IOL Strength and Conditioning

After a particularly involved corrective exercise discussion in the forum, or via email after a blog post on recovering joint mobility, queries pop up about how to find local help with fixable dysfunctions. The desperation is understandable: Can’t someone just tell me what to do so I don’t have to study a bunch of anatomy?

At this point in the fitness and wellness industry, it’s almost an impossible question. If you get yourself in the right hands, anyone from a personal trainer, a physical therapist, a chiropractor, a physiatrist, Feldenkrais practitioner or Rolfer can sort out a live person in about an hour. In allopathic medicine, it would be the physiatrist, but they mostly work with patients in pain; I’m not sure what the response would be if you showed up with no symptoms, wanting to know how to fix your problems.

The thing is, finding the right person is real iffy, pretty doubtful, in fact. In the next few years, more and more people will be practicing using these assessment techniques, but we’re just not there yet. And, of course, each body is incredibly complex, so a person without a good deal of experience will have the basics, but the more subtle structural issues may go unnoticed. It really takes a good eye, a lot of opportunity to look at people, and a lot of patience to carry them through the trial and error process as they learn their craft.

For that reason, my first recommendation for a reader looking for local assistance would be Rolfing, because their regime is a systematic, ten-session, bottom-up process that covers the entire body, including the deeper parts we don’t usually think about. By the time the ten weeks are over, the fascia that contributes to holding things like feet tilted or arches dropped, hips twisted or tilted, abdominals tight, neck stretched, etc etc etc, has all been loosened, and the recipient has been retrained out of his or her faulty postural habits. For now, Rolfing is my initial recommendation for a full-body makeover when a local specialist isn’t a sure thing; if you can find a KMI-trained practitioner, so much the better — this is structural integrity similar to Rolfing, but with two extra sessions, all twelve based on the body’s myofascial slings.

But Rolfing takes a ten-week commitment, and the work is paid out of pocket. Shifting a 40- or 50-year-old back to feeling like 20 is priceless, and hopefully some readers and forum members will decide to go that route in the months and years to come.

A cheaper and shorter-term option is a near-local practitioner. How about this? Find a corrective exercise expert within driving distance; head down the road and make a long weekend of it. For a reasonable fee to cover a couple hours’ time, you could walk away with your current dysfunction evaluation and list of the exact exercises and stretches that will convert your ailing body from aching to fully functional. A couple months of dedicated effort and you’ll feel reborn.

Here are the options on my current list. I’ll update it from time to time as I discover more corrective exercise specialists. Feel free to drop me your name and link if you work with individuals with assessments and corrective exercise programs, or if you have suggestion for this list. I’m at ldraper@davedraper.com.

Find a local Rolfer

Find a local KMI-certified practitioner

Find a local Feldenkrais practitioner

Dr. Eric Cobb has trained practitioners in Z-health, right up our alley.

Pete Egoscue has a few clinics where they also do this work.

Paul Chek has trained practitioners in corrective exercise.

Gray Cook and Lee Burton have a program to train personal trainers and physical therapists in screening; find a certified Functional Movement Screen specialist.

Another option: MAPS Certified Orthopedic Manual Therapists, a program developed by Australian physiotherapist Geoffrey Maitland, who appears to be expanding upon Rolfing practices similar to Tom Myers’ KMI stuff, combined with joint mobilization.

If you’re shopping for a personal trainer in the phone book, the National Academy of Sports Medicine (NASM) has an advanced specialization for corrective exercise. It appears they offer no online directory, however the initials the trainers will use is NASM-CES.
By state:

Alaska:
Juneau, AK, Corey Pavitt, D.C. at Pavitt Health and Fitness

Arizona:
Scottsdale, AZ, Josh Henkin at Innovative Fitness
Chandler, AZ, Keats Snideman

California:
Santa Cruz, CA, Suzie Lundgren
San Diego, CA, Anthony Carey at Function First
San Diego, CA, Justin Price at The BioMechanics
San Diego, CA, Todd Durkin’s team at Fitness Quest 10
San Diego, CA, Jason Karp
Santa Clarita, Alwyn or Rachel Cosgrove at Results Fitness
Montrose, CA, Lenny Parracino
Danville, CA, Clay Hyght, D.C.
Santa Monica, CA, Core Performance Center specialist
Santa Rosa, CA, Lana Pacheco
Venice, CA, Howard Skora

