A systematic theme over the outcomes of my life has always been one that
leaves me feeling as though I could have done much more. Today, as I reflect
upon the goals I set for myself at the beginning of this course, I do not
necessarily have this feeling. My initial goal was to render “the ability to
look deeper into a matter immediately after the matter has occurred,” in an
effort to solve the problem as quickly as possible.
All professionals have metaphorical or tangible tool belts. Physical
therapists have goniometers and manipulations, Popeye has spinach, and Batman
has batarangs and a zipline. What builds the efficacy of a professional is
their ability to call upon these skills in a matter of seconds in their individual
lines of work, but it all starts with how they think.
I comfortably reside in the fact that I acquired the skill I initially
set out to ascertain at the beginning of this course. Through conversations
with peers, reading and writing on numerous topics, and developing relationships
with faculty who know much more about these skills than I do. I believe this cornerstone
of knowledge is one that will withstand future winds of uncomfortable learning,
and will not wash away like biased thought built on a house of sand.
The goal was to acquire the axe, and though it may be dull, I have the
wet stone to sharpen it. I believe I have found a mentor like Liam Neeson in Taken. He “[has] a very particular set of
skills, skills acquired over a very long career.” This is a grand happenstance,
as it is my hope to saturate every gyri of my cerebral cortex; well, more
specifically my hippocampus, as I move forward in this crazy whirlwind known as
Physical Therapy School.
Part II:
Dear Self,
I hope this letter finds you well. It has been an arduous and downright
difficult journey.
But alas, as sure and true as Chris D’elia’s impression of
drunk girls:
WE DID IT. We actually did it. You are graduating this week. All of the
cadaveric blood, lab partner sweat, and learning-the-gait-cycle-tears have paid
off. You are about to become a Doctor of Physical Therapy. We are at the event
horizon now, so let’s take a look back shall we?
We have learned a lot over these years. So much about anatomy and
biomechanics, pain science, and biopsychosocial models of medicine. From school
and internships, we’ve had a very real and visceral look into what is to be
expected in our next 40 years in the field. From the internet, we’ve learned that
a lot of our colleagues have varying,
and sometimes vehement, opinions on the path that should be trodden with
patients to arrive at the same conclusion – return to what they love to do.
Furthermore – stretching is usually not warranted, foam rollers just
kinda suck, and saying adhesions on the Internet is a sure-fire way to get a
lot of people #triggered,
so avoid that all costs. But always continue to promote loading it over
stretching it, that just always seems to get the job done.
You’ve surrounded yourself with a group of individuals whose hope is to
change the game of Physical Therapy – stay close with them. Ya’ll have a lot of
work to do, so stay diligent once you walk out of that venue with your cap and
gown. These are my reflections.
Your benediction is as follows:
Continue to ask questions, always ascertain the why, show others the
why, learn something new daily, problem solve, know why you do things before
you do them, remember why you went into this field, help people, empower people, love people.
Where
to, you might ask? Definitely not down the yellow brick road with Toto in my
basket. This time, the [wo]man (or Dr. if we're being nit picky) behind the
curtain was referencing my vision. More specifically, the lack thereof and the
problems associated with it.
A
person kinda knows when there's something just not right inside their body. So
when I scheduled my yearly eye exam, I had a feeling that at least a miniature
C4 explosion would be dropped into my lap. And it really depends on who ya ask
but in the grand scheme of things, this isn't exactly an atomic bomb. But what
really is nowadays anyway?
So while I wish my Dr. was telling me that I was headed toward a
tub of ice cream or improved coordination while completing daily tasks or even
a social filter that's less Sheldon Cooper and more First Lady, she wasn't. My
handy dandy pamphlet that Dr. Baker sent me home with defines Glaucoma as,
"an eye disorder that causes progressive damage to the optic nerve and
loss of nerve tissue resulting in loss of vision, especially peripheral
vision." Well, LA TEE DA! My first thought was that I'm 25. Thought #2: I
have no family history of Glaucoma. #3: I'm literally the healthiest person in
this building right now, how could this be possible. #4: you gotta be able to
see to practice medicine. If I let myself think about #4 for too long, that’s
about the only time I become visibly upset. Otherwise, I find myself very okay
with it all.
