<![CDATA[FROM THE GROUND UP - Blog]]>Sat, 17 Feb 2018 01:30:45 -0500Weebly<![CDATA[Exercise "Thought Viruses" That Must Stop]]>Wed, 17 Jan 2018 10:05:45 GMThttp://andrewmillettpt.com/blog/exercise-thought-viruses-that-must-stopExercise and training are wonderful things.  It is great to see people moving and trying to better themselves.

There are certain claims or ideas that are out there that are still being perpetuated by either professionals and/or people who may not know otherwise.  Everyone is entitled to their beliefs, but today’s post is here to discuss why certain “thought viruses” must stop in order to help move the professions of physical therapy, strength and conditioning, and performance forward.

Exercise Thought Virus #1: Don’t Let Your Knees Go Over Your Toes When You Squat
I don’t know about you, but it is pretty hard not to let your knees go over your toes when you squat.  This idea has been around for a long time and was most likely perpetuated with a study about the increase in patello-femoral forces with anterior (forward) tibial translation.

If increasing tibial translation aggravates a client or athlete, find another way to load that person without increasing their symptoms.  But, in order to squat effectively with proper form and depth, the knees need to migrate forward.

In the case of a box squat,

There is very little to if any anterior tibial translation.  This would be the only instance I can think of where there is no forward translation.  In order not to fall backwards, the knees must move forward in order to counteract the weight shift posteriorly with squatting.
There are studies stating that squatting and allowing the knees to go forward is not detrimental to knee health.  As long as someone can squat pain-free and with good technique, the knees should relatively be allowed to go over the toes.  

Exercise Thought Virus #2: Strength Training Makes You Lose Flexibility

I don’t remember how long this one has been around for.  Coaches years ago would claim that if you lifted weights, you became big and bulky and in turn would lose flexibility.  The research has shown that someone’s flexibility is not hindered by someone lifting weights.

For the first 24-48 hours that DOMS (Delayed Onset Muscle Soreness) is occurring, someone may “lose” flexibility temporarily, but it is not permanent.

Many clinicians and coaches have spoken about the benefits of strength training for improving mobility.

Performing movements that consist of slow eccentric isometrics such as:

Slow Eccentric Reverse Lunges

Slow Eccentric Goblet Squats
Slow Eccentric Single Leg Deadlifts



Slow Eccentric 1-arm DB Bench
and many more can all help to improve mobility.  With any of those slow eccentric movements, a pause should be incorporated at the bottom position to include the isometric portion of the lift.

Exercise Thought Virus #3: Self-Myofascial Release(SMR)/Stretching Fixes All Mobility Problems
This is still a discussion point in the rehab and performance worlds.  There is one side of the debate that thinks stretching and SMR does not work whatsoever and the other side of the debate believes that is the best thing to implement into any program.

Like with most things…

IT DEPENDS.

SMR and stretching has it’s place in an athlete’s program.  It can be a great tool to improve soft tissue tone in problematic areas.  The idea that a foam roller or stretching is physically lengthening a muscle has been debated and the research has found that there is no actual tissue length changes occurring.  

What is believed to be happening is that SMR and/or stretching is neuromodulating tone at the level of the Central Nervous System (CNS).  With that being said, SMR and/or stretching can be a way to decrease tone in certain areas to allow for improved mobility and improved lifting and performance.

So, a well-rounded program should not just consist of SMR and/or stretching.  It should consist of SMR, mobility work, motor control drills, and strength training.  Consistent strength training when coupled with the other aforementioned parts can be a great way to maintain/improve mobility.

As mentioned before, there are countless movements that can incorporate slow eccentric isometrics to help teach the CNS to be able to control any “new” mobility so that it can be maintained.

Exercise Thought Virus #4: 3 sets x 10 reps

I’m not sure where the idea of 3 sets x 10 reps came from, but I figured it was an easy way to train clients and athletes and just tell them to do 3 sets x 10 reps for each exercise.  Think about it, do 3 sets x 10 reps of x weight and when that becomes too easy, go up in weight and do 3 more sets x 10 reps.

The problem is that this has continued and still continues to this day in the rehab and performance worlds.

Don’t get me wrong.  Athletes and clients can make gains and improvements in strength and muscular endurance with this method.  If someone is very weak or recovering from a surgery, there is nothing inherently wrong with this method.  Things with eventually plateau though.  You can only continue to progress linearly until changes need to be made in regards to reps, sets, weight, etc.

