Six Things I’ve Learned In Six Years of Practice (by Dr. Reiner)
If there is one thing I have come to accept in six years of practice, it’s the more I learn the less (I feel) I know. I believe this is what drives so many of us in the fitness and rehabilitation profession. We are in constant search of the latest and greatest information to improve upon ourselves and ultimately create better athletes, clients, and patients. Reflecting on 2011 made me realize how much material was absorbed this past year. Had I possessed this information fresh out of chiropractic school, there would have been far less headaches and days of frustration. However, learning the hard way often makes us more appreciative of how far we have come. Without further adieu, my list of the top six things I’ve learned over the last six years.
1. It’s not just about you
Sure it’s always nice to think an athlete is back on the field and feeling better than ever because of what “you” did. The fact of the matter is, it’s a team effort. We can’t be experts in every field and with an overwhelming number of therapies, specialists, and philosophies, it’s imperative to create a “team” of like-minded specialists. Our “team” at Fitness Quest 10 consists of chiropractic, physical therapy, massage therapy, acupuncture, nutrition, strength and conditioning, yoga, and Pilates. More often than not one of our athletes will at some point encounter all of us in their quest for athletic perfection. My previous article, “Who’s on your Team“,discusses the importance of surrounding yourself with a group of specialists that communicate well and provide a comprehensive approach to rehabilitation, injury prevention, and athletic performance.
2. Get it right from the start
Top of the line equipment and trendy treatment techniques can make any clinician/therapist feel invincible to any injury that walks through the door. Without proper assessment and a correct working diagnosis, it’s easy to chase pain and treat the symptoms with those cool toys. While chiropractic school provided the basis for standard examination, it’s through courses, seminars, books, and colleagues outside of the chiropractic profession, that I’ve come to understand biomechanics and motor patterning. Understanding movement and analyzing dysfunctional patterns will direct you to the cause of the injury. Bottom line….don’t chase pain. Some of the most influential to my practice include Gray Cook, Dr. Stewart McGill, Shirley Sarmon, Sue Falsone, Greg Rose, Charlie Weingroff, Craig Liebenson, and Mike Reinold.
3. Don’t get caught up in the “black and white” of biomechanics. The nervous system is a bigger beast and creates many shades of gray when treating patients.
Only considering biomechanics when assessing injuries or faulty movement patterns will often leave you short of solving the problem. The nervous system is a far bigger beast to comprehend when motor control issues and compensatory patterns exist. Is it the pain that drives the faulty pattern or the faulty pattern that drives the pain? Studies have shown pain, regardless of its origin, alters motor control.
This same concept applies to the rehabilitation of our stabilizers. Just six years ago in school we learned to “strengthen” weak stabilizers (ie. core and rotator cuff). Current research, however, points to timing as the key factor. Without the nervous system activating our stabilizers first, it doesn’t matter how “strong” we make these muscles. Put down the tubing for your IR/ER shoulder exercises and focus your attention towards patterns that consider timing. Understanding biomechanics is the first step in looking at function, but improving the pattern only comes with careful consideration of the nervous system.
4. Look beyond static posture and alignment
Chiropractic school emphasized posture and alignment with the majority of the assessment occurring in the standing or lying position. While this continues to be a part of my examination, evaluating movement is just as important. The majority of musculoskeletal injuries occur as a result of poor movement quality. For the general population the overall decline in activity, I believe, translates to poor movement competency. As such, the weekend warriors and/or gym goers often present with mechanical neck and lower back pain. Posture and alignment are a start to understanding the problem, but looking at fundamental movement patterns such as gait, running mechanics, and throwing, are essential when working with any patient or athlete.
5. Don’t throw the baby out with the bath water
The health and fitness industry often discount various techniques, exercises, and philosophies if evidence is inconclusive or unfavorable. While I’m a firm believer in testing our hypothesis and seeking out the best information, it’s the combination of clinical experience and evidence based research that should be the driving force behind our programs/treatments. The majority of the assessment, treatment, and training techniques I utilize are evidence led. Notice I didn’t say evidence based. Performing and executing flawless clinical studies and trials is virtually impossible. Brett Contreras wrote an article demonstrating that one could find a study to prove or disprove just about anything. Whether a study supports or refutes the testing hypothesis, taking into account your clinical experience is sometimes more important. Many researchers are limited to working in a lab without stepping foot in a clinic/training facility. As a clinician or strength coach working in the trenches, we see first hand what is effective and what is not. Just because the Journal of whatever discounts your school of thought doesn’t mean you toss the technique or philosophy aside. While research fuels the growth and science of the health and fitness community, always consider your experience and results within your setting. Proving efficacy is often evident in your success. Bottom line…do what works.
6. Without written goals, it is difficult to track your progress and map out where you are headed
It’s that time of year again, time for New Years resolutions and planning for the upcoming year. We all talk about it, but it often becomes a distant memory by mid February. This past year I took the time to write out several goals, both the professional and personal. Creating a list and placing it a high traffic area my house, kept me on track for the year. Let this be the driving force for self-improvement in the important areas of your life. For me, I made it a point to spend at least 10% of my income on continuing education (thank you Diane Vives for the recommendation). Looking back at the number of seminars, courses, classes, workshops, and books I have learned from this past year, has kept me motivated and passionate about my work. Most important, the attention to both personal and professional goals will help maintain the balance between the two and your focus on the things that matter most.
Let this be the most enlightening and productive year you’ve had yet.