Colorado:
Greenwood Village, CO, Greg Roskopf does similar work with his Muscle Activation Techniques

Connecticut:
Hartford, CT, John Izzo

Florida:
Orlando, FL, Chuck Wolf at Human Motion Associates
Tampa, FL, Brad Kaczmarski

Illinois:
Evanston, IL, Evan Osar

Indiana:
Indianapolis, IN, Bill Hartman or Mike Robertson
Also in Indianapolis, Robb Rogers’ group at St. Vincent’s Performance Center

Louisiana:
Mandeville, LA, Charlie Hoolihan at the Pelican Athletic Club

Maryland:
Baltimore, MD, Nick Tumminello

Massachusetts:
Winchester, MA, one of Mike Boyle’s trainers at MBSC
Hudson, MA, Eric Cressey and his guys at Cressey Performance
Woburn, MA, Aaron Brooks of Perfect Postures
Boston, MA, Peter McCall
Natick, MA, Eric Beard

Michigan:
Adrian MI, Gary Gray’s team at the Gray Institute
Gary Gray is at the forefront of this industry and has provided much of the training used by others in the corrective exercise and performance fields.

Minnesota:
Woodbury, MN, Brad Nelson
White Bear Lake, MN, Mike Nelson

Missouri:
St. Louis, MO, Tracy Fober at IronMaven

New Jersey:
Fair Lawn, NJ, Martin Rooney at Parisi School
Montville, NJ, Eric D’Agati at One Human Performance
Freehold, NJ, Charlie Weingroff at CentraState Sports Performance
Manasquan, NJ, Jon Messner
New York:
New York, NY, Ming Chew
White Plains, NY, Anthony Renna at FiveIronFitness
Manhattan, NY, Chris McGrath

Brooklyn, NY, Annette Lang
North Carolina:
Raleigh, NC, Tom Dalonzo-Baker and his crew at Total Motion Release

Oregon:
Newberg, OR, Dewey Nielsen at IPT

Pennsylvania:
Pittsburgh, PA, Brett Jones
Yardley, PA, Kareem F. Samhouri
Shenandoah, PA, Tom Deebel, D.C.

Texas:
Austin, TX, Andy Twellman
Austin, TX, Diane Vives
Austin, TX, Adam Davila
Houston, TX, Paul Yost

Virginia:
Danville, VA, Gray Cook or Lee Burton

Washington:
Seattle, WA, Tim Vagen

Wisconsin:
Madison, WI, Jon Hinds
Germantown, WI, Dave Schmitz

Canada:
Mississauga, Ontario, Jim Reeves

There are hundreds, possibly even thousands of qualified corrective exercise specialists who aren’t on this list. If your trainer is missing, please do not consider this a comment on his or her work. In fact, if you’re getting good guidance on fixing dysfunctioning joints from a specialist not on the list, please drop me an email with his or her name and a link.

A couple of recent conversations with friends made it clear my “How to Get Hip Mobility” post a few weeks ago was interesting, but still too advanced for a beginner at joint mobility. Let’s try this again from a remedial point of view and see if we can’t get a few more hips in motion. Before we get started, those truly interested in getting this mobility job done should first re-read the original post (link above); there are important points in it that won’t be repeated here.

What we’re doing involves a little bit of stretching of tightness, a little bit of strengthening of weakness and a whole lot of neural reprogramming, that brain-to-muscle connection that gets shorted out the longer the area has been locked down. Be it from the trauma of a sports injury, car accident or simply lack of use, as the joint gets less motion, the brain learns to work around it to get the job done another way. A big part of a joint mobility program is to renew lost neural pathways, and sometimes this works fast and feels miraculous. I pray for one of those AHA moments for you this week, because just one is enough to keep you in the hunt.

The biggest problem you’ll probably have — the biggest problem I had and what seems to be most troublesome for Dave — is making the movement smaller, slower. Where neural learning happens is in the small, slight movements, particularly at the beginning of the action. Yet as weight trainers we have a need to push harder, to make something happen, and instead of getting something new, we fall back into habitual, prime-mover action and nothing is gained.