I think that the human body is a magnificent and fascinating
thing. Here I am, a 25-year-old Caucasian that was just told she’s in the early
stages of Glaucoma, a disease that statistically affects African Americans over
40 and Hispanics over 60. Yay for always going against the grain! Now before I
continue and your little hearts go pitter-patter with too much sympathy, the
odds of me going blind in this lifetime are slim, I’m pretty sure. Glaucoma is
a slow progressing disease, treatments exist and we caught it early. The odds
of me losing portions of my field of vision; unknown. The pressure in my eyes
has always been high and it has fluctuated greatly over the course of my patient
history with this doctor. However, my optic nerve has thinned at a concerning
rate over the years but, we just don’t know what exactly will happen. Many
people get diagnosed with Glaucoma at a young age and never see a change in
their vision. But loss of vision and blindness can occur. My Dr. is
particularly aware of my case because I have zero indicators of the disease.
Why I’m “headed in that direction,” again, we don’t know. Which brings me back
to why I think the human body is so fascinating.
The only thing constant in life is change, right? It is so with
our bodies as well. Your taste buds change every 7 years, cancer survivors
often regrow hair of different texture, your hypothalamus is constantly
secreting hormones to keep the body in a homeostatic state and for a handful of
reasons, the pressure in my eyes may increase and my optic nerve may thin so
much that my vision may or may not be altered. But when I sit back and think
about it, I can’t help but acknowledge how absolutely cool it is that a mostly
perfectly healthy body, with zero hereditary indicators, can still change like
that. It’s a wondrous thing to know that we are not in control. This doesn’t
mean that I am being captured by a possible change in my sight. There is no
hindrance. Instead, I get to shift as my body does and for that I am grateful.
I have been allowed to live a certain way and obtain a certain awareness of
life over the passed 25 years and now, I get to do new things. Whether physical
changes occur or not, whether I never lose a single speck of vision or I lose
it all, I get to experience and respond to things in new ways because what has
changed is my mentality, my light, my spirit. The things that make me, me.
Again, this shift is something that was out of my control. One doesn’t really
realize that it’s even happening. The course of my life may or may not change
according to my eyeballs and I find it an incredibly fascinating thing to have
the privilege to learn how to navigate such a shift.
So I guess the reason I’m sharing all of this long-winded stuff
with you and the real question is, what do you do when you get rocked with
something in life? What do you do when you’re suddenly uncomfortable with what
you thought was your normal? Or when
you’re not really that happy with
something you were once happy with and change has come yodeling its little
heart out? Do you go down with a TKO and await your demise in the corner of the
ring thinking that it’s just a phase and you just gotta shake it off before the
10 count? Do you keep on livin’ the same way? Life is LITERALLY a constant
state of entropy and yet, we are all called to great things. You are not meant
to spend even one millisecond on this earth being in a state of internal
distress. No matter if it’s a firework or a nuke. So when life shifts, don’t
waste time avoiding the change and instead, choose to shift with it. Be the
Cowardly Lion, surround yourself with preferably a less frivolous bunch than
Dorothy, Tin Man, and Scarecrow (but keep the ruby slippers) and head that direction. Whether you can see
or not.
Our lives are frequently shaped
by pivotal moments. And by pivotal I mean
involving of a point of no return. Getting a puppy, having a baby, opening a
business, starting school, ending a relationship, achieving a goal, a death in
the family. What was once there is now different. Time does not wait for
anyone, it moves as it wishes – and as humans,
we only have so much of it. We know neither the time nor hour that our time
will run out.
For some this may plant the desire in our hearts to latch onto the things
we hold dearly, to try and control the amount of time with the person, place,
or thing – and whenever it is time to change we are at a loss. Personal
identity begins to morph into association with something that is not yours to
define, and yet, we start to define
ourselves by that very thing.
As a GoT fan, and for the sake of metaphor – “The Hold the Door” scene
was a pivotal moment of the series and show. It left most jaw-dropped, wide
eyed, and probably a bit tearful. Fans were attached to a character, and within a few seconds, he was gone. Hearts broken, emotions
wrenched – most were deeply in their feels. What did you do the next day? You
were probably a little upset. I mean, you may have fallen victim to a plethora
of memes that prodded your open wounds, but by the next day you were over it.
You didn’t mire yourself down into the Swamp of Sadness like Artax in The Neverending Story (RIP Artax), no –
you moved on.
