I’m on to you. You’re not here to read. You’re here to improve. You want to train better, perform better, feel better – whatever your better may be. You are willing to suffer through this article hoping to add just a little bit more knowledge to help you achieve your better. You are also smart enough to know there are no quick fixes or shortcuts, so you’re willing to work. Hard. But in spite of your impressive dedication and awe-inspiring work ethic, you still want better as fast as possible.
Since I know your secret, I’m going to let you in on one of mine. I want to tell you the one thing I see over and over again. The one difference between good performance and maximizing performance potential. The one thing that can be the difference between staying healthy and getting injured. And because you are so smart, you ask, “Why should I listen to you?”
Here’s what you need to know: I am a physical therapist who works almost exclusively with athletes. From lacrosse players to CrossFit, from recreational to the very elite, these are the individuals with whom I work day in and day out. I left the humdrum world of ultrasounds, icepacks, and ankle-cuff weights to work with the most motivated clients and best teachers – athletes. All day every day I work one-on-one with athletes watching them move and problem solve their way (back) to 100%. And over and over again I see a common thread limiting my athletes, their Achilles heel – the hip.
Almost all of the cases I treat stem from lack of core stability – specifically, from the lateral hip musculature (and yes, I group hip muscles into the core). Certainly you could see how this may be true if I were to only specialize in lower extremity treatment, but since I am telling you one of the secrets to my success, you should know that hip dysfunction also explains almost all of my waist-up cases (the technical term). As we go about our day-to-day lives moving from point A to point B, much of our activity requires us to move forward, or in the sagittal plane. Marathon runners, swimmers, point guards, and quarterbacks all have their eyes on the prize, in front of them. In order to produce any movement in this front-to-back plane, we must be able to use our lateral stabilizers, or anti-rotators, in the right amount, at the right time. Piece of cake, right? Now stabilize your core and control functional, diagonal, movements. Bob and weave, pivot and cut, juke your guy out of his cleats. Better have hips that would make Shakira drool.
The hip muscles – the glutes, the deep rotators, and yes those adductors that seem like they only exist to cause problems – are collectively charged with the daunting task of stabilizing everything above and below the hip. For example, as we walk, when we stride forward the standing hip must provide the force needed to prevent our torsos from dropping side to side and hold the hip and pelvis stationary (relatively speaking) to allow the knee to perform the simple hinge action for which it was designed. With such a large role, you can easily see how individuals of all abilities would have difficulty successfully controlling this multi-planar joint and the real trouble begins when compensations set in.
Let’s start with the Trendelenburg gait. This is a dysfunctional movement pattern we physical therapists are taught ad nauseam and love to point out during gait analysis. “Ooh, ooh! His pelvis dropped to the contralateral side, Trendelenburg!” This gait pattern occurs due to weakness of primarily the gluteus medius. We learn that this hallmark sign of lateral hip weakness can be spotted when the non-weight bearing hip drops lower than the level of the standing hip. Since we go to school for a really long time, we also learn that some individuals will compensate for this weakness by leaning their torso toward the side of weakness. You can assess this by watching someone walk, or stand on one leg. In our advanced classes, we learn that the glute med (we are older and cooler, so we abbreviate now) is also a rotator and when it is weak, the knee caves into an ugly valgus position (pictured right) because the hip dropped into internal rotation, straining the medial aspect of the knee.
When you zoom the microscope out, you can see that hip weakness looks like a lot of things, not just the Trendelenburg sign. Often, there are no deviations in sight and more importantly, the negative effects have far greater reach than just pain at the hip or the knee. My athletes have shown me time and time again that when one movement strategy fails, they have an arsenal of second and third-string muscles ready to take over. Being able to substitute muscles in a time of need makes for a great short term strategy, however if such compensations are sustained over time, you will eventually see a plateau in performance and breakdown of muscles that are doing someone else’s job in addition to their own. Have you ever had to pitch in a little extra to make up for a colleague or teammate? Sooner or later being taken advantage of will get old.
- Instead of demonstrating “down and in” collapse at the knee and ankle, the posterior tibialis at the inner shin can do a great job of lifting the arch and reducing the knee valgus. The posterior tib also excels in causing debilitating shin splints when used to do more work than it is supposed to.