About Dr. Reiner
Dr. Jennifer Reiner is the chiropractor for Water and Sports Physical Therapy and Fitness Quest 10 in San Diego, California. She obtained a Bachelor’s of Science Degree in Exercise Science from the University of Florida and went on to pursue a Doctor of Chiropractic degree from Palmer College of Chiropractic West. As a member of the Palmer West Sports Council, Dr. Reiner focused her studies on sports injuries and rehabilitation. She is also a Certified Strength and Conditioning Specialist (CSCS) by the National Strength and Conditioning Association.
She spent five years as the official chiropractor for the University of California San Diego, providing care to a variety of sports including swimming, soccer, volleyball, track and field, tennis, and basketball. Dr. Reiner is certified in Graston Technique as well as Active Release Technique (ART). She also holds certifications in FMS (Functional Movement Screen), SFMA (Selective Functional Movement Assessment), TRX suspension training, and K-laser therapy. Follow her on Twitter –@drjreiner.
Explode…TRX Style
Plyometric movements with the TRX are a great way to perform explosive movements in a safe and effective manner. This 3-movement circuit will really challenge your heart rate and test your mental toughness. At first, I would recommend performing each exercise for 20-30 seconds. Since these circuits are intended to test your abilities, try to keep the rest time between each exercise to 10 seconds or less. For example; performing bilateral jumps for 20 seconds, rest 10 seconds, then perform your lateral jumps for 20 seconds. After 10 seconds rest, go right into your burpees for 40 total seconds (20 seconds per leg). Rest for 1 minute and complete that circuit 2 more times.
Doug Balzarini | Founder of DBStrength
Is your core MMA ready?
Think your core is MMA-ready? Give trainer Doug Balzarini’s 8 MMA midsection exercises a try to find out.
The “core”, “trunk”, “torso”, “belly”, “stomach”, “abs”, “6-pack”… The terminology alone confuses me. It would seem, somewhere along the way, the definition of one’s core has gotten lost in translation. I cringe every time I hear someone say it’s, “time to blast the core,” only to then lay on the floor and begin crunching away for 5 minutes to get that good burn. Which is to say, we need to better understand what the core really is, and how best to train it.
One term for the core I actually do like is the “transfer station” for the body. EMG studies show that muscle activation begins from the ground up, so when we are curl, push, or press something with our upper body, we generate our movement from the bottom and transfer it up to the moving parts. One great example of this is when we throw a punch, as we begin to generate that power from the ground all the way up to our fist. A couple studies that support this include; 1) Dyson, Smith, Martin, Fenn. (2007). Muscular Recruitment During Punches Delivered At Maximal Force & Speed. XXV ISBS Symposium 2007, Brazil, 591-594. 2) Valentino, B., Esposito, L.C., Fabrozzo, A. (1990). Electromyographic activity of a muscular group in movements specific to boxing. Journal of Sports Medicine and Physical Fitness, 30, 160-2.
Frankly, to me, the core is - any muscles and structures that support and stabilize the pelvis, spine, and shoulders. It’s everything but our limbs some people like to say. I’d have to refer back to my A&P textbooks to confirm it, but I’m fairly certain then that this involves more than just our rectus abdominis. It’s this definition that makes exercises like squats, deadlifts, tire flips, pushups and pull-ups all excellent “core” movements in my book. It’s also this definition that makes lying down and pulling on the back of your head to facilitate cervical and thoracic flexion not my idea of healthy “core” work.
Most of us sit for 8+ hours a day. Our hip flexors, pecs, and anterior shoulder muscles are tight, and our gluteals inactive. If our scapulae are stuck in protraction, why then would we have them come in to our facility and sit them, or lay them, down?! We’re, in the long run, doing more harm than good. I like to refer back to one of my favorite exercise-related questions, “Why?” Why are we performing a particular exercise? You should be able to defend, or explain, every exercise you do.
To Move or Not To Move
While we train most muscles to move and accelerate, we should train our core musculature to decelerate, control, and transfer movements. They work to prevent motion and provide the solid foundation needed for safe, effective movement.
Midsection Moves for MMA
Your core is especially important in MMA. Having mobile hips and a strong, stable, and efficient core leads to better footwork, stronger takedowns and takedown defense, and increased power in all of your striking. Now, while I’ve made it no secret that I’m not an advocate of crunching movements, MMA athletes are a different breed. If we are being sport-specific and training them functionally for their craft, one could then make a case that we should be performing various crunching movements. For this particular article, however, I’ll keep it a “crunch-free” zone.
My Current Top 8 - I say “current” because I’m always trying new movements and changing the list up.
1. Seal Walks
This is a great “anti-rotation” movement because our goal is to minimize the rotation of the pelvis as we move. Keep your abdominals braced and be sure to not lock out your elbows as you move.
2. Valslide Hip Circles
This is a variation of the popular abdominal knee tuck that we commonly do with the Valslides or TRX. The primary difference is the abduction and adduction component of the hips. This is great for opening up the groins and an important movement for combat athletes who want to improve their flexibility for their ground game.
3. Stability Ball “Stir The Pots”
This is a great progression from the traditional plank. By adding an unstable tool, such as the stability ball, we easily increase the intensity.
4. TRX Body-Saw with Knees
From the plank position with your feet in the cradles, initiate the movement from your torso and shoulders by pushing your body back (think heels toward the back wall). As you come forward drive one knee towards the same side elbow.
5. TRX Hi Plank w/Stops & Perturbations
These are two variations I like that both begin in the pushup, or hi plank, position. For the perturbations, have a training partner push your feet in various directions while you try to resist. For the stops, you will perform pendulum swings and your partner will cue you to stop moving at random times.
6. Sandbag Get-ups
The traditional get up, which I also love, is typically performed with a kettlebell and an extended arm. Two reasons I choose to show the sandbag version are 1) it’s slightly easier to teach and 2) I like having the heavy sandbag laying across the chest to challenge breathing patterns.
