard physical therapy, Rolfing sessions for years and oxycodone for pain management. NONE of these therapies were working, as they did not get to the actual source of what was wrong, but treated the symptoms and the pain.
Dimitry takes the time to evaluate your total problem and looks for the issue that is causing the pain or dysfunction. In my case, I have a complicated medical history, as well as multiple issues relating to dysfunctional movement patterns, old scar tissue, etc. that other therapists had not properly diagnosed. Prior surgeries had caused scar tissue and other internal conditions that made a diagnosis difficult for most practitioners. As case in point: in addition to low back pain, I have been plagued with planter fascitis. During the first session, Dimitry resolved a big toe issue that was preventing proper movement, allowing the toe to behave properly and thus, along with other fascia issues resolve the planter fascitis. I am now FREE of this condition after having this for 5 years. The best thing is that I did NOT go to Dimitry complaining of this condition, as I had accepted it as something that other podiatrists have simply made orthotics for in lieu of finding out WHY I have this condition. This was caught by Dimitry from his overall evaluation of hip and low back pain.
My pelvic pain was the most complicated and is extremely difficult for most people to get properly diagnosed and properly treated. After several sessions, I am now finding pain relief by following the protocol of exercises and releases twice a day. For the first time in 5 years, I see light at the end of this alopathic horror. I do the exercises and release routines twice a day and see results every day. In fact, I drive 60 miles to see Dimitry simply based on the results I am achieving. I strongly recommend Dimitry and Total-PT if you are serious about pain relief and need someone that has an amazing knowledge of anatomy & neurology.
The fitness industry is no stranger to fads. In fact, aside from the impossible-to-keep-up-with world of fashion or the ever-obsolete-rendering technology domain, fitness might just beat out all other businesses in the game of here today, gone tomorrow. Once in a while, however, some fads rise above the others, surpass trend status, and make it big. They stick. Mobility is one such fad.
The Roots of the Mobility Fad
Not too long ago – somewhere around the Jane Fonda and Get in Shape Girl era – the tip of the mobility iceberg began to surface. Everyone suddenly needed to dress in spandex (regardless of gender), pop in an awesome mix tape, and stretch. Flexibility or lack thereof became a huge focus of fitness. Even diehard stretching devotees knew they should be stretching more.
Fast forward a few decades, and other fads have come and gone, but the mobility iceberg has surfaced further. With the help of the Internet, word spread quickly as people figured out that flexibility is only one component of mobility and that there was more work to do. An exponentially growing number of people now understand that fascia, connective tissue, and ligaments all play a part in restricting movement, or at least that stretching doesn’t cover all the bases.
In light of this, almost any gym you walk into – Globo, boutique, CrossFit, or otherwise – has a section separate from the main gym space reserved for mobility work. Foam rollers, bands, straps, yoga mats, and lacrosse balls are ready to help mash, smash, roll, and pull tight body parts into unrestricted bliss. And, since more is always better, lots of dedicated athletes and gym-goers have the same arsenal of mobility tools available at home. Had I known mobility was about to reach its tipping point, I would have bought stock in high-density foam and lacrosse ball manufacturing companies.
Mobility may have started as a fad, but it gained serious momentum in the trend phase, and now – fueled by viral videos and using CrossFit’s popularity as a vehicle – we are in the middle of a full-on mobility craze. We’re talking a Beatlemania, Beiber Fever, kind of craze. Have we gone too far? What does the rest of the mobility iceberg look like, below the surface?
Two Sides of the Coin: Mobility and Stability
To start, let’s first give mobility credit where credit is due. Mobility is (almost) everything. If you lack range of motion, no amount of muscle strength will power you through that restricted movement, at least not without serious repercussions – for example, pain. Restricted movements will force the body to compensate, creating further dysfunction. Additionally, if a muscle cannot achieve its optimal length, it cannot generate sufficient force.
In short, good mobility is a basic requirement of quality, safe, and efficient human performance. I am a fan. I’m psyched that the masses are aware that restricted mobility causes trouble and they are ready to take charge and do something about it.
As amazing (and necessary) as mobility is, if it’s “almost” everything, then the other side of the coin is – you guessed it – stability. Stability can exist without mobility, but you wouldn’t get too far. If everything locked down to stabilize, you would have a lot in common with a tree stump. On the other hand, if you had amazing mobility without stability, movement would be next to impossible and sloppy at best.
Thankfully, most of us fall somewhere just off to one side of the correct proportions of each. In other words, we are likely either walking around with a bit too much mobility without sufficient stability, or a bit too much stability without enough mobility.
The Problem of Excess Stability
The first scenario – excessive mobility while lacking stability – is an easy fix. Strength training. Stability work. Get control of all that movement. It would make sense then that in the case of the latter – mobility deficits with excessive stability – the same approach would help. Increase mobility. Stretch, roll, and release. Achieve unrestricted range of motion.