- The sartorius is an abductor and external rotator of the hip and with connections at the anterior hip and the medial knee, like the posterior tib, this long strappy muscle can pull the knee up and out when it contracts. Makes a good substitute for the glute med, right? Absolutely, with hip and knee pain to boot.
- If the glute max slacks off and lets your torso lean too far forward, the ankle plantarflexors are ready and willing and help hold you up. How much weight do you think your calf muscles can squat? You get the point.
The secret should be pretty clear by now – by mastering hip control in all planes, you can control whatever kind of movement you would like your body to create. You can be as static or dynamic as the hip allows. When the body works how it is designed, it is a powerful machine capable of both force and finesse. Big muscles do the heavy lifting while small muscles make minor adjustments. This results in efficient (read: strong and safe) movements. Control your hip, and you control your body.
According to Time, the person of the year is selected because they have been influential and pushed the envelope in some way. For me, you are my “Person of My Year”! Because of your highly developed PT skills, I am back to hiking, working out, and I am finally pain-free, something that a year ago I did not believe would ever be possible. i also now understand the importance of strength, balance, and proper standing and sitting posture. More importantly, I understand how easy it all is once I understood everything. I have also now learned how to fix issues as they inevitably come up as I’m going through life . You certainly are the most influential person to me in 2013. As for the pushing the envelope, well, let’s just say that would be the deep tissue work 🙂 When I ask, “is this supposed to hurt?”, I now know to trust you as it always produces a positive outcome.
Additionally, you recommended excellent resources in a web developer and personal trainer. You do it all with a positive attitude and approach that makes you a pleasure to work with. Thank you!
So how does the height of your seat impact your low back pain, ease of sitting and capacity to maintain appropriate posture? It’s all about the hips and the knees. In this case . . . size DOES matter! Check it out!
Turned 50 this year and I decided to address some nagging aches and pains in my life: pain in both shoulders, minor lower back aches and pains, and neck stiffness. After ten minutes with Dimitry, I came to learn that all the issues were related. Dimitry explained to me that pain in the shoulder is dealt with by addressing fundamental body issues: posture, muscle tone, core strength, how I walk, how I sit, how I stand. After working with Dimitry for a single session, I became acutely aware of my body, my posture, and my gait. To my horror, I began to realize how much I hunch, how poor my posture is, how I lean forward and hunch my shoulders when I sit at my desk at work. Dimitry explained to me that we would re-train everything. After a three sessions, I feel renewed. My shoulders are much looser. The exercises that Dimitry has given me — in combination with his physical manipulation of the capsules in my shoulder — have begun to change my life. I feel so much possibility. So much freedom. Fix it once. Fix it right!
The third pose that we’re going to take a look at within the Sun Salutation is the Down Dog. Proper hand placement, shoulder stabilization along with appropriate spinal and pelvic control is integral in getting into and maintaining this pose. Check out this quick video for details.
The second pose within the Sun Salutation progression is the Upward Facing Dog. Extension through the thighs, foot position and stability within the shoulder complex are all critical elements of this portion of the pose. Breakdowns are abound. Check this video out for the specifics and what you need to watch out for!
The first part of the Sun Salutation is the Low Plank or Yoga Push-Up. Proper alignment and cuing is critical for appropriate stabilization. Elbow position and core activation is quite relevant here for prevention of back injury.
Part 1 in a series to address Yoga poses with their progressions coupled with proper mechanics and appropriate mobility. These videos will be here to take a more in-depth look at what occurs when breakdown in form forces the Yoga practitioner to compensate and eventually place themselves at risk for injury. In this video Lululemon Ambassador Anne Britt and Total-PT’s Lauren Beasley will look @ the Sun Salutation progression along with the appropriate cuing and body mechanics that are involved.
Very talented, knowledgeable, professional physical therapists who are passionate about helping their clients. They do a great job communicating with the client in a manner the client can actually understand! Follow up, attention to detail, and a personalized approach is top notch across the board. Consider yourself lucky to have found them!