7. Standing Tornado Ball Figure 8’s
This movement is great for developing rotational power through the thoracic spine. Try to minimize the movement of the hips and really focus on keeping your abdominals braced and your shoulders rotating.
8. Hanging Wipers
This is one of my favorite midsection movements. Like I mentioned in the clip, perform this in a controlled manner and don’t feel you need to go too far from side to side. Once you are you hanging from the bar, swing your legs up so you are inverted with your ankles, knees, and hips are in a straight line, perpendicular to the ground. From here, let the legs fall from side to side controlling the speed and movement from your obliques, erectors, and abs.
Please give these a try and let me know what you think. I encourage feedback and would love to try any crunch-free abdominal exercises that you’ve had success with.
About the Author
Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). He is also the strength coach for Alliance MMA in Chula Vista, CA. He earned a B.S. in Exercise Science with a minor in Business Management from Westfield State University and completed some graduate work in Biomechanics at SDSU. Certifications and specialties include the ACE Personal Trainer Certification, NSCA-CSCS Certification, TRX instructor training, EFI Gravity instructor training, LIFT Sandbag Certification, Spinning certification, FMS training, and CPR/AED instructor status. He has appeared in multiple fitness videos, manuals and magazines; produced his own 2-DVD Set on strength & conditioning for combat athletes, completed a MMA Conditioning Coach certification program, and has competed in multiple grappling tournaments.
Top Pushing movements
Over the years I’ve made clear my preference to posterior chain/pulling movements over pushing exercises. I feel that, for the majority of the population, the benefits of backside exercises far outweigh their anterior chain counterpart. Now, this doesn’t mean that I don’t like pushing exercises. In fact, pressing and pushing are staple movements in all my programs. They are essential for a well balanced routine.
Whether you are a professional MMA athlete or an “everyday population” client, make sure you include effective, functional pushing exercises into your workouts. The list could go on for pages with all the variations and various tools that one could use…I’m going to share four of my favorites.
1. Chest Press
The chest press is the “go to” exercise for developing the pecs, anterior deltoids, and triceps muscles. If you want a well-rounded routine, you should include some form of a chest pressing movement into your weekly program. In the video below, you will see the ‘Dumbbell Floor Press’. Compared to the traditional bench press, you will lose some leg drive with this variation; however, I feel it’s a bit safer for the shoulder joint and still extremely effective for developing strength and power in those upper body pushing muscles. Exercise in video below: Dumbbell Floor Press
2. Pushup
I love bodyweight exercises and pushups have been a staple bodyweight exercise for years and years. Search on YouTube and you can find hundreds of pushup variations out there…some I question the reasoning behind and some I love. When done properly, pushups force you to really engage the entire body, testing you from feet to fingertips. This variation below will add an additional challenge to the shoulder joint, your obliques, and your hip mobility. Keep the entire body “stiff” and engaged throughout the movement to protect your lower back and shoulders. Exercise in video below: Pushup with Toe Taps
3. Get-Up Variations
Kettlebells and sandbags are my tools of choice when talking about the get-up. This exercise is a great full body exercise in terms of both strength and mobility, especially for the glutes and hips. I included it in with these “pushing” exercises simply due to the fact that we are pushing our bodies away from the ground and working the anterior chain a great deal. It is essentially a static press exercise for the shoulder.
My two get-ups of choice:
Sandbag ½ Get-Up
This is the closest “crunch exercise” you will see in my consistent routines. As long as you lead with movement with your chest and roll onto your elbow and post up onto your hand, you will limit the spinal flexion that occurs during the movement. Check it out in the video below.
Full Kettlebell Get-Up
I love this version for shoulder-health reasons. When performed correctly, you must keep your shoulder “packed”, which will ensure the scapula is stable on the thoracic spine and the surrounding muscles are fully engaged. It helps keep the shoulder strong and safe. Be sure to include Get-Ups to ensure you are getting a true core workout. Exercise in video below: Sandbag ½ Get-Ups
4. The Prowler
The prowler is the best tool for developing both pushing power/acceleration and metabolic conditioning at the same time. The Prowler, and all its variations, is a lock to always make my list for best equipment on the market today. The exercise below is the most standard movement you can do with the Prowler. Simply load up the weights, grab the handles, get in a proper forward lean position, and get pushing. I like to incorporate the Prowler into a circuit, as a stand along exercise, or as a finisher at the end of a workout (see more on “finishers” here). Be careful not to get the “Prowler Flu”!
Exercise in video below: Prowler Pushes
To see these exercises in more detail, as well as 100’s of other movements, click here.
“Everyday Population”
Proper pulling/posterior chain movements are a must if you fall into the “9-to-5 client” category. As long as your program is sensible, then there’s no reason you shouldn’t include a couple pushing exercises into your weekly routine. Incorporate with proper flexibility exercises for the chest, hips, and ankles (another article in itself) and you are on your way to reaching your goals.
“MMA Athlete”
We want to build both the strength and endurance in your front side. “Long strong” is a favorite term of mine in the industry. It refers to your ability to stay strong in the later rounds of a fight; to have the will and endurance to fight on…a lot of that is mental preparation and a lot of that is proper strength training. Incorporate these movements into your routine and you are more likely to stay “long strong” and have your arm raised in victory after the bell rings.
Make sure you incorporate pushing exercises into your weekly routine to ensure you are maintaining balance in your program.
About Doug
Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). He is also the strength coach for the Alliance Fight Team in Chula Vista, CA. A Massachusetts native, he earned his Bachelor’s degree in Exercise Science with a minor in Business Management from Westfield State University. Since moving to San Diego he has completed some graduate work in Biomechanics at SDSU, obtained an ACE Personal Trainer certification, the NSCA-CSCS certification, a Spinning certification, TRX instructor training, EFI Gravity instructor training, FMS training, and received his CPR/AED instructor status. He has also appeared in 8 fitness videos, written numerous fitness articles, completed a MMA Conditioning Coach certification program and has competed in multiple grappling tournaments.