This approach focuses on deficits and increasing what is missing. For my gangly, mobile, Bambi-on-ice patients I want to focus on increasing stability. However, by only trying to increase what is missing, we fail to look at the whole picture. While my goal is not typically to decrease available movement, sometimes, somewhere along the process of increasing stability we might get a reduction in (hyper)mobility. Not necessarily a bad thing.
On the flipside, those with insufficient mobility need to consider the role stability plays in their dysfunction. It is quite easy to come to the conclusion that you have a limited range of motion, but how in the world would you assess that you have an excess of stability? Simple. They are one and the same. Yep, Finkle is Einhorn.
That tight muscle you assault on a regular basis is likely an overworked scapegoat, providing stability to keep you going. In the presence of instability, muscles and joints lock up to hold you together. You’ve always known you’ve had tight hamstrings, but you blame it on not stretching enough, too many posterior chain workouts, or perhaps genetics is your excuse. Haven’t you ever wondered the real reason your muscles were tight?
Did you ever consider that maybe those muscles can’t let go because they are holding on for a reason? When muscles start doing more work than they were designed to do, we have a problem. Tendinitis, muscle strains, decreased mobility. If you can teach a muscle to relax, not by pounding it into submission, but rather by turning on the correct muscles to create stability, the tight, limiting offender might just be able to let go.
The Best Application for Mobility Work
So here we are, in the middle of this mobility craze, borderline epidemic. As I approach the end of my first decade working as a physical therapist, I can say with absolute certainty that the number of people suffering from self-proclaimed mobility problems is an all-time high. Just a few years ago, I’m pretty sure I never heard the word mobility used by anyone outside of the health and fitness fields. At this point, it’s a tossup between selfie and mobility for most overused words.
Worse yet, mobility is not just an overused part of our lexicon but it is now becoming the sole approach to address movement dysfunction. Over-prescribing mobility drills for poor movement patterns is not all that different than a physician doling out antibiotics for every ailment. Just like medication, when the right drills are applied for the right condition, mobility work will be successful.
“Normal” mobility, without question, is a requirement to perform safe, efficient, and quality movement. Mobility drills such as stretching, foam rolling, and the like are all good ways to increase soft tissue pliability and increase range of motion. But for those of you consistently chipping away at these drills without yielding the desired change, perhaps it is time to step back and see what else may be going on. It’s time to ask where immobility stems from. If mobility work hasn’t helped yet, I’m not sure more suffering will get you the results you are looking for.
So, is mobility just a fad? No. It’s a real thing. But it’s not the only thing.
The butt-wink, the slouch, and the rounded back. Snooze. We’ve heard time and time again that these positions are bad. Hopefully, if you haven’t already corrected these dangerous, faulty, and weak (did I say dangerous?) patterns, you are making significant strides.
During a squat, you might be trying to work on keeping your chest up, sending your butt back, and keeping an arch in your lumbar spine, as these movements are typically lacking in a rounded back dysfunction.
Coincidentally, those same three frequently used cues are fairly accurate in describing the unsteady, overextended waddle of a toddler taking his first steps. While I don’t want you to flex your spine into a herniated disc, round your shoulders forward into anterior instability, or shorten your hamstrings by tucking your pelvis under, I most certainly don’t want you walking around like some novice ambulator. The toddler stance may save you from the potential repercussions of flexed positions, but this alternative is no lesser of two evils. An overextended posture and movement dysfunction sets you up for equally disastrous injury risk.
The Dangers of the Toddler Stance
The Toddler Stance – or overextended posture – describes an anterior pelvic tilt, an extension of the thoracolumbar (lower thoracic and lumbar) spine, and usually some hyperextension of the knees. While not ideal for adults, this posture is useful to toddlers as they learn to walk because their body has yet to develop the strength necessary to support good, efficient walking.
Instead, toddlers seek stability by locking out and hanging on ligaments and joint capsules of the knees and lumbopelvic complex. They rapidly grow out of this stage as they develop better strength and balance – right around the same time they start to execute the perfect squat we all strive to recreate. Adults, however, have a much harder time kicking the overextension habit, relying on this strategy to compensate for much more than an unsteady gait.
An Attempt to Fix Core Instability
Overextension is our solution to core instability. Through hanging on structures of the lumbopelvic complex, an athlete can create a stabile midline and go on to achieve whatever greatness he or she is destined for. Specifically, the prong-like facet joints that interface between two adjacent vertebrae lock in when you hold yourself in extension. But we all know that structures only do what your muscles allow them to do, and in this situation that means the spinal extensors along with their buddies the hip flexors are doing a lot.