You may have been attached to the
character, but they didn’t define your being. You weren’t going to let it negatively
affect you on a daily basis. Why? It’s because you weren’t in control of what
occurred. In real life, we have next to zero ultimate control over another’s decision
or their timeline. So why does this logic so frequently apply to fiction? Why
isn’t the same train of thought applied to doing the most in your work
circumstances, moving past heartache, or accepting that your puppy isn’t going
to stay that way forever?
A wise-bearded-man once gave me this metaphor:
You have just walked through a door,
and you are in a hallway. The door you just walked through is to your back. There
is a large room in front of you, filled with other doors – ladders even, to
other stories within the chamber. You
walk into the room, and your visceral
intuition proclaims there is only going forward. You can’t go back, but Sweet
Christmas you want to – you go back to the door,
and it isn’t quite shut. It’s cracked open,
and you find yourself looking into the pensive that is filled with the Once-Was,
but that’s all it is full of. The past,
what once was. Not what is now. It
looks nice, it feels comfortable, but it isn’t real.
Going for the Harry Potter analogy here, the Mirror of Erised will only
ever show us what we do or have, desired.
Dumbledore warns us that no matter how deeply we peer into its alluring sheen, we
will never be satisfied. It will always make us thirst.
Take heart! Move forward! Close the door. You have faith in the
simplest of things on a daily basis – a light switch, the brakes of your car,
your Instagram account not getting spontaneously hacked – how much more faith
do you need to believe that what is to come will almost certainly be better
than what once was? Close the door.
Faith is the substance of things hoped for, the evidence of things not
seen (Hebrews 11:1). Therefore, close the door.
This week I teamed up with Doctor of Physical Therapy candidate, CrossFit coach, #CWCC & @clinicalathlete student forum member, @physio.praxis to use the reliable and valid #KendallLegLoweringTest as an objective measure to determine where your athlete or patient is on the #HollowBody spectrum.
Scoring is as follows:
3 - From 90 to 45 degrees: These athletes will
compensate through the hip flexors, extending the lumbar spine when asked to
hold a hollow just off of the ground. They will build upon dysfunction in an
effort to get into appropriate position.
2 - From 45 to 15 degrees: These athletes
maintain control throughout most of the movement, but begin to lose that
control at the end range of movement - say on a heavy-ish shoulder to overhead
or after a few toes to bar.
1 - From 15 to 0 degrees (or to the ground):
These athletes exhibit good strength, endurance, and control of the anterior
core and are well prepared for loading and dynamic movements.
Here @dani.f.baby would be on the border of 2
& 1.
Over the next few weeks we will be providing
exercise progressions and suggestions to build upon where the athlete currently
stands. Keep in mind, core strength and endurance can be subjective—but this
system aims to provide a starting point for you, your athlete, and/or your patient.
Tune in next Monday for the first progression, or for the full series, follow
the link in @praxis.physio's bio!
Cite:
Staniszewski B, Mozes J, Tippet S. The relationship between modified sphygmomanometer values and biomechanical assessment of pelvic tilt and hip angle during Kendall’s Leg Lowering Test of abdominal muscle strength. Proceedings of the Illinois Chapter of APTA, Fall, 2001.
Level 3 First Progression: Single-Leg Active Leg-Lower:
#MondayMusings:
This test is a good starting point for those
athletes who have difficulty getting into the hollow position. By taking a limb
out of the equation, we reduce the force demand of the core and the difficulty
of the task.
Many athletes make a common fault when
“contracting” the deep core, or transverse abdominus (#TrA), where a
hyperactive or excessive contraction is produced. This in turn engages the
lumbar parapsinals -- creating over extension of the lumbar spine.
Points of Performance:
-Exhale the entire downward motion of the
exercise while keeping the lumbar in contact with the ground.
-Once 15 degrees is reached, the athlete will
isometrically hold—inhale and exhale—then bring the leg back up
to 90 degrees.
-Avoid External Rotation of the leg, focus
on keeping the leg linear throughout the full movement.
-Repeat 8-10x
Progressing from Level 3 to 2: Dead Bug Upper Extremity Isometric Variant
#MondayMusings:
The #DeadBug against the wall is a good starting
point for those with a score of 2, or as a warm up/ramp up for athletes who
score a 1 prior to lifting or gymnastic movements. This variation employs the
use of upper extremity isometric firing to light up the central nervous system
(#itsLIT), which in turn increases neural firing to the deep core musculature.