Mobility Matters
In the last ten years, the term mobility within the fitness and sports performance community has been pushed to the forefront. Foam rollers, slant boards, rolling sticks, baseballs, and other torture devices are a mainstay in gyms to improveflexibility and mobility. As a chiropractor that works primarily with athletes and the active population, I feel the hierarchy of movement begins here. In school, we spend years understanding the basis of joint movement, how to assess it, and ways to improve upon it. I hope to provide a little insight from a clinical chiropractic perspective on mobility and perhaps give you a few exercises to add to the toolbox.
A wide variety of philosophies and therefore treatment and assessment protocols exist in the chiropractic profession. While some are deeply rooted in the older chiropractic philosophy of maintenance care and wellness, others focus on rehabilitating neuromusculoskeletal problems. To provide a little background into my methodologies and techniques, I graduated from chiropractic school with a focus on sport related injuries. This led me to a series of seminars, specifically Active Release Technique and Graston. I spent a three-month internship with the University of Miami and later moved to San Diego to work with the University of California San Diego’s athletic training staff. A few years of Active Release and manipulations on 300 pound offensive linemen and 6’9” basketball players took its toll on my 5’3,” 115 pound frame. If I continued at this rate, I knew my career would be short-lived. It was time to treat smarter, not harder.
I began questioning the soft tissue techniques I utilized as well as my own abilities. Common areas, such as the IT band or hip flexors, would be resistant to repeated treatments using Graston and Active Release. I blamed the athlete’s mechanics, the sport, or a previous injury for the recurring issue. Bottom line, my hands and body were taking a beating only to achieve temporary improvement in the athlete’s condition. Around this time I returned to my roots of exercise science and obtained my Certified Strength and Conditioning Specialist certification. A plethora of information related to functional movement and corrective exercise existed opening my eyes to many physical therapists, strength coaches, researchers, and other like-minded chiropractors. Gray Cook, Mike Boyle, Craig Liebenson, Greg Rose, Stewart McGill, and Mike Reinold are just a few whose research, articles, seminars, and philosophies I took interest in. I believe my “aha” moment came during the FMS/SMFA (Functional Movement Screen/Selective Functional Movement Assessment) seminar when the discussion began on joint mobility and stability. Finally, objective findings coinciding with our understanding of biomechanics, to effectively provide a rationale for repetitive soft tissue and joint tightness, pain, and/or injury. It wasn’t so much my treatment techniques that were in question, but rather the assessment. Evaluating movement in relation to mobility and stability would be the guiding factor as to which area was the weakest link. As such, treatment directed towards the cause utilizing objective evidence rather than symptoms, would produce long-lasting, efficient, and effective results.
Whether the FMS/SFMA is your evaluation tool or another, mobility limitations must be considered before progressing to motor control problems. For those unfamiliar with the joint-by-joint approach described by Gray Cook and Mike Boyle, each segment of the body is viewed by its role in providing mobility or stability. To begin, our ankle, hip, thoracic spine, and glenohumeral joint should be mobile while the knee, lower back, cervical spine, and scapulae should be stable.
The hips can be tricky, however, as this region serves both a mobility and stability purpose. Based on these patterns, it is no wonder that disrupting the sequence creates compensation elsewhere. For example, clinicians (me included) can get caught up at the site of the patient’s symptoms. Insidious onset of anterior knee pain is a great example. If orthopedic tests fail to reveal instability, compromises in range of motion, meniscal problems, etc., we often categorize the issue as patellofemoral pain, tendonitis, and so forth. These diagnoses are more of the symptom rather than the cause. Typical treatment including ultrasound, myofascial release, rest, and non-steroidal anti-inflammatories may provide short-term relief, but often the same issue rears its ugly head a short time later, perhaps even worse. Well it is time to take a step back both figuratively and literally to view the areas above and below the site of complaint. It is time to include an assessment of the fundamental movement patterns our patients and athletes are utilizing in their every day activities. Sure, standard orthopedic tests, isolated muscle strength, and range of motion are integral to each examination, but often these do not provide the rationale for the cause of injury. A movement screen can provide foreshadowing of a potential problem to come. Utilizing this information begins to tell the story of the mechanical breakdown producing the dysfunction.
After performing a movement screen or assessment and evaluating your results, addressing joint mobility limitations and/or soft tissue extensibility problems is the first step in treatment. Let’s get back to the basics, if the range of motion at a particular joint is significantly lacking, the motor control of the muscles surrounding the joint will also be compromised. Unfortunately, you cannot exercise yourself out of poor movement patterns. The system must be reset at the most basic of levels. The lack of mobility may be due to several factors including a poorly managed injury, posture, stress, or inefficient stabilization. Over time, our body detects the lack of movement and begins to compensate by making up for it elsewhere. This is our innate ability for survival. Compensation, however, was designed for short-term management…. i.e. running away from a pack of wolves. Nowadays, however, when our bodies begin to signal signs of distress by way of pain, tightness, and discomfort, we run for the nearest bottle of Ibuprofen. Silencing the alarm system leads to ongoing distress at the joint or soft tissue priming us for that disc rupture, ACL tear, meniscal derangement, rotator cuff injury, and the list goes on.
As babies, we are born with ample mobility throughout our spine and extremities. Personally, I think God was doing us a favor (being a woman that is) providing substantial movement to be able to twist, turn, flex, and extend during the birthing process. Mobility provides the platform by which we build our stability. The developmental process involves movement milestones beginning with the mobility of the hips and shoulders and progresses to rolling patterns and core stability. Therefore, we must address mobility before expecting a new level of motor control in order to overcome movement dysfunctions.