As professions, we need to elevate ourselves away from the 3 x 10 mindset.  We need to program intelligently for our athletes and clients and incorporate variations in reps, sets, weight, rest breaks, etc.  I wrote a post awhile back entitled, “An End to 3 Sets x 10 reps.”  Check it out here.  In that blog post, I delve into ways to program for training and ways to get away from the 3 sets x 10 reps mindset.

Exercise Thought Virus #5:  Theraband/Pink Dumbbells Are All That You Need

If you plan on training and/or treating athletes or clients who wish to get back to an athletic lifestyle, you are going to need more than theraband and pink dumbbells.  If you have someone that comes in and they can back squat 300-400 lbs or overhead snatch a significant amount of weight, you are going to need the equipment to help rehab and train them to get back to that.

To piggyback on my previous point, there is nothing wrong with pink dumbbells and theraband.  I use theraband or similar implements with some of my clients...when indicated!  Someone coming off a surgery or are flared up from a recent exacerbation, these tools may be needed.

Eventually, clients need to be loaded!  Whether it be with barbells, kettlebells, dumbbells, the body is resilient and in order to improve that resiliency, it needs to be challenged and loaded to withstand the demands of life and sport.
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<![CDATA[5 Tips to Improve Low Back Pain]]>Thu, 11 Jan 2018 00:00:00 GMThttp://andrewmillettpt.com/blog/5-tips-to-improve-low-back-painEighty percent of people will experience low back pain at least once in their lifetime.  That’s huge!  Whether you are an athlete or someone who exercises to stay in shape, low back pain has been considered an epidemic.

There are many causes to low back pain and this is probably one of the reasons why so many people experience it at some point in their life.  Pain, specifically low back pain, is multi-factorial.  

The purpose of this post is not to claim that there is one way to fix low back pain or to help people with low back pain. Consider it more of a way to help others to optimize their life, to decrease the chances of experiencing low back pain in their life, and/or recovering from low back pain quicker.

1. Move

As a society, not enough people move.  Sitting has been considered the new smoking.  I’d go a step further and say that “Not Moving is the New Smoking”.  Whether you sit all day at work, stand all day, lay down, whatever the case may be, the body likes to move.  Therefore, we should do that throughout the day.

Now, I’m not saying that you need to be moving 24/7.  That is not feasible.  But, change positions frequently.  Sit down for 30-minutes then switch to ½ kneeling or standing and vary the positions for your body throughout the day.

Anecdotally, I’ve found that if I move more throughout the day, my back and the rest of my body feels a whole lot better.

2. Optimize Mobility

There are people out there who are stiffer than a board and don’t have low back pain and there are those who are more flexible than Gumby and have low back pain.

photo credit: hallmark.com
Photo credit: hallmark.com
The point here is that whether you have no mobility or too much than you can handle, lack of mobility in certain areas of the body can predispose someone to an increased chance for low back pain.

Areas where limited mobility can affect the low back are the hips and the thoracic spine.

Photo credit: en.wikipedia.org
Studies have shown that lack of hip internal rotation mobility has a direct correlation on the incidence of low back pain, especially in rotational athletes.  If you can’t move rotate through the thoracic spine and/or hips, the one common area between those two is the low back and this is where the body is potentially going to compensate for that lack of mobility.

Drills to optimize thoracic spine mobility are:

Bench T-Spine Mobilizations

Sidelying Rib Roll


A-Frame Thoracic Spine Mobilization


Drills to optimize hip mobility are:

½ kneeling Couch and Hip Flexor Stretches

Quadruped Hip ER Mobilization
There are a multitude of other mobility drills to help improve hip and thoracic spine mobility.  Working on a few can help hip and t-spine mobility and help to decrease stress on the back.

3. Core Stability AND Strength

Through my experiences, I have found that the body needs both stability AND strength.  These 2 terms sometimes get lumped together to mean the same thing, but they aren’t.

Stability is “controlled mobility” as termed by Sue Falsone.  It has to do with muscle timing, coordination, and precision.  It isn’t about brute strength.  It is about being able to control a certain position.  Stability typically only requires about 20-25% of a muscle’s maximal voluntary contraction.  With that being said, it doesn’t require a lot of muscular effort.

Strength is the ability to exert a certain amount of force.  Whether it be holding a certain position with maximal force or lifting something from point A to point B, strength tends to run above 25% of a muscle’s maximal voluntary contraction.

The body needs both.  It needs the precision to control certain positions as well as brute strength to resist forces that life throws at it.