Points of Performance:
-Forceful exhale prior to initiating the
movement followed by a quick inhale to breathe into the created tension while
pressing into the wall or weight.
-Raise the tailbone slightly off of the ground
and lower one leg slowly. Make sure that the pelvic positioning is maintained
during this eccentric motion
-Repeat for 5-6 breaths per side.
Tune in Monday for the next progression with
@the_movement_dr, or head over to #MusingsOfMills -- link in bio.
Level 2-ish: Plank to Pike on Rower:
#MondayMusings:
Our 3rd installment for the
#KendallLegLoweringTest is the Plank to Pike on Rower. This exercise is for
those who scored a high-level 2, moving closer to a 1 during the test.
The starting position of this movement is
opposite to the starting test position and the previous two exercises. We begin
in a bottom up fashion: starting in a plank then working towards a Pike. By
doing so, we are able to increase our initial lower core engagement in a
concentric fashion.
We need variance to create change, and this
movement fulfills just that.
Points of Performance:
- ROM may become an issue, just pike as high as
you can and the exercise will still maintain the benefits.
- Exhale
as you pike up
- Hold for 1 to 2 seconds at the tope
-Slowly lower the body back down
-Repeat 4-5x
Levels 2 to 1: Bar-Supported Leg Raise:
#MondayMusings:
In our second to last exercise, again for those
on the border of 2 & 1, we use a barbell (or heavy resistance band) to
externally cue the athlete (@dani.f.baby) to maintain a #hollowbody position
while perform an active leg raise.
Points of Performance:
-Begin by exhaling and elongating your spine,
while gently hollowing the low back into the bar or band
-Brace the core, squeezing the feet and
quads together synchronously.
-Initiate the movement with your lower abdomen
(focusing on engaging the internal obliques and TrA) similar to how you did
with the #pike.
-Only lift so high as you can maintain the position
without compensation, i.e. beginning position.
-Repeat for 5-6 reps/breaths or until fatigue
This can be paired with a #hollowarch to begin
working on the movement specificity needed to perform all #kipping movements,
especially if you turn into a #FloppyBaby as soon as you attempt full speed.
Tune in next for the final exercise - or visit #MusingsOfMills -- link in bio .
Level 1: Strict Hollow Body to Arch
#MondayMusings:
For the athletes who have made their way through
the progressions or for those who scored a 1.
The Hollow Body to Arch Strict Transitions are
the ideal precursor to any kipping Bar or Ring movements.
Focused and controlled transitions will help
engage the #Lats and #Trunk in the free-hanging #HollowBody position, as well
as improve our bodies kinesthetic awareness as we engage in movement towards an
arched position.
Points of Performance:
-Do not swing. Stay as still as possible.
Synchronous, co-contraction.
-Keep your body elongated and your feet touching.
-Each transition from Hollow to Arch should take
roughly 3-5 seconds
Ever since tearing my ACL 3 years ago everything that
resembles a lunge has given me problems.
They feel uncomfortable and weak in comparison to squatting motions, and have since formed a mental block
that has always made me nervous to go heavy
– especially on the split jerk. Ever since the @cwcseminar, @elisbad7 has been
programming them regularly, and I’ve been using what I knew before, along with cue’s and drills that I picked up from both
@quinn.henochdpt and @ricky_redus to work towards evening out the weight with
my power jerk.
Step one was to incorporate bottoms up kettle bell presses with a focus on maintaining
a stacked spine to work on the strength deficits from one shoulder to another,
along with a bias towards keeping my core controlled, spine stacked, and rib
cage down. Here is a simple progression
and self-cue that I find helps facilitate this by both keeping the ribs down
and palpating the serratus anterior. I will be piecing together a review of
current literature that speaks on current evidence of unstable load training
for unilateral strength improvement and as a rehabilitation tool over the next
few weeks.
There are varying opinions amongst researchers on whether or
not training with an “unstable load” is effective or not. Some researchers say
there is no striking difference in
shoulder activation using a #barbell vs. a #dumbbell at the same weight, some say that training with an unstable load offers no additional benefits
for force and power production, and some say that co-contraction of the
musculature around the joint is always a good thing.