When you settle down into smaller movements, you’ll get frustrated, annoyed. If you stick with it, you’ll notice the motion smoothing out in the tiny subtle beginning of the movement. A movement that originally was jerky and amplified your feeling of klutziness soon becomes effortless. Once you feel that a single time, the imagery will carry you through the rest of the beginner joint mobility frustration, sort of how a nice golf swing brings you back for more misery.

Here are four hip mobility exercises to get you started. Practice these daily for two weeks, then you’ll be ready to move over to the other exercises on the hip mobility menu to address the muscles surrounding the pelvic structure.

What I most want to get across is to simply do the movements — don’t try to understand why they’re suggested, don’t pay any attention to knowing the anatomy… just move the joints. The movement of the hip joints will probably be short and stunted and unfulfilling. Do them anyway, daily for two weeks, and I promise you the difference between day one and day 14 will explain everything you need to know.

Tabletop stretch:
Stand about torso length from the kitchen table or countertop. Bend at the hips, knees straight but not hyperextended, and put your hands on the table surface. Move your feet as needed to achieve a comfortable bend at the hip joints and a long torso stretch. Hold the stretch for a minute.

Kneeling hip flexor stretch:
Kneel on one knee, putting your knee farther back than a normal straight-to-the-floor position. The other foot will be in front of the forward knee, and the torso will be straight. Once in this position, you’ll quickly feel the stretch in the hip flexor region of the kneeling side… you know where we’re going with this. If the hips are extremely tight, this is the final position for now; build up to a 30-second hold on each side. If that position isn’t difficult, increase the stretch by lifting the arm on the knee-down side. From there, should that not be enough of a stretch, shift your overhead arm toward the opposite side.

Side-lying hip flexion/extension:
Lying on your side, bend both legs as if sitting, but with the top leg a bit farther behind. Grab the ankle of the top leg with the same-side hand, stretch the quad lightly, then move the leg forward and back in a small, smooth motion. Make this as effortless as possible, with the leg loosely swinging. Rest whenever you need to, and after one of those rests move the leg up and down so the knee moves closer and farther from the floor. Repeat the sequence on both sides, at least 20 reps of each, but more if you have time.

Standing femur circles:
Stand tall; stick one leg across the body to the opposite side and make small circles with the foot outstretched to the side, then reverse direction. Move the foot to the front and repeat; shift the foot to the outside and repeat; continue to the back and repeat the circles on both directions. Change legs and do it all again. Remember, these are femur circles — you’re moving the top of the leg bone in circles around the inside of the hip socket; you’re not circling the knee or ankle, the knee and foot are just going along for the ride. As you begin, the circles will be small and the hip will fatigue quickly. Happily, these small muscles strengthen fast.

Now it’s time to move on to the full hip mobility program.

One last thing: You don’t need to understand this for it to work. Let the doing happen now; the understanding can come later.

You’re not going to believe this: I found another four pages of notes from Chuck Wolf’s IDEA presentations in Las Vegas. If you’re just arriving, you can catch up here at part one and here at part two. We’re going back to bullet points because of the volume. When you bump into a statement that catches your attention, a simple google search will fill in the gaps.

I mentioned earlier Chuck hammered his priority of training in multiple planes of motion, and nowhere was it more evident than during his discussion of the functional spine. You’ll see that throughout the following thoughts, a bunch of gems comin’ up.

1) Walking – gait – occurs in all three planes of motion. The hips move in the sagittal plane to propel you forward, in the frontal plane as you move from side to side (weight moving from one leg to the other) and on the transverse plane as the hips rotate. If there’s a problem on any plane, there’s a problem in the gait.

2) To help sort out the cause of and solution to chronic back pain, consider first in what plane of motion the pain occurs, bending forward and back, side to side or rotational.

3) In your back stabilization exercises, include something in all three planes. Front planks are great, but they’re not enough.

4) The proprioceptors that tell the brain where we are in space work when the muscles are lengthened, and don’t work when they’re shortened. Bent-forward walking, such as often seen in older adults, shortens the muscles, causing poor proprioception… that is, bad balance, increasing the chance of falling.

5) 80% of non-impact injuries occur due to lack of control in the transverse plane. In your program design, include rotational work, and do it before your linear training.