The toddler stance often appears on heavy back squat day. Watch someone step under the bar, rack the weight, and descend. Those who are not rounding are likely overextending. Using those hip flexors and lumbar extensors, the overextender shoots his hips back until his previously hyperextended knees can hinge into flexion, as the spine forms the exact shape of a knock-hockey stick. Overextension gets the job done and as an added bonus is way less likely to get you called out by your coach, but like all movement dysfunctions, using your body incorrectly means that you are inherently missing out on optimal performance. Of even greater importance, incorrect stabilization strategies predispose you to injury risk.
In overextension, the amount of compression loaded onto the lumbar facet joints skyrockets, which over time with repetitive loading can lead to a stress fracture of the spine called spondylolysis. Spondylolisthes, a similar condition, involves actual displacement of a vertebra, usually after both facet joints of the same level fracture as a result of the undue strain. This sounds bad, but only because it is bad. More commonly, overextenders are likely to get that “pinchy” feeling in the front of their hips, or impingement. Just as with shoulder impingement, faulty mechanics of the hip joint creates a physical compression – in this case usually the rectus femoris, part of your quads. Additionally, with your center of gravity displaced forward by overextension, the lower extremities are forced to make adjustments to keep you upright. Pick your poison – they are all potential products of the toddler stance.
When Toddlers Go Overhead
Overextension clearly creates local mayhem at the lumbopelvic complex and can initiate chaos in the lower extremities from a top-down domino effect, but your upper half is not out of the woods when you look at what happens from the bottom up. In fact, some of the worst overextenders maintain good control over their lower half and instead, these individuals rely on the toddler stance to compensate for another dysfunction.
Athletes who have difficulty with overhead movements commonly recruit an overextended position as a secondary dysfunctional pattern. Restrictions of upper thoracic extension, loss of shoulder flexion, and scapular instability are all potential contributing factors limiting overhead capacity, inviting an overextended posture in to pick up the slack for both mobility and stability deficits.
For athletes lacking range of motion as well as control, the toddler stance allows the athlete to “balance” weights overhead – keeping the weight directly in line with the base of support (the feet). As an added bonus for athletes lacking overhead mobility, overextension creates a false range of motion at the shoulder that is useful when trying to hold, push, or catch heavy weights overhead. The problem with balancing weights overhead is that you are doing just that – balancing – instead of owning that weight and maintaining control.
Sloucher by Day, Badass by Night
Lastly, and most ironically, many overextenders are also slouchers. Yes, these special folks use two contradictory strategies to achieve one common goal – stability. By day, these guys are probably your average desk-jockeys, slumped over a computer, hanging on their overstretched spine. By night, they transform into badass metal-moving mo-fos, overextending and locking out their spine to press an excessive weight overhead. This is a recipe for disaster. Compressing structures and using muscles incorrectly is exactly how you wear and tear your way to surgical repair.
Slouching – the most recognizable of the bad postures – is certainly not the only bad position, and definitely not the only dysfunction that comes with risks. For some of you, the toddler stance dilemma is like that of the chicken and the egg. Was your shoulder dysfunction the gateway drug into overextension? Or did your overextension lead you to believe that your arms were fully overhead when really they had ten degrees to go? For those of you battling the “butt wink” and avoiding a rounded back like the plague, perhaps a misunderstanding of where the middle is led you to inadvertently create a new dysfunction.
Regardless of how you found yourself in overextension, do yourself a favor. Find neutral. Unload your spine. Decompress your hip flexors. One thing is for sure – the only people who should be walking around in overextension are nine-month pregnant women, curve-embellishing tweens, and actual toddlers.
We all have our weaknesses. You know, those things you skip out on or (not-so) silently protest when you see them programmed into your workout. Come early and stay late to tackle your goat? Maybe tomorrow. Only you can make excuses for why you haven’t nailed the double under or conquered a strict pull up. But I can give you some reasons as to why – despite your best efforts – you are not getting stronger.
For those of you who leave the mind-body connection to the Zen masters of the world, now is your chance to understand why you, too, need to be one with your body. Body awareness, or proprioception, is your body’s position sense and the key to successful movement. Close your eyes. Is your left knee bent or straight? How do you know? You just know, right? No. Proprioception is how.
Someone once asked me, how could a person be “good” if they don’t know what “good” looks like? At the time, this advice was intended to motivate me to lead my staff by example, but I later realized this person was 100% right. I’m sure this was great general boss-employee advice, but I’ve found that this is also some of the best advice for movement. If you don’t know what good looks like – or better yet feels like – you don’t have a working model to help guide your behavior.
“Pinch your shoulders back,” “Pull your ribs down,” and, “Reach your tailbone back,” are a few examples of cues that are usually met with blank stares. Pinching shoulder blades often turns into a shrug, pulling ribs down looks like a crunch taking the shoulders along for the ride, and people trying to reach their tailbones back look like they are auditioning for Soul Train. Even some of my best athletes have no idea what “good” looks like and they certainly have no clue as to what “good” feels like. So, if you don’t know what to feel, how can you activate and strengthen those muscles? This is reason number one you aren’t getting stronger.