I follow the train of thought that there is a give and take
between what the research says and what has been
used as an effective tool in varying settings. I have not stumbled upon
a prospective study on the ongoing effects that a majority bilateral training program
has on the body, but I know #CrossFit has a lot of it. If you are only using an
evenly loaded barbell for the majority of your training chances are your strong side is getting stronger, and your weak side is getting weaker.
The Half Kneeling Landmine Press
is a unilateral movement, which some
would call intrinsically unstable, and has been shown to cause greater
recruitment of the local core musculature, specifically the internal obliques
and transverse abdominous. I have found
that the specificity of training in this position gives a foundational and
simple awareness of what you should be feeling in the feet, hips, core, and
shoulder during a #splitjerk. Also, try adding in neuromuscular re-ed because
your lock-out is slow, soft, and self-limiting. 3x8-12 with a two second pause
at the top, 3 seconds on the way down, explode up.
Cites:
Behm D, Colado JC. THE
EFFECTIVENESS OF RESISTANCE TRAINING USING UNSTABLE SURFACES AND DEVICES FOR
REHABILITATION. International Journal of Sports Physical Therapy.
2012;7(2):226-241.
Kohler J, Flanagan S, Whiting W. Muscle Activation Patterns
While Lifting Stable and Unstable Loads on Stable and Unstable Surfaces. Journal
of Strength and Conditioning Research. 2010;24(2):313-321.
doi:10.1519/jsc.0b013e3181c8655a.
When I was a freshman in high school I remember performing
lunges for the first time in an exercise setting, and I hated them. I can
picture the trainers face when I said something like, “Yeah, the lunges feel
okay, but they really just hurt my big toe.” He seemed bewildered, and stated
that in all his years of training, he has never once heard that. It was not
until I learned of the Windlass Mechanism that my statement was validated.
Clinicians argue that you need between 45-60 degrees of big
toe extension for proper walking mechanics, and 80 degrees for proper running
mechanics. When I first goni’d my big toe in PT school I was rocking out at a
lackluster 30 degrees, bilaterally. My entire big-toe-life had been a lie. The
Windlass Mechanism utilizes the elastic properties of the bottoms of your feet
to transfer energy at toe-off during walking and running, and I had utilized
virtually none of it for years.
The #WindlassTest is traditionally used as diagnostic tool
for ruling in plantar fasciitis, but can also be used to determine hallux
rigidus, or a really stiff toe. Here, @djhousebrother and I use it to determine
the latter in the first clip.
The stretch performed in the second clip can be
utilized both dynamically for a warmup, or held for a prolonged, static stretch.
Current evidence suggests that a stretch must be sustained for ~20 minutes to truly add length to the tissue. Tune in
Wednesday for exercises and points of performance to solidify positive
outcomes.
We’re going to Tarantino this and give you the end first:
turn your sound on and listen as @djhousebrother breaks down what your back
foot needs to be doing in the #SplitJerk.
If your big toe doesn’t extend, your body will compensate –
when walking or running, you may push-off on the outsides of your feet, or your
arch will just collapse. In a lunge/split jerk position, that uncomfortable
feeling of your big toe slamming into the ground will, in turn, cause the body to move away from that uncomfortable position through compensation –
whether that be in the other joints of the foot – or the ankle, knee, and hip. Some
can get away with it, others cannot – but if you are not getting into the
optimal position, you may not be reaching
your maximum potential.
In the second clip,
Josh demonstrates a simple Step-1 to gaining motor control in that new range we
got from the previous video, all the while focusing on weight bearing through
that first ray of the foot. Step-2 increases specificity of the movement in the
#lunge – work in a pain-free range as a warm up
and work on optimal hip and foot
alignment. Then begin to load the movement
with 3-4 sets of 10-15 reps, first by increasing depth, then by adding weight
to make it a strength training accessory movement. Step-3 is the Bulgarian
Split Squat – follow a similar fashion as the lunge by working into depth and
tolerance, followed by load, depending on the goal of the athlete.
Clip three, and Step-4 puts it
all together in the #JerkBalance – here focus on technique and timing before
loading the bar, as the timing of a jerk
may be just as beneficial as loading it, especially for beginners. The jerk balance is a great drill to perform between
your initial warm up sets to hammer out
any inconsistencies.