Different core stability drills are:

Bird Dogs

½ Kneeling Chops

Prone Superman’s
Different core strengthening drills are:

Stability Ball Rollouts

Anti-Rotation Press

Suitcase Carries
Incorporating both stability and strengthening drills into your training or exercise program can be an effective way to help decrease your chances of experiencing low back pain.

4. Exercise Technique

We can sit here and debate that exercise technique doesn’t matter.  There are some people who think that you can deadlift with a round back, round your back or hyperextend your back in a squat, etc. and you can repeatedly do this over time and be ok.

There is another school of thought that you must have perfect technique all day, every day, whether you are in the gym squatting or deadlifting or picking up a pencil off the floor.

The answer typically lies somewhere in the middle.

Good technique is a spectrum.  It is going to vary from person to person based off body type.  Maintaining good technique when you train or exercise is important.  I will never tell someone that lifting with poor technique is ok.  

There are some people that can deadlift with some rounding in their low back, etc. and are totally fine.  This is one person.  This rule should not be applied to everyone.  A good overarching theme is to train with good technique.  With that being said, if you have a rep or two that aren’t “pretty”, your back will not explode.

This leads to my next point.  You do not have to have perfect technique 24/7.  You are going to have reps when you lift that don’t look as good as others.  This happens to everyone!  The key is to train with good technique most of the time.

On the flip side, when you are living your life, you do not have to have a perfectly neutral spine all day every day.  Not allowing your back to move through flexion, extension, rotation, and lateral flexion during everyday life is no way to live either.

If you need to lift up a heavy bag of something, use good technique and lift it off the ground.  But, if you have to pick up a pencil or a piece of paper from the floor, just bend down and pick it up.  Training your back to never move is just as bad, if not worse than training with poor technique.

A good way to think of this is that if you are loading your body, ie. whether it be with weights in the gym or something heavy in real life, use good technique and lift it.

If you are going to pick up something simple that you dropped on the floor, don’t think about it, just go down and pick it up.

5.  Listen to Your Body

Last, but not least, is listen to your body.  This is one that many people don’t do and is one of the most important.

This can come in the form of having some pain/discomfort and just completely trying to push through it OR having a slight amount of pain/discomfort and completely shutting down all activity.

Each scenario is not ideal.  For the 1st scenario, blindly pushing through pain is not a good idea.  It’s your body’s way of telling you to adjust or change something.  Pain does not always mean there is something structurally damaged.  But, it is your body’s way of trying to tell you something so you can fix the situation.

For the 2nd scenario, this can cause some people to not want to move at all if they feel a slight tweak/twinge/pain/discomfort.  This can be “paralyzing” and cause people to avoid and type of movement.  

In either of these cases, dial back the intensity, check your form on an exercise, try a different movement, etc.  The options are endless.  Listen to your body and make adjustments accordingly.  Not everyone is made to lift the same way or do the same exercise as everyone else.  Either make an adjustment yourself or ask a professional to find the exercise or movement that is right for you.

There you have it!  This was not an all encompassing list of ways to get rid of back pain.  Back pain is one of the biggest epidemics in the world today.  These 5 tips were just that, tips, to help you move and feel better and try to help reduce your chances of having back pain or to help you get rid of it faster.

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<![CDATA[2 "Must-Haves" to Train Overhead]]>Mon, 18 Dec 2017 10:34:24 GMThttp://andrewmillettpt.com/blog/2-must-haves-to-train-overheadLifting and training overhead is cool!  Being able to lift heavy from the ground or overhead is a sign of brute strength.

Many people get in trouble when they lift overhead because they may lack the mobility or stability to get into the proper positions.

Here are 2 “Must Have” pre-requisites in order to be able to train overhead.

1. Full Shoulder Flexion

If you want to lift overhead, having full shoulder mobility is a must-have!  Don’t get me wrong, there are variations that you can perform if your overhead shoulder mobility is limited.

Overhead pulling variations such as:

Tall Kneeling Batwings

Overhead Pressing variations such as:

Landmine Press

Just to name a few.

Having sufficient overhead shoulder mobility is key for performance and decreasing one’s risk for injury.

If you want to work on your mobility, the drills below can help.  If not, seek out a medical provider to help improve your overhead position.

Self-Myofascial Release

Bench T-spine Mobs


2. Sufficient Scapular Upward Rotation


Even if you have full passive shoulder mobility, your shoulders and arms still need to be able to get into an overhead position.  One common area that can limit full ACTIVE overhead shoulder mobility is the ability of the scapulae (shoulder blade) to upwardly rotate to allow for the arm to get overhead.
The arm itself will only travel so far without the scapula moving.  Either there will be limited motion or there will be an altered pattern of movement.  Typically, the scapulae will not upwardly rotate and can cause pinching on the top or front side of the shoulder.