6) Calves turn on the abdominals during gait; they’re the neural switch. Inactive calves or the feet not fully involved means weak abdominal action.

7) With excessive kyphosis, look for posterior hip tilt and fix that before working on the kyphosis. Stretching the pecs and strengthening the back won’t work until the hip tilt is addressed.

8) The lumbar spine is controlled in large part by the psoas and the adductors. Make sure the psoas and adductor length and strength matches right side to left.

9) You need good hip extension in order to have good back extension.

10) If you lose thoracic spine extension, it’s hard to rotate.

11) Sciatic nerve pain can be caused by a pinch in the lumbar spine or glute weakness, inactive glute and tight piriformis. If relief is provided by reaching one arm overhead, start at the chiropractor for attention to the lumbar spine. Otherwise, roll the piriformis over a tennis ball (remember, the knee must be bent to access the piriformis), and work glute strength and activation.

12) Strengthen foot musculature to provide relief of piriformis problems and sciatica.

13) Your isolated stability exercises (planks, bird dogs, etc) should be done first, before moving to integrated movement patterns.

14) Chronic muscle tightness is a sign something is wrong. If it keeps happening, you have to figure out why. Muscles tighten up in response to instability at a joint.

15) Since mobility without stability creates a vulnerability, the body tightens up in protection. This means we have to strengthen opposing muscles in order to gain nearby flexibility, for example strengthening the hip flexors to loosen the hamstrings.

I triple-checked: This wraps up my notes from Chuck’s IDEA presentations. Now that we’re done with the notes, I’m ready to go back for more. Three tremendous seminars, outstanding stuff.

We’re going to stall a little longer on Chuck Wolf’s IDEA presentations because when writing last week’s post, I forgot I’d made notes all over his handout sheets, and I’d forgotten how brilliant his handouts were under all my scribbles. We’re going back to the bullet format for more tips, any one of which might strike a nerve down one of your aching bodyparts.

1) Tight muscles are weak muscles. When muscles weaken, they get tight. Think strengthen before moving directly to the instinctive stretching.

2) Tight hip flexors or adductors cause anterior pelvic tilt. This in turn will lengthen the abdominals, causing suboptimal abdominal loading, leading to a loss of force production as the spine cannot fully extend.

3) Adequate range of motion is required in the foot, ankle, hip, pelvis and thoracic spine in order for the abdominals to fire.

4) Don’t neglect stretching and strengthening the feet and toes. Most of us have chronic tightness in the muscles of the feet. When this happens, the feet lost the ability to absorb force, causing trauma, torque on the joints and reduced propulsion.

5) Tightness in the forefoot, calves or hips will shorten the stride length.

6) Stretch your hip flexors and same-side calf at the same time, not separately. You want them both equally flexible.

7) Drop conventional rubber tubing shoulder rehab. The range of motion is limited; it disassociates the humerus from the scapula; it doesn’t involve the lower extremities; and the scapula doesn’t clear, creating a bony barrier.

8) Where the pelvis goes, the low back will follow.

9) Abdominal region function: decelerates spinal extension, lateral flexion and rotation; decelerates anterior pelvic tilt.

10) Abdominal region action during gait: decelerates pelvic motion, decelerates shoulder motion, lengthens to create elastic energy.

11) At the ankles during gait, eccentric loading (calcaneal eversion, dorsiflexion, tibial internal rotation and forefoot abduction) must occur maximally to recruit glutes.

12) The segments of the spinal regions (lumbar, thoracic and cervical) all have a different degree of range of motion, with the lumbar spine having the least. This is the reason modern corrective authors suggest limiting our lumbar rotation, and why most have removed exercises such as the scorpion from their line-up.

13) In gait, as the foot hits the floor on loading, it goes into pronation. It’s loading, stretching, absorbing and decelerating eccentric action. As it begins the unloading, it shifts into supination as it shortens, propels and accelerates in concentric action.

14) In standing, reaching overhead will create a neutral foot with no pronation or supination, increasing quad involvement and decreasing glute recruitment. In single-leg standing, reaching to the same side will put the foot into supination; reaching to the opposite side will force pronation. If you have a problem getting your foot into one of these positions, practice the appropriate side reach.