Generally speaking, many of the mobilizations/manipulations I perform are directed towards the ankles, hips, thoracic spine, and glenohumeral joint. As such, the videos below are examples of a few exercises commonly prescribed to patients.
Whether you are a “top down” or “bottom up” believer, I’m sure we can all agree that limited dorsiflexion of the ankle can produce a number of issues up the kinetic chain. Many athletes I treat present with low back, hip, knee, and/or ankle issues that relate to the limited mobility of the talocrural joint. This is a modified hinge, synovial joint, comprised of the talus and distal tibia and fibula. While the articular geometry of the ankle limits the amount of inversion and eversion, the mobility lies primarily in the sagittal plane (plantarflexion and dorsiflexion). Dorsiflexion in the non-weight-bearing position is 20 degrees and plantarflexion is 50 degrees. Perhaps a more functional measurement, closed chain dorsiflexion, is standard at 43 degrees with the knee flexed and 36 degrees with the knee extended (Reischi, Noceti-DeWit).
For many individuals, especially those who have played sports, an ankle sprain is as common as a winter cold. Left untreated, scar tissue forms around the joint and soft tissues impeding dorsiflexion, an imperative component to shock absorption in running and jumping and in fundamental movements such as squatting and lunging. Rather than strengthening the supporting musculature and improving the proprioception of the foot and ankle, patients subscribe to heavy taping and ankle braces. In his book, Movement, Gray Cook reports a direct connection between the stiffness of a basketball shoe and the amount of taping and bracing that correlates with the high incidence of patella-femoral syndrome in basketball players. Therefore, improving the movement within the sagittal plane improves knee tracking creating less stress at the knee, hip and lower back. Soft tissue extensibility and joint mobility techniques are both essential for improving ankle mobility. The video below includes stretches directed towards the flexibility of the lower leg musculature and ankle mobilization techniques directed toward the joint.
According to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), repetitive strain injuries are the nation’s most common and costly occupational health problem, affecting hundreds of thousands of American workers and costing more than $20 billion a year in workers compensation. The typical workstation is not ergonomically designed, and even when it is, a conscious effort in correct sitting posture is not at the top of most people’s list. Poor sitting habits are considered a repetitive stress injury. Although the amount of stress is minimal (literally the weight of ones head, upper extremities, and torso), the repetition or duration, in this instance, is extreme. Insistent flexion stress to the spine causes deformation of the supportive anatomy that holds us upright. This phenomenon is known as creep, a condition where passive, supportive structures such as ligaments and joint structures are stretched. As a result, the mobility of our spine becomes more limited and the supportive musculature cannot function properly. Compromising the movement of the thoracic spine only increases the stress to the adjacent joints and tissues. As previously mentioned with the lack of hip mobility and subsequent stress added to the lumbar spine, the cervical spine suffers a similar fate. Clinically, in the cervical spine, the most frequent degenerative changes and disc pathologies occur at the mid to lower cervical spine as a result of increased shearing and movement. Thoracic flexion should measure 20 – 45, extension 25 – 45 degrees, lateral flexion 20 – 40 degrees, and rotation 35 -50 degrees. Compared to other joints, this is a wide range for accepted movement, so erring towards the higher number is to our benefit. To quote Mike Boyle on thoracic mobility, “almost no one has enough, and it’s hard to get too much.” From a chiropractic perspective, I feel joint manipulation is very effective here, particularly at the cervicothoracic and thoracolumbar junction. Daily mobilization and stretching techniques are just as important and can easily be given to patients/clients for homework. In fact, most of my patients, whether they are coming in for a shoulder, neck, or lower back problem, will receive a home exercise program including thoracic mobility.
Because shoulder mobility is closely tied to thoracic mobility, I will address the glenohumeral joint here as well. The shoulder could easily be a whole other article so, to keep it short we’ll discuss it in relation to the thoracic spine. Before beginning to consider the movement of the shoulder, we must look at the posture and movement of the thoracic spine. Patients with poor thoracic extension often present with impingement (secondary) issues. In essence, improving your thoracic spine mobility will also improve shoulder mechanics. For example, try flexing the shoulder while sitting in a slouched posture and you will experience limited motion and possibly discomfort or pain as you raise the arm. Conversely, forward shoulder flexion with an extended thoracic spine clears the subacromial space allowing the glenohumeral joint to move freely. Once this is established, we can move distal to the scapula stabilizers and the glenohumeral joint when considering movement dysfunctions and other pathologies. Below are some of my favorite thoracic mobility exercises that also benefit the shoulder.
Sometimes clients may reach a plateau in their flexibility and mobility or they complain of pain (not the typical discomfort felt during a stretch). If this is the case, be sure to refer to a clinician who is licensed to evaluate musculoskeletal conditions. There are a variety of pathologies, which affect bone, joint, and soft tissue that can underlie movement restrictions and/or produce pain. There are also a variety of manual techniques to mobilize soft tissue and joints such as Active Release Technique, Instrument Assisted Soft Tissue Mobilization Techniques (IASTM), belt mobilization, and manipulation/adjustments that will go beyond self-mobility work. These can often break through soft tissue barriers including scar tissue and capsular restrictions, which can be resistant to stretching, foam rolling, and the like.
Most importantly, and the answer to my issue of repetitive “tightness,” consider your evaluation process when clients/patients complain of persistent IT band issues or chronic lower back stiffness. Stop blaming his/her exercise regime or work environment and look deeper into their movement patterns. Evaluating fundamental movements may actually reveal joint mobility issues or underlying stability problems away from their site of complaint. Your hands and client will thank you when you find the cause of the tightness and offer a solution to their problem rather than continuing to treat their symptoms.