Now, if this happens once or twice, no big deal.  But if someone is training through this and continuing to try and work through a pinch, not so good!

To assess how someone’s scapulae move, just have them reach overhead.
We like to see about 50-55 degrees of scapular upward rotation.  One quick and easy was is to see if someone has this is if the bottom angle of the scapula gets to the midline of the side of the body.  If so, sufficient scapular upward rotation.  Also, if if the medial border of the scapulae creates a 50-55 deg angle with the midline of the body/spine.

If scapular upward rotation is lacking, exercises such as:

Back to Wall Shoulder Flexion
Key Points:
-When you arms get to shoulder height, gently reach out in front of your body.
-Continue to reach as you bring your arms overhead.

Forearm Wall Slides
Key Points:
-Slide forearms up the wall.  
-When elbows get to shoulder height, think of pushing your trunk away from the wall and maintain pressure/contact with your hands as you slide up.

Yoga Push-Ups
Key Points:
-As you bring your hips up into the air, think of pushing the ground away from you.

These exercises can help to train your body and scapula to upwardly rotate when going overhead.

If you want to train overhead, make sure you have sufficient overhead mobility and scapular control.
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<![CDATA[3 Tips to Improve Glute Activation]]>Tue, 05 Dec 2017 10:06:09 GMThttp://andrewmillettpt.com/blog/3-tips-to-improve-glute-activationThe glutes aka Gluteus Maximus aka "the butt muscles" as well as the other glute muscles are very important for low back and lower extremity health and performance.  Often times, athletes and clients have a difficult time using their glutes or feeling an exercise in this particular area.

Here are 3 Tips on How to Improve Glute Activation

1. Find the Outside of Your Heel

This was a cue that I learned from Tony Bonvechio with squatting.  It is a great cue for teaching an athlete or client to keep their knees from caving in when squatting without saying “drive your knees out.”  It can be a more effective cue to put the lower body in a better position.

With that being said, the major muscles that put the lower body in a better position are the glutes.  By using the cue “find the outside of your heel when squatting” it improves activation of the glutes and the muscles that externally rotate the hips and lower legs.

If someone has difficulty with this verbal cue, you can place your hands on the outside of their heels and instruct them to push into your hands with their heels to improve their glute activation.

2.  Frog Pumps

This is a great exercise that is a variation from the typical bridge movement.  I first saw this from Bret Contreras. 
By placing the lower body in a feet together, hips externally rotated position, it puts the glutes in an advantageous position to work since they abduct and externally rotate the hips.

Then instruct the person to keep their feet together and lift their hips up like a normal bridge variation.  This can be a great way to teach someone how to activate their glutes.

If that doesn’t work, try placing a band around their knees while doing a frog pump and that can also improve glute activation as well.
3.  Exercise Selection

There are various strengthening exercises that can favor glute activation.  Anecdotally, with me, I find that doing Front Foot Elevated Reverse Lunges or Landmine Single Leg Deadlifts(SLDL) are great for working the glutes.

Front Foot Elevated Reverse Lunges

Landmine Single Leg Deadlifts
For the Front Foot Elevated Reverse Lunges, it increases the range of motion, specifically hip flexion, for the exercise.  The glutes work to extend the hip for terminal hip extension, but they are also active in a deep hip flexion position.  When you are in the bottom position of the reverse lunge, the glutes work to bring you out of that deep hip flexion position.

For the Landmine SLDL, the glutes work to extend the hip to bring you back up to a standing position, but also work to control rotation in the frontal plane.  When performing single leg work, the trunk has a propensity to want to rotate.  The glutes work to maintain a neutral spine when on one leg.

So, if you or your athletes/clients have difficulty activating their glutes, try having them incorporate frog pumps, landmine SLDL/front foot elevated reverse lunges, or “finding the outside of their heels” when squatting.

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<![CDATA[Unorthodox Core Strengthening Exercises]]>Tue, 17 Oct 2017 14:04:05 GMThttp://andrewmillettpt.com/blog/unorthodox-core-strengthening-exercisesEvery exercise you do in the gym can be considered “core strengthening.”  Whether it be deadlifts, dumbbell bench press, etc., all movements can be considered “core stability” or “core strengthening” drills.

Think of it, when you are performing a movement with your upper or lower body, you are attempting to or you are maintaining a neutral spine while moving your arms or legs.