15) Check your feet for calluses. If you have calluses from other than an ill-fitting shoe, you probably have a faulty walking pattern. A heavily callused heel with a smooth forefoot indicates a heel doing all the work; a callus on the bottom of the foot, on the big toe, at the metatarsals or on the outside of the foot indicates a deficiency in the way the foot hits the ground. Use the calluses as a guide to correct your gait or, farther up, how your hips are moving.

Bonus: In every session Chuck hammered single-leg balance and lunges with a variety of reaches: overhead, side (high, even and low) rotational from the hip, low reaches. Over and over he had us doing medicine ball lunge reaches. Tri-planar action is his number one gig, same deal with Fraser Quelch. There must be something to this, something we should stop and consider.

This is a guy who wants us all to have this information and who loves to teach. Many thanks to Chuck for the stellar presentations.

Want a little more? Here’s part three.

Five hours with Chuck Wolf covering function, assessment and program design for the shoulder, foot and spine left me with a pile of notes to ponder and thoughts to share. Rather than do a lousy job of explaining in a blog post material that requires book-length copy, photographs and hands-on demonstration, I’ll compile what were the most remarkable tidbits for easier sharing. From one-liners to longer, here are some of Chuck’s finest mindbenders.

1) When looking at shoulders in terms of the joint mobility/stability stack, we need to split up the shoulder girdle because the scapula requires mobility, while the shoulder joint requires stability.

2) Muscles are stabilizers first, then movers.

3) Proprioceptors are triggered when the muscles are lengthened.

4) All muscles, all joints work on all three planes of motion, including the foot.

5) If you can’t get good dorsiflexion of the foot, you won’t get good knee flexion.

6) Aside of a traumatic injury, the site of an injury is usually not the problem. Check the joint above or below.

7) The glute on the side with the least ankle mobility will be the less active one. Ditto low toe mobility.

8) The leg press uses little glute action because there’s no foot or ankle function.

9) If you have a problem putting your heel in a pronated position (reverse heel guarding), you can force the action by standing on that foot and reaching out in a side reach with the opposite hand. Same side reach will bring a heel from pronated to supinated.

10) Arms overhead will trigger a more neutral position of the foot.

11) If you have a tight calf, work subtalar joint mobility to loosen the calf and regain ankle mobility.

12) Your toes need exercise, too. In particular, the big toe needs good dorsiflexion.

13) If you’re pigeon-toed, your problem begins at the hip.

14) With pronated or supinated feet, if it’s a structural issue (including stretching of the ligaments), orthotics are needed permanently. If it’s a functional issue, it can be fixed: Change shoes; increase foot and ankle mobility; increase big toe mobility and correct walking pattern. Even if orthotics are required, plan on lifetime exercises to strengthen the ankles, feet and toes.
15) Don’t talk on the phone when walking. It messes up joint rotation and core activation head to toe.

16) A shoulder injury effects movement action from the top down. No body movement is normal when a shoulder injury is present, including walking or running.
17) If your stride length is shorter one side to the other, it indicates a tight hip on the opposite side.

18) To test single-leg internal hip rotation, stand with the big toe of the test leg down on the floor. Move the loose foot around the toe to test. Go slowly so you can pay attention to the first point of tightness in order to target the best correction.

19) If you lose frontal plane motion, you lose rotation, and lose glute function.

20) Joggers and bikers have tight hips in the frontal plane and need work to open up the hips. These people need transverse plane programs, and no sagittal plane exercises.

21) Tight IT bands do not need to be stretched more. Instead, you need to identify the cause. Excessive anterior tilt? Weakened, shortened glutes, tight hamstrings? Fix the tilt, fix the foot to activate the glutes, train the transverse plane and a life-long IT band problem could be cleared up in a couple weeks.

22) When you stretch, don’t stretch the muscles, stretch the fascia – the myofascial slings. Think fascia when stretching.

23) With plantar fasciitis, look for a tight, weak glute(s) and tight hip(s), and work to fix them. Work on calf flexibility and ankle mobility on all three planes; stretch and massage entire foot to loosen. Massage toward the heel, not away.

Bonus: In the lateral (side) lunge, don’t bend forward at the hips. Keep the toe, knee and hips lined up to work the glutes. Memory trick: Stack nose, knees, toes.

Ready for more? Here’s part two.