A few hours prior my friend @amberm88 was a Cranky-McCranky-Pants,
mopping around the gym with a whole lotta low back pain. She had been unable to
pick up a barbell without pain for the past two weeks. Want to see what went
into these clips coming to be? Then PAY ATTENTION.
Amber was training hard for a competition. Amber moves a lot
of weight frequently. Amber is a proficient and fluid mover. Amber is athletic
and knows how to compensate really really well, almost to the point that you
probs wouldn’t even notice that something is wrong. WRONG: Amber has a really
stiff thoracic spine, or, upper back.
The training that goes into being an elite CrossFit athlete
involves weightlifting and gymnastics. These two modalities of movement exist
mostly in the sagittal (forward and backwards) plane, this is what one could
refer to as a training bias. Considering her impressive athletic history, Amber
used to ball on sucka’s in softball and basketball, both of which include
frequent thoracic rotation. Now, not so much.
With the foundational idea of treating the athlete as a
whole, I made a student-hypothesis: Make one segment move better to offload the
other segment. This is what happened.
**Disclaimer**: I am a student, and this is not medical
advice. If you are seeking medical advice refer yourself to a local physical
therapist.
Testing, Testing;
1, 2, Rotate:
You can think of most joints that don’t move well as a stuck
drawer. How do you open a drawer whenever it is stuck? There is a scientific
approach to mobilizing joints, but for the sake of simplicity and wit, do you
rip that beast straight out? NAH. You wiggle that thing. You wiggle it and then
see what happens. More often than not that wiggle will grease the tracks and
the drawer will slide right out.
Apply that to your thoracic spine. Amber had limited wiggle
once you limited movement in her hips and lumbar spine (low back) on the bench.
In my personal experience working extension on a foam roller is waste of time,
because you can so easily compensate in other areas.
Not to mention a lack of thoracic rotation can negatively
impact the relationship between our shoulder blades ribcage. And who wants
their shoulder being codependent and whinny all the time? I certainly don’t.
This being said, a hypomobile (doesn’t wanna move) upper back may have negative
effects up and down the spine. In Amber’s case, the issue surfaced in her low
back.
AAROM, Take
a Breathe, Re-Test:
I once read that if you can’t breathe in a position, you
don’t own that position. The statement holds true here. I apply gentle pressure
opposite the direction that I want Amber to go, I use Active-Assisted Range of
Motion (AAROM) to guide her in the range that is there, but dormant. I give her
some assistance to hangout in her end range, and to take a few breathes (sped
up here).
The same thing can be done by pressing up against a wall, or
using a band to pull you in the opposite direction. Just make sure you are
moving with your upper back, not your lower. Chances are you have the range of
motion, but you don’t know what to do with it because it’s 2017 and everybody
has a tight thoracic spine.
SPINE TIP (no, not the coccyx): if one segment is tight,
another segment will reflexively “loosen.”
But do you
Extend?
Ask a CrossFitter if they’ll get prone on the ground and
extend. They’ll get down there, crush it, and look at you and say, “I can do
this all day, I can do unbroken “Michael,” [a hero WOD: 3 rounds of 800m run,
50 back extensions on a GHR, 50 situps], duh.” But then you limit the degrees
of freedom, and BOOM, #gnarwhale.
Exercisers are fantastic at global extension, but it’s
really hard to extend your spine segmentally. I saw @unchainedphysio use this
exercise to prevent mashed-potatoes’ing on front squats, but it’s also a great
assessment.
Slow your roll, block the hips, and gain some control of how
your back extends. I’d say if you can do 3x30 of these your upper back moves
just fine.
Your Ribs
Aren’t Moving and Your Diaphragm Hates You
The average human takes 12 breathes a minute. There are 60
minutes in an hour, 24 hours in a day…and so on and so on, you do the math. I
don’t want to, that’s why I’m in physical therapy school. Did you forget that
your ribs attach to your thoracic spine? Its in the name ya’ll.
Here’s a way to get the intercostals (muscles between the
ribs) working double time to expand your rib cage. If you sit on one side of a
seesaw, does the other side move? Yes, yes it does. This is virtually what is
happening here, creating much needed movement around a bound down fulcrum.