You might be starting to pick up on the fact that I’m a huge physical therapy nerd, but long before I was geeking out about anatomy and movement, I was a different kind of nerd. I was in the band. In the seventh grade, I was selected to play the clarinet in an all-county orchestra comprised of other nerds, just like me. All of us talented (awkward) individuals were given sheet music ahead of time so we could learn the song. When we assembled as a group, we divided into sections (winds, horns, strings, etc.) and began to practice. Gradually, we started to integrate all of the parts into a whole, but not without help.
The most important member of the orchestra was not a single musician, but instead was the conductor. With his baton, he signaled how fast or slow to play, when to get louder or softer, and when to cue in a solo performance. Eventually we memorized our parts and relied less on the conductor’s guidance, but at any given moment with one wave of his baton he could make us speed up and get loud, or slow down and get soft. He was the regulator. Without him, the horns section might have played at the wrong time, or a violinist might have forgotten her solo. The conductor coordinated our individual strengths into a strong, successful performance.
Here’s what I’m getting at: every time we move, the body performs an intricate masterpiece. Individual muscles team up to create a kinetic chain, and then these groups of muscles work with other groups of muscles to do something as simple as turning off a light switch. Seems complicated, but lucky for us, just like the orchestra we have a guy standing up front waving his baton. That’s the cerebellum. The cerebellum is in constant communication with muscles like a circuit, moderating movements using proprioception. When we learn new movements, the cerebellum gets involved – a lot. As movement patterns become more established, our muscles rely less on higher-level intervention and more on memory. Muscle memory. Good patterns or bad patterns, these will be the strategies you body remembers – and uses.
During your waking hours, you have two choices: reinforce good habits or reinforce bad habits. What you do fifteen hours a day always trumps what you do fifteen minutes a day, so pay attention to what you do outside of training just as much as what you do during a session. It is never too late to teach your muscles how to work together to produce better, more efficient movement patterns. Using poor habits is the second reason you aren’t getting stronger – you are using the wrong muscles at the wrong times to execute a movement. Otherwise known as cheating.
If I told you to pick any three movements to perform, odds are pretty good you would choose three movements you are good at. Maybe a few overachievers would throw a weakness into the mix because “you know you need to work on it.” But let’s assume you are like the rest of us. You give me your three best movements because those are your strengths and the actions you feel most confident performing. This is human nature. Tiger Woods didn’t turn down the NBA to work on his golf game. He played to his strengths. We all do it. Your body does it, too.
Pinching shoulder back turns into a shrug. This example can be explained by poor body awareness (reason number one), incorrect movement patterns (reason number two) or our third reason, inhibited muscles. You’ve got upper traps that could shrug a refrigerator, but your middle traps are mediocre at best. When I ask you to pinch your shoulder blades back, how could you not shrug?
Just like you gravitate toward your strengths, your body defaults to the muscles and movement patterns it feels most confident with. With upper traps dominating this movement pattern, no matter how hard you try you can’t pinch your shoulders back without shrugging. In this scenario, your upper traps are overriding, or inhibiting, your middle traps and often times these compensations are not obvious. When you use the wrong muscles to get a job done – even unintentionally – you are not going to achieve your full potential.
Over the course of your life, you’ve learned how to move in an astonishing number of ways. Not all of the ways you move are correct, in fact some of your habits are probably downright horrific. But that doesn’t stop you from moving. When you ask your body to do a job, your body doesn’t care what it looks like – it carries out an order using the resources it has available and the habits you have developed over the years. If you have poor body awareness, poor movement patterns, and the wrong muscles are inhibiting the right ones during your performance, if you haven’t already hit a plateau in strength, then there’s a good chance one is coming your way. And usually, injury is not too far behind.
I cannot thank you enough for your commitment to my recovery from hip surgery and getting me back to one hundred percent. I feel your personal approach to treating patients is unmatched anywhere and has ultimately allowed me to progress quicker than I could have imagined – one month ahead of schedule! After 5 months of PT my hip is feeling the best it’s felt in two years and I am finally back to doing all the things I love to do in the gym: squatting, deadlifting, running and jumping- all pain free!
Strength and stability are different. I address strength with mobility for the simple reason that a muscle needs to be strong enough to produce movement. Having enough strength to move is not the problem for most people. Stability on the other hand is more advanced and although the act of stability is difficult, the concept of is simple – hold still. We achieve stability through co-contractions. What happens if you squeeze your push muscles at the same time that you squeeze your pull muscles? Muscles are pulling equally on opposite sides of a joint, like a dead heat of tug-of-war. Nobody moves. You’ve got stability!