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Getting to Pain-Free with Corrective Exercises and Rehab Efforts

We’ve got a dozen lengthy articles here in the blog, and another fifty or so threads in the rehab/corrective exercise section of the forum dedicated to sorting out our various physical dysfunctions. Let’s do a quick recap to bring it all together into a sort of introduction to fixing pain caused by a poorly functioning body.

Often we’re in pain here or there; other times we just don’t move as well as we used to. Everyone we know says, “Ah, getting older,” as if we’re not supposed to be able to move our joints after we hit our forties. The field of physical therapy has begun to develop new ways to teach people who to move again, and their work is expanding into the training rooms of pro and collegiate level sports and trickling down to us. Those methods give new life to beaten-up athletes and middle-aged desk jockeys alike, and somewhere in that group slides the likes of you and me.

Once on the structure and movement rehabilitation path, each time we find another problem we discover it’s connected to something else, another weak or tight or immobile or inactive bodypart that’s not working as it should. Sometimes it’s so confusing or overwhelming we want to give up, but usually before we get to that place we’ve had an amazing success… enough to keep us eagerly and greedily searching for more.

Because every body is malfunctioning to a different degree, and there are so many joints and muscles that might be involved, it’s pretty much impossible to tell you how to get started. Still, let’s take an overview, possibly enough to get you started on your own path to rehabilitation. Each bolded point below is a link to more information on that topic; when you get to one that intrigues you or sounds like something you’re having a problem with, click over and start your journey there.

  • Joint mobility and stability—joint movement, encompassing both the ability of the joint to move through its widest safe range of motion, the ability of the nearby muscles to cause that motion, and stability, such as at the knee, low back, neck and elbow that have a short range of motion and the need to be stable
  • Muscle flexibility—muscle lengthening, whether it can move to its full structural range, or if it’s instead shortened to a less than optimum length
  • Hip mobility—tightness of some muscles and weakness in opposing muscles keeping your hip from its natural ability to move
  • Pelvic tilt—anterior (tilts to the front) or posterior (tilts to the back); you may even have both
  • Hip rotation—internal or external rotation; we need both, but in balance
  • Strengthen weakness—discover and strengthen lesser muscles that are overpowered by larger surrounding muscles
  • Fix the feet—if foot problems aren’t fixed, the structure will never be fully sound
  • Activate muscles—waking up a muscle group that’s not firing well
  • Thoracic spine mobility—optimal freedom of upper spine movement
  • Pectoral flexibility—releasing tight muscles in the front caused by our forward-positioned lifestyles, creating poor upper spine position and mobility
  • Core stability—the enduring power of the deep abdominal muscles that control posture and stabilize the spine
  • Foam roller—a dense foam cylinder used in self-massage of the legs and torso, and even for the front delts, triceps and forearms
  • Triggerpoints—adhesions in muscles or between muscles and tendons that cause surrounding muscles not to function well

Now let’s move over to the forum and get you some help sorting out your next step. Click here to review the topic list of our prehab/rehab and corrective exercise section; you’re welcome to join the conversations in progress, or to start a new topic with your personal concerns. Note: You do have to register and be logged in to post in the forum.

Want to skip all the reading and just get started? Here’s a three-week workout plan for those who don’t care much for the theories, and just want to get started on corrective exercise rehab work.


Steve Cotter Bodyweight Exercises

Bodyweight exercises have taken center stage as I attempt to train up a faltering structure; most of the corrective exercise experts remind us not to try to add strength to dysfunction, and they point to bodyweight work as a key in determining our fail points.

Yet, many of us can’t think of anything past the pushups and situps we learned wrong back in the third grade. Sure, a YouTube search will dredge up a few hundred clips, but are you sure you want to learn from the authority who calls himself iamdrunk?

There’s a guy, Steve Cotter, who’s well known in both the martial arts and the kettlebell worlds. He’s an outstanding kettlebell instructor, and a generous teacher; if you get a chance to join in a Cotter workshop, you’ll end the day having learned your money’s worth, and more. Just watching the guy is a jaw-dropper.

Meanwhile, for us at home, we have a chance to expand our exercise selection with his bodyweight conditioning dvd series. I expect you’ll plant your face in the floor a few times as he inspires you to try more than you’re able to pull off. I even had to drop back and relearn the basic pushup; somewhere along the time between grammar school and middle age, I picked up an elbow-flaring habit that Steve clearly and repeatedly advised against.

In his teaching, he demonstrates easy, beginning options to the movements, building on each one until only one in a thousand will be able to follow along. On top of these useful progressions of common exercises, we also lay our eyes on unusual ideas such as the side-to-side squat as demonstrated below.