Focusing on your breathing, and if you start to cough on your
exhales that OK – it just means your diaphragm is moving for the first time in
awhile. If you don’t have a wallball, just stack some sturdy pillows under your
ribcage and give it a go. And if you fall off like Amber, at least you’re
already right next to the ground.
Crawl
Before You Walk
As infants, we spend most of our time on our back. Our
baby-brains instinctually desire movement and exploration, so we rolled onto
our side and then on to our stomachs (in prone). You hated it, and you cried –
because your little baby neck was entirely too underdeveloped to hold up your
disproportionate noggin.
You began to spend to more time here, then you pressed up
onto your elbows, then you began to move around. Eventually beginning to pull
yourself up on furniture, getting onto your knees, eventually making your way
into standing. These concepts apply to learning exercises. It's easier to learn
stuff on the ground, especially if you are like me and tend to be a floppy
baby. Try 3x12-15 per side of these exercises to build up
rotational endurance.
Stop extending solely from your low back and just hanging
out on your passive structures. Please: Use your muscles. Progress yourself with
these exercises. If King Soloman were a PT he would probs say something like,
“Guard your low back above all else, for from it flows the innervation for
everything downstream.” PTverbs 4:23
·The “Clean Series” will delve into
this Olympic lift through the eyes of a lifter en route to becoming a scholar. We
will be discussing a broad spectrum of faults and misnomers, along with
tried-and-true cues and corrective exercises that can be used for yourself, or
your athletes. The clean is an excellent tool for any trainer or rehab
specialist alike to build explosiveness, dynamic power, jumping and landing
mechanics, and fast-twitch muscle activation in athletes/patients. If you are
looking to add some tools to the tool belt this series is for you!
Video 1 – “All Things First Pull”:
·
When considering the concept of stability before mobility during movement, the
squat clean is no exception. If a movement begins in a stable manner, more
often than not the rest of the sequence will fall into place.
In the setup of the squat clean: the
athlete’s gaze should be focused on a single point along the horizon with the
head in neutral; the bar and athlete’s weight should begin over the midfoot;
the shoulders should be above the level of the hips and slightly in front of
the bar; and the back creates a stable arch – all prior to initiating the first pull of the clean (i.e. initial
separation of ground and weight). Here we use slow-mo to identify a proper
first pull vs. a faulty one. Once initiated, the torso and hips should raise in
one accord, with the angle of the back remaining fairly constant throughout the
lift.
Common faults seen in beginner and
intermediate lifters set-ups include, but are not limited to: the shoulders
remaining behind the bar, the athlete’s hips being set too low causing improper
hamstring tension, and a kyphotic/rounded posture in the thoracic spine. All of
these faults can potentiate the athlete’s hips rising first. This position will
predispose a lift with the back, rather than their full posterior chain. When
considering the Olympic lifts, think of your back as the lever for the weight, not the
lifter.
Clean pulls are a great tool to
utilize proper initiating mechanics, and should be prescribed at the latter end
of a lifting session in the ball park of 1x5 (95%), 1x5 (100%), 2x5 (105%) of
their max squat clean.
Now that we have established a
frame of correctness for what to look out for with the full clean, parts 2-4
will break the lift down segmentally. Remember, if you or your athlete is
trying to improve their clean with a poor first pull, it will be like building
a house upon sand…not stable.
Video 2 – “From the Knee to the Hip”:
·The “Second Pull” of the clean is comprised of
the bar position from the knees to hip extension. Beginners having trouble with the concept of
the “hip hinge,” Olympic lifters who tend to let the bar drift away from their
body, or CrossFitters who are having issues stringing together reps, this is
for you.
With a properly initiated squat
clean AND hang clean, there should be virtually no mechanical change in the
angle of the back, with the shoulders remaining slightly over the bar and
slightly higher than the hips. This arched back position creates a powerful
lever that allows the bar to “whip” once the bar meets hips a.k.a. the
launching position. If you notice in the
first clip, as the bar launches from the hip position, the knees are bent, this
action is known as the “double knee bend.” This whip is facilitated by a transfer
of energy from the posterior chain to the quads, and actuates at the launch due
to the double bending of the knee.
In the second clip, there is
minimal to no double knee bend, which will cause decreased power and more often
than not, a separation of the bar from the body. This can cause a faulty
catching position, which at higher loads will result in a loss of thoracic
extension, and the athlete will bail the bar forward.