Cook, Gray. Athletic Body in Balance. Champaign: Human Kinetics. 2003.
Cook, Gray. Movement. Lee Burton, Kyle Kiesel, Dr. Greg Rose, and Milo Bryant. Santa Cruz: On Target Publications. 2010.
Magee, David J. Orthopedic Physical Assessment. 4th Edition. Philidelphia: Saunders. 2002.
Reischl, Stephen F. Noceti-DeWit , Lisa M., Current Concepts of Orthopaedic Physical Therapy. The Foot and Ankle: Physical Therapy Patient Manageemnt Utilizing Current Evidence. Orthopaedic Section, APTA, Inc. 2006.
Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby. 2002.
About Dr. Jennifer Reiner
Jennifer is the chiropractor for Water and Sports Physical Therapy and Fitness Quest 10 in San Diego, California. She obtained a Bachelor’s of Science Degree in Exercise Science from the University of Florida and went on to pursue a Doctor of Chiropractic degree from Palmer College of Chiropractic West. As a member of the Palmer West Sports Council, Dr. Reiner focused her studies on sports injuries and rehabilitation. She is also a Certified Strength and Conditioning Specialist (CSCS) by the National Strength and Conditioning Association.
She spent five years as the official chiropractor for the University of California San Diego, providing care to a variety of sports including swimming, soccer, volleyball, track and field, tennis, and basketball. Dr. Reiner is certified in Graston Technique as well as Active Release Technique (ART). She also holds certifications in FMS (Functional Movement Screen), SFMA (Selective Functional Movement Assessment), TRX suspension training, and K-laser therapy.
“2 For 1″ TRX Specials: Doug Balzarini
“2 For 1″ TRX Specials
Here are 5 TRX movements we utilize that involve alternating between two exercises. You will perform one rep of one exercise followed by one rep of another exercise and continue to alternate back and forth for the desired number of reps. Using the interchanging sequence requires a bit more coordination and core stability.We use these with healthy clients and feel that, as long as they are executed with proper form, are safe, effective movements that will challenge you in a fun, new way.
Here is a brief breakdown on the 5 exercises:
1. TRX Bicep Curl to Row
This is a pretty popular interchanging sequence that you may have seen before. Perform a TRX bicep curl with your palms up and your upper arm parallel to the ground. After one rep of your bicep curl, rotate your hands to a neutral grip and perform one rep of a low row with your elbows down by your side and your spine neutral throughout.
2. TRX Pistol Squat to 1-Leg Balance Reach
When performing the single leg squat (pistol), keep your arms relatively straight and try to keep your weight on the heel to the mid-foot while maintaining an upright posture. After each pistol rep – hinge from your hip, maintain pressure into the handles, extend your heel towards to back wall, and lower down into a balance reach or deadlift position with a neutral spine throughout the exercise.
3. TRX Curtsy Lunge to Lateral Lunge
Begin by lowering down into a reverse lunge position and reaching the rear leg diagonally back to the 4 o’clock position (if looking at a clock). On the way up bring that rear leg way out to the 9 o’clock position and line up the ankle, knee, and hip joint while keeping the trail leg straight. Head and chest should remain upright and feet should remain forward throughout the exercise.
4. TRX Burpee to Scorpion
After the pushup portion of the burpee, you will perform the scorpion by rotating your torso and bringing the “free leg” under your body and then rotating your torso the other way to bring that “free leg” over your body. Next, return to the pushup position and drive that knee up before standing tall to complete one rep.
5. TRX Row to Triceps Extension
Keep a neutral grip for your row exercise and pull explosively enough to carry you through and under the anchor point where you will go right into an overhead triceps extension movement. This will also be done in an explosive nature so that you can return back to the row position. Make sure the strap length is fully shortened and only offer this to healthy and experienced TRX users.
Check out the Movements on Doug’s YouTube page.
Get with these movements and let me know what you think!
About Doug
Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). A Massachusetts native, he earned his Bachelor’s degree in Exercise Science with a minor in Business Management from Westfield State College. Since moving to San Diego he has completed some graduate work in Biomechanics at SDSU, obtained an ACE Personal Trainer certification, the NSCA-CSCS certification, a Spinning certification, TRX instructor training, EFI Gravity instructor training, FMS training, and received his CPR/AED instructor status. He has also appeared in 8 fitness videos, written numerous fitness articles, completed a MMA Conditioning Coach certification program and has competed in multiple grappling tournaments.
Prior to working at Fitness Quest 10, Doug worked for the American Council on Exercise as the Continuing Education Coordinator where he was responsible for managing over 400 continuing education providers.
Doug Balzarini in UFC Magazine
I love training clients with that “competitive fire” inside. They are there at the gym with you for a reason. They are there to reach a particular goal. They are there to get better.
I believe this should be true of every client; from a high level professional athlete, to the 65-year old who wants to keep up with her grandkids, to everyone in between. They should have a goal because goals are what drive us.
If a client is at the gym to move their legs on the recumbent bike while they text on their phone, watch the latest episode of “Housewives” on the attached TV, and chat with their “training partner” about the cute guy doing curls in front of the mirror, then I don’t want that person as a client. They are wasting both their time and mine.
Training Combat Athletes
One of the reasons I love working with professional athletes is because of their strong will. They know that if they work hard in the gym, it will pay tremendous dividends in the next match or tournament.Phil Davis is an example of why I love my job. I’ve had the opportunity to be a part of his last few training camps at the Alliance Training Center. He is, hands down, one of the hardest working individuals I’ve ever known. Aside from his passion for donuts and the occasional strudel, he is a great client to work with. He is dedicated, follows instruction, and has an unbelievable motivation to be the best at what he does. This is the work ethic and determination I strive to get out of every client I work with.