You need to a flashplayer enabled browser to view this YouTube video

His Encyclopedia of Bodyweight Conditioning is a three-dvd set that covers 56 upper body exercises, 62 lower body exercises and 42 core torso options. There are plenty of $40 and $50 dvds out there running a whopping 45 minutes; clocking in at almost four hours, Steve’s Encyclopedia is a gold mine as well as bargain.

Steve Cotter

Seriously, don’t you think you could learn something from this guy? Scroll forward to the 30-second mark for a mind-blower:

You need to a flashplayer enabled browser to view this YouTube video

Byron calls Steve a mutant. You can be sure he means that most respectfully.


Shoulder Range of Motion and Thoracic Mobility

The last piece of the shoulder rehab puzzle fell into place recently, at least I hope it’s the last piece. Feels like the last piece. The 15-year progression went something like this:

Long-term trainees with aching shoulders always start with rotator cuff work using thin rubber tubing. We started doing that in the mid-‘90s and the trend continues, both for rehab and for daily warm-up.

A few years ago many added shoulder YTLWs to the mix, on a stability ball if they were bold enough to do that in public.

A couple years ago wall slides and joint mobility came to the forefront, and the forward-thinkers jumped on board. And the desperate.

These shoulder rehab efforts work, unless the damage done is serious enough to require medical intervention… er, surgery. For most of us, pretty good is good enough.

But is it really? What if there’s one more thing you could do that would make your shoulders feel young again? Would you try it?

A couple months ago in Florida, I had Bill Peel run me through the Gray Cook Athletic Body in Balance version of the functional movement screen. I passed the overhead squat progression, but it was nothing to brag about, and there was room for more range of motion in the backward shoulder movement. The worst of the lot that day was the thoracic mobility screen; I claimed a pass, but barely.

A month of focused attention to shoulder range of motion and remedial thoracic spine mobility work didn’t change much, so what was missing? I thought about some of the practices of the past months and remembered my problems with posture; specifically that in the end it wasn’t back strength to hold my shoulders in position that was missing, it was that tightened muscles in the front were pulling the shoulders forward. No amount of strength would be enough to keep my shoulders back until the muscles in the front were stretched regularly to give them the length to rest in good postural position.

Huh. What if that’s the problem with the rear range of motion in the shoulders? Huh! What do you know? It’s magic!

If your shoulder range of motion to the rear is lacking, one side more than the other or both sides equally, give this a try:

Lie on your back on the floor, knees bent, feet flat as if standing. Raise your arms overhead to rest on the floor; if both arms are flat on the floor, move along… there’s nothing for you here.

If only the backs of your wrists or not much more of the arms are touching the floor, or if one side if touching more than the other, rest in position, breathing regularly and deeply into the abdomen. Occasionally, breathe deep, expand the ribcage and keep it expanded by letting out a tiny bit of air and refilling the space. The point of this is to use your full air to hold the ribcage open and as far as possible from its connections at the spine. Stay there, arms overhead, knees bent until you begin to feel the backs of your arms flatten onto the floor.

This is probably going to take awhile, five minutes, ten, maybe more. You’ll probably be okay with that, though, because as it happens it feels a bit miraculous. The muscles and tendons of the upper torso and the thoracic spine and rib cage are relaxing, lengthening, and you can feel it happening.

In a few days, what was stressful and took fifteen minutes will be easy, relaxing and will only take five.

Couple of tips:

If you simply can’t get your hands overhead, start with a lesser angle, such as hands outstretched in a T position. If (or when) the backs of your arms rest heavily on the floor, move your hands up a bit, heading towards a Y angle. This way you’ll ease your way into the overhead position over time; it may take what feels like too much time, but in the end, it will work.

If there’s a twinge in your upper back, different than the stretching that you feel throughout the upper torso, you may need to roll around on a tennis ball or medicine ball to address a triggerpoint or a tight lat before doing the stretch. The trigger point work can be outrageously painful, but the upside is releasing that triggerpoint may be a key — and immediate — factor in relieving your shoulder pain.

Final points:

Don’t do this early in the morning; afternoon or after a workout is best. A light and easy doorway stretch — not forced — is good in the morning to reverse overnight sleeping posture, but your thoracic spine and rib cage aren’t ready for this radical stretch before warming up to the day.

After resting with the arms overhead for awhile, has one side settled onto the floor with the other side still lifted? Try shifting the hip of the lifted side. Did the shoulder just flatten? Triple bingo going on here: Go back and read up on the troubles of hip rotation.

It’s remarkable, really. And it may be the answer to the last of your shoulder distress.