The concept of neuromuscular
re-education in the physical therapy world involves a slow eccentric movement,
followed by an isometric hold, and finishing with an explosive concentric
contraction. In the third clip, I perform a hang squat clean from below the
knee, with a 2-3 count eccentric descent, a 2 second pause just below the knee,
and explosive extension upward. The athlete should focus on sending the hips
back, and maintaining the position of their back. This is a great tool to both
reinforce proper mechanics and retrain faulty movement. This position can be
further expounded upon by utilizing the bent over row (w/ the shoulder blades
locked down and in), where removing the movements degrees of freedom allows for
the athlete/coach to build brute strength.
Video 3 – “Keep the bar close with: Hook Grip”:
·An LSU powerlifting coach once told me to think
of my arms as nothing more than a hook and lever when deadlifting the bar, and
I think the same holds true when performing the clean.
For those who are somewhat inexperienced in
the ways of explosively accelerating their body, the clean can cause the novice
to attempt to muscle the bar to the shoulders by flexing the elbow PRIOR to
completing full extension. Coach Hatch always says, “When the arms bend, the
power ends.” This mantra holds true in ~98% of the population, but there are
always exceptions when considering athletic adaptation (i.e. My slight jump
backwards after extension).
A faulty start may cause an early
arm bend in an effort to get the bar to the hip faster to make up for lost time
and speed, which can also lead to the athlete completely missing the power
position. Seen here is an early arm bend into a muted hip in order to rush
under the bar. This can cause the athlete to bang the bar off the thighs,
rather scooping/sweeping the bar into the hip with elbows extended while
maintaining tension as the bar reaches the hips.
To facilitate elbow extension, we
need to turn on the triceps, and relax the biceps. This is best done by using
the “hook grip,” which will relax the grip and help the athlete differentiate
the clean from what could potentially turn into really fast curl to
upright-row. @brucebarbell’s cue for pointing the knuckles down is a fantastic
way to rev-up the triceps, and inhibit the biceps.
A corrective exercise to really
drive this home is a sequential clean pull from below the knee – above the knee
– and ending at the hip in order to train the athlete to keep the bar close and
rely on hip extension as the primary mover, NOT the arms. As with most
relationships, a crushing grip will never produce the results we want, rather
loosen your grip and let the rest happen. Your relationship with the clean is
no different.
Video 4 – “Flex[ed] and you Shall Receive”:
·The archetype of virtually every movement where
we are either producing a force or receiving a force involves a flexed hip
position. This concept most definitely holds true when catching a barbell. Many
a time I’ve seen athletes’ form breakdown past 90% of their max lifts. Many I
time they will cut their movement short, and rush under the bar. Cueing the
athlete “think power” often remedies this problem by giving them the gusto
necessary to achieve full extension, receive the weight, and THEN ride it down
into the squat.
There are two common faults I see
with the catch. The first being a catch with the knees forward and hips
extended, which may stem from poor motor control or a weak anterior core which
cause the hip to remain flexed and the thoracic to overextend in compensation.
The second being the “bar dive” where the athlete will rush under the bar and
begin their descent into the squat BEFORE making contact with the bar. At
higher loads this can cause an unsafe bottom out, improper hand placement that
can over-torque the wrist, or cause your upper back to mash-potatoes leading to
a miss forward.
A classic Hatch-method that I have
found to be especially effective in building both athlete confidence, power and
proper bar receiving technique is the Top-to-Bottom clean. It is performed by
building up to 80% of the athlete’s 1 rep max, and will reinforce that
regardless of where the bar begins in space, landing with the knees bent and a
slightly flexed hip will properly distribute the weight of the bar and act as a
precursor-squatting position. Receive the bar, meet the bar, but do not just
simply catch it.
If you can power clean the bar from
the hip, you can surely hit 80% of your 1 RM any day of the week, whether fresh
or exhausted, as long as you believe in what your body knows to be true. Trust
your technique, believe in what you are doing, and happy lifting.
WE DID IT. We actually did it. You are graduating this week. All of the
cadaveric blood, lab partner sweat, and learning-the-gait-cycle-tears have paid
off. You are about to become a Doctor of Physical Therapy. We are at the event
horizon now, so let’s take a look back shall we? 