Below is a piece on our strength and conditioning that was featured in UFC Magazine. These are just a few of the things that Phil does to get better everyday.
CLICK ON THE UFC MAG IMAGE TO VIEW THE ARTICLE
Regardless, of your occupation, age, gender, or background; create your game-plan, set it in motion, and “train like a fighter” until you accomplish that goal!
About Doug
Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). A Massachusetts native, he earned his Bachelor’s degree in Exercise Science with a minor in Business Management from Westfield State College. Since moving to San Diego he has completed some graduate work in Biomechanics at SDSU, obtained an ACE Personal Trainer certification, the NSCA-CSCS certification, a Spinning certification, TRX instructor training, EFI Gravity instructor training, FMS training, and received his CPR/AED instructor status. He has also appeared in 8 fitness videos, written numerous fitness articles, completed a MMA Conditioning Coach certification program and has competed in multiple grappling tournaments.
Prior to working at Fitness Quest 10, Doug worked for the American Council on Exercise as the Continuing Education Coordinator where he was responsible for managing over 400 continuing education providers.
Doug Balzarini breaking down the TRX
Here are 5 TRX movements we utilize that involve alternating between two exercises. You will perform one rep of one exercise followed by one rep of another exercise and continue to alternate back and forth for the desired number of reps. Using the interchanging sequence requires a bit more coordination and core stability. We use these with healthy clients and feel that, as long as they are executed with proper form, are safe, effective movements that will challenge you in a fun, new way.
Here is a brief breakdown on the 5 exercises:
1. TRX Bicep Curl to Row
This is a pretty popular interchanging sequence that you may have seen before. Perform a TRX bicep curl with your palms up and your upper arm parallel to the ground. After one rep of your bicep curl, rotate your hands to a neutral grip and perform one rep of a low row with your elbows down by your side and your spine neutral throughout.
http://www.youtube.com/watch?v=U_2eiv7lyeA
2. TRX Pistol Squat to 1-Leg Balance Reach
When performing the single leg squat (pistol), keep your arms relatively straight and try to keep your weight on the heel to the mid-foot while maintaining an upright posture. After each pistol rep – hinge from your hip, maintain pressure into the handles, extend your heel towards to back wall, and lower down into a balance reach or deadlift position with a neutral spine throughout the exercise.
http://www.youtube.com/watch?v=diGSr-P6KPA&feature=channel_video_title
3. TRX Curtsy Lunge to Lateral Lunge
Begin by lowering down into a reverse lunge position and reaching the rear leg diagonally back to the 4 o’clock position (if looking at a clock). On the way up bring that rear leg way out to the 9 o’clock position and line up the ankle, knee, and hip joint while keeping the trail leg straight. Head and chest should remain upright and feet should remain forward throughout the exercise.
http://www.youtube.com/watch?v=Fp7QNtauqJo&feature=channel_video_title
4. TRX Burpee to Scorpion
After the pushup portion of the burpee, you will perform the scorpion by rotating your torso and bringing the “free leg” under your body and then rotating your torso the other way to bring that “free leg” over your body. Next, return to the pushup position and drive that knee up before standing tall to complete one rep.
http://www.youtube.com/watch?v=u_WlPsTHxEY&feature=channel_video_title
5. TRX Row to Triceps Extension
Keep a neutral grip for your row exercise and pull explosively enough to carry you through and under the anchor point where you will go right into an overhead triceps extension movement. This will also be done in an explosive nature so that you can return back to the row position. Make sure the strap length is fully shortened and only offer this to healthy and experienced TRX users.
http://www.youtube.com/watch?v=83E5n_mlOsY&feature=channel_video_title
Get with these movements and let me know what you think!
Doug Balzarini CSCS DBstrength
About Doug
Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). A Massachusetts native, he earned his Bachelor’s degree in Exercise Science with a minor in Business Management from Westfield State College. Since moving to San Diego he has completed some graduate work in Biomechanics at SDSU, obtained an ACE Personal Trainer certification, the NSCA-CSCS certification, a Spinning certification, TRX instructor training, EFI Gravity instructor training, FMS training, and received his CPR/AED instructor status. He has also appeared in 8 fitness videos, written numerous fitness articles, completed a MMA Conditioning Coach certification program and has competed in multiple grappling tournaments.
Prior to working at Fitness Quest 10, Doug worked for the American Council on Exercise as the Continuing Education Coordinator where he was responsible for managing over 400 continuing education providers. For more information please visitwww.todddurkin.com, www.fq10.com, and www.dbstrength.com.
Ok…l am injured, now what?
Find the silver lining in your injury
By Doug Balzarini
**Disclaimer — I’m not a doctor and I’ve never played one on TV** My thoughts on this topic of injuries are simply from my personal experience and the experience of my clients and athletes. I am currently dealing with a shoulder injury due to my poor arm-bar escape technique, so this subject is fresh in my mind at the moment.
The focus of this article is to discuss what you do AFTER you have sustained an injury. Are you going to be proactive and get better? Are you going to cower in the corner of the stall like Jim Carey in “Dumb & Dumber”? I vote being proactive; accept it, get your required rest and rehabilitation work going, work on your imbalances, and come back stronger and better than before.
Injuries occur for a variety of reasons and come in all shapes and sizes. They can range from a bump on the knee to severe sprains, fractures, and dislocations. Regardless of whether you’re a professional athlete, weekend warrior, or housewife, chances are you are going to get injured at some point.