*****

Late edit: I’ve had a few private notes about this from people who were amazed at how this worked for them. However, one person pushed too hard and tweaked his shoulder, so let me bring up two more points.

Relax into this; don’t push it. The point is to wait long enough to allow your body to relax. You can’t make that happen… you have to be patient enough to lay there until it happens.

Which brings up point two: This may take days, weeks even. Dave’s doing this, and his hands overhead are nearly a foot off the floor behind him. Seriously… no, I’m not exaggerating. No amount of forcing is going to loosen up his upper torso. He’s going to have to wait it out, and so might you.


What is Hip Rotation?

We’ve been talking about corrective exercises a lot, and many readers don’t really know what this means and how it might apply to them. Let’s take a closer look at one common habit to demonstrate how a simple twist can expand up and down the body.

Think about how often you stand on one leg. Most of us do it regularly throughout the day, and it’s somewhat likely it’s causing a problem that starts at the hip and reverberates from there.

Get up from your chair. Seriously, stand up. You’ll have to feel this to catch the meaning.

From a standing position, shift your weight to the right leg. Go ahead and rest your weight to the side as you’d normally do. Does your left hip drop down and your right hip jut out?

Re-center yourself and put the palm of your right hand on the front of your right hip. Shift back to the right side, only this time slow it down. Do you feel how your hip actually turns?

What has just happened is your right hip rotated inward, moving the weight of your body off the muscles of your full leg and onto the weaker muscles above the back of the hip and at the outside of the leg. Over time, this common habit is causing both tightness and weaknesses that are not natural.

Next, still with your weight on the right leg, purposefully bring your hip around so it’s facing the front, which is its correct position. Do you see how hard that is to do, and to hold there? Those are the tightness and weakness issues keeping your hip from its natural placement. Interesting, isn’t it?

We’ve seen the problem at the hip and realize we’re reinforcing that bad position numerous times each day. You next question may be, “What’s the big rip?”. What’s the difference if the hip rotates inward?

Go back to the original side stance, the weight resting fully on your right side with the hip jutted to the right. Look down at your knee (you may have to drop your pants for this one; hope you’re not at the office). Is it still facing forward, the healthy way it should be? Nope, probably not – how could it be? You have knee pain? Stop and read this again, slowly; you’re onto something important.

No wait, let’s look a little further: The ankle’s messed up, too, isn’t it? The knee is turned in, so the weight on the ankle is toward the outside. And there’s pressure on your heel instead of having your weight balanced on your entire foot, am I right?

Just for kicks, check out the left side by shifting your weight over there. Is it as bad as the right?

You’ve just seen how our bad standing habits, our postures, have a ripple affect down the body. Over time, this puts strain on the joints, connective tissue and muscles causing the joints to become less mobile in an attempt to protect the body, causing arthritis due to excessive pressure in unnatural positions, causing muscle tightness and vulnerability at crucial points, all leading to a list of easily fixable pain that can last a lifetime.

And that can be prevented if you’re willing to recognize that Dave and his peers were wrong about one thing: There actually is a little more to this than just hitting the iron, and in this case, those science guys really are onto something.

We talk about this and more in the movement patterns section of the forum. This stuff is important, and I’m so thrilled it’s becoming part of the mainstream fitness discussion.


This week’s top weight training discussions

Time and time again, our IOL forum discussions entertain while they educate. I can’t begin to measure all I’ve learned from my friends there, nor count the times they’ve had me giggling at my desk. Let’s take a look at some of this week’s top conversations.

Here’s a guy who’s been training for 25 years and is thinking of quitting the weight room because of back pain. The forum members gather around with re-building suggestions that most readers would do well to practice.

Over here, Andy asked for clarification on central nervous system burnout. We’ll see some interesting comments, with a real zinger from Keith Wassung that makes clear the whole CNS question.

Ever wonder why anyone would stand on a stability ball? Let alone try to do loaded squats on one? Byron begins the discussion on balance work.

Every guy I know walks around the gym rubbing his shoulders (fewer women do this, because most of us aren’t as stupid about bench pressing). John Izzo contributes his 7-phase approach to protecting the shoulders, and a good group chime in with questions and additions on this important subject.

Wondering about Smith Press or barbell, behind the neck or in front, a member from the UK asks for views on shoulder pressing.

When would you choose a full body workout; when is a split routine better? The pros and cons of both are discussed in this thread.

In the IOL Co-op Training Log this month, Dan Manor leads a team through a fat-loss quest during April. There’ll be plenty to read in here this month, me thinks.

Spend a little time clicking around the 16,152 topics. There’s a lot to learn, and we promise some grins along the way. With 422,277 posts, however, it make take you a bit to catch up. How’s the weekend looking?