GET OVER IT Being proactive means we have determined the severity of the injury and now it’s time to plan the best course of action. If warranted, rehab work may be required. When it comes to rehabilitation and injuries I have always said when in doubt, refer out. I think it is vital to have a solid network of rehab specialists at your disposal. Physical therapists, ART specialists, massage therapists, Chiropractors, MDs, etc; the stronger your list, the better your chance for complete recovery. If you’re a trainer or coach reading this, you should have a network already in place so you can make recommendations for your clients and athletes. If you don’t, then start researching today. A colleague of mine, Eric Cressey, said it well in his “Proactive Patient” article “it’s better to know who you’re going to contact when you get injured than it is to scramble to find someone on a moment’s notice when you’re already in pain.” http://ericcressey.com/7-tips-for-your-physical-therapist-visit
Personally, I always try to learn from my injuries. If I have a muscle imbalance or mobility issue; I will really try to focus on that in my training to help fix the problem. I like to know why I got hurt and then work to correct the issue so it doesn’t happen again. Mr. Einstein said it best when he said, “Doing the same thing over and over again and expecting different results”.
WHAT DO I DO NOW? CONTINUE TO IMPROVE… Just because you have an injury does not mean you get a free pass from training. Of course, this depends on the nature and severity of the injury. Sadly, the calories we consume during an injury still count so we need to keep moving. These setbacks just require us to get a little more creative with our training. Two alternatives to consider are the use of machines and expanding your programming. Even though I’m not a huge fan of training with machines; this may be a time when it’s ok. At least until the injury is healed. This is also a great time to focus on those aspects of a complete program that we tend to rush through such as our flexibility exercises and joint mobility work. If you have a lower body injury you can continue with your upper body training, incorporate your lower body rehab movements and spend some extra time on those mobility and flexibility exercises that will help to prevent the injury from reoccurring.
PERSONAL EXPERIENCE My rundown from this past year includes 3 injuries; an oblique strain, plantar fasciitis, and a labral tear.
Oblique strain – This injury occurred during a grappling session. I figured my lower body movements would be unaffected and I could still focus on my upper body pushes and pulls. I was proven wrong when my first attempt at a pull-up resulted in me on the floor writhing in pain. As soon as I began to pull my body towards the bar, I felt a searing pain in my oblique muscle. Pull-ups are already my favorite upper body exercise; however, this drove the thought home even more. It incorporates so many muscles that you wouldn’t think of. Ironically, it wasn’t too long after this incident that I read a great article by Bret Contreras titled, “Inside the Muscles – Best Ab Exercises”. Bret showed us that your abdominal muscles play a major role in performing pull-ups. The take-away from this painful lesson is that pull-ups are a great “core” and “ab” exercise. I love to tell my clients that we are going to train abs today and I walk them over to the pull-up bar. http://www.t-nation.com/testosterone-magazine-627#627#best-ab-exercises
Plantar Fasciitis – This is an issue I’ve dealt with on a couple occasions now. Years ago it was simply improper programming on my part while training for my first ½ marathon. This past year, however, I have discovered that it has occurred due to an old ankle injury I sustained back in high school. At the time of my symptoms, my right ankle range of motion was literally 50% of my left. Since then I have incorporated ankle mobility exercises, daily calf stretches and lower leg foam-rolling, and that discrepancy is improving. The take-away lesson is that I need to work on my lower body mobility EVERYDAY. My lack of ankle dorsi-flexion and extreme calf tightness are keeping me from running which is something I really enjoy.
Labral tear – This was the injury I prefaced at the beginning of the article. I’m an amateur grappler (emphasis on amateur) and I attempted to pull my arm out before my opponent locked in an arm-bar position. Needless to say, I shouldn’t have pulled, he had it locked in solid, and I have had shoulder pain ever since. After a couple days of rest and ice, I saw a sports chiropractor and a DPT who both determined it was a probable labral tear. I realized bench pressing and any overhead work were out. I began with two weeks of A.R.T., physical therapy and laser therapy. Next, I began to focus a lot more on training the small, intrinsic muscles of my shoulders. External rotation work, Y’s, T’s, W’s, scapular retraction, lower trap recruitment, and rotator cuff stabilization movements were now first and foremost in my routine. While I’m not at a 100%, I feel like I’m getting better everyday and this injury will be a blessing in disguise as my overall shoulder health will be greatly improved.
FINAL THOUGHTS I listed these three injuries as examples to help make my point. An injury is not an excuse to keep you from training. Just be smart and have that strong referral network at your disposal. We are at our best when we are moving! So, listen to your body, fix what needs to be fixed, and continue to get better everyday.
About Doug Doug currently works at Fitness Quest 10 as a personal trainer, strength coach, and Operations Director for Todd Durkin Enterprises (TDE). A Massachusetts native, he earned his Bachelor’s degree in Exercise Science with a minor in Business Management from Westfield State College. Since moving to San Diego he has completed some graduate work in Biomechanics at SDSU, obtained an ACE Personal Trainer certification, the NSCA-CSCS certification, a TRX instructor training, EFI Gravity instructor training, FMS training, Spinning certification, and received his CPR/AED instructor status. He has also appeared in 8 fitness videos, written numerous fitness articles, completed a MMA Conditioning Coach certification program and has competed in multiple grappling tournaments. Prior to working at Fitness Quest 10, Doug worked for the American Council on Exercise as the Continuing Education Coordinator where he was responsible for managing over 400 continuing education providers. For more information please visit www.todddurkin.com, www.fq10.com, and http://twitter.com/dbstrength. Want to use the article above? As long as you include the bio blurb at the bottom, you are welcome to use the article in your own publication.
It’s for a contest…I need views!! DBSTRENGTH
Doug Balzarini CSCS DBstrength
Check out my boy Doug Balzarini at DBSTRENGTH!