In today’s post, we are going to discuss a bunch of “unorthodox” core strengthening exercises that you wouldn’t think would be considered that at all.

Upper Body

1-Arm Row
Whether you are doing 1-arm rowing variations on a bench or in standing with a cable  machine, the idea is to use you arm to move the weight, but also to maintain a solid core position.  By providing a solid core position, this will allow better force transmission to your arm.

The same can be said for a 1-arm Elevated or Non-Elevated Push-Up.
With the 1-arm row variation, either the weighted implement or gravity is attempting to rotate you or extend/flex you through your spine.  With the 1-arm push-up, gravity is attempting to extend and rotate you and YOU have to resist that for optimal performance of that movement.

Anytime you are incorporating 1-arm or 1-leg for a movement, it can be considered a core drill as well because when you place the weighted implement on one side of your body, it offsets you and forces you to have to control your body as compared to with 2 weights, 1 on each side of your body.

1-arm Dumbbell Bench
The 1-arm dumbbell bench is another example.  As you lower the weight towards you, the dumbbell or kettlebell is attempting to rotate you and your body towards that side.  As you press the weight away from you, you have to resist over rotating to the opposite side.

Standing 1-arm KB Bottoms Up Press
This movement can be applied for any type of 1-arm overhead press, whether it be bottoms up or down kettlebell or dumbbell.  When you press the weight overhead, you have to resist your body from bending to the opposite side as well as resist bending to the same side when bringing the weight back down.

Suitcase Carries
Since the weighted implement is on one-side of your body, you have to resist side-bending to the side the weight is on as well as resist over side-bending away from the weighted side.  Resisting of trunk rotation and trunk flexion/extension as well when you walk.

Racked Carries
Similar to the suitcase carry, but more challenging since it is further away from your Center of Gravity (COG).  The racked carry works shoulder stability as well as core stability.  You will be resisting similar movements as mentioned with the suitcase carry.

Bottoms Up Kettlebell Carries
Similar as the previous 2 movements, but will also work shoulder stability, the rotator cuff, and scapulo-thoracic musculature.

Lower Body
With lower body movements, holding a weighted implement on one side of your body will also make any lower body exercise a core exercise as well.  

Movements such as:

Single Leg Deadlifts
In this movement, you are resisting lumbo-pelvic rotation during the movement as well as flexion and extension of the spine throughout various points in the movement.  If you feel single leg deadlifts in your low back, make sure your hips are square and facing straight ahead.  

Far too often, if the hips rotate in one direction or the other, this can place increased strain on the low back.

Offset Rear Foot Elevated Split Squat
With this movement, it is mostly strengthening the forward leg with some contribution from the rear leg.  With the weight being held in the opposite hand, it is increasing stance leg muscular activity as well as forcing the athlete to have to stabilize the spine due to the weight being offset.

Landmine Single Leg Deadlift
Not as challenging as traditional single leg deadlifts, this movement will still force the athlete to have to maintain a neutral spine and use their core to optimize function for the stance leg.

Anterior Step-Ups
Even though the weight can be held at the chest or one in each hand, anytime you use one leg in a movement such as this, your core musculature has to stabilize your entire pelvis when going up onto the step as well as when going back down to the ground.

If the weight is too heavy and/or performed incorrectly, the athlete will have a tendency to tilt their body towards or away from the weight when performing.

Deadlifts
Not typically thought of as a “core stability/strengthening” exercise, the deadlift forces the athlete to have to maintain a solid core position for reducing the risk for injury as well as optimizing force transmission throughout the entire body.  With the weight being held in both hands, the athlete has to resist flexion and extension of the lumbar spine.

Squats
Similar to the discussion regarding the deadlifts, the athlete has to maintain a solid neutral spine position and resist flexion and extension at the lumbar spine throughout the movement.

Skater Squats
Whether it be skater squats off a box, to the ground, or skater squats with or without weight, the athlete has to resist the pelvis from dropping down to the ground towards the non-stance leg side.

By maintain a level pelvic position throughout the movement, this also can be considered a core exercise as it is forcing the athlete to have to avoid sidebending through the hips/pelvis in the frontal plane.

Even though you may not be doing a specific movement that is labeled “core”, basically every single movement you do in the gym can be considered core strengthening due to the need to maintain good technique at the lumbopelvic complex as well as provide a base for good force transmission for the body.
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<![CDATA[Can't Touch Your Toes? Options to Train the Posterior Chain]]>Wed, 11 Oct 2017 09:20:27 GMThttp://andrewmillettpt.com/blog/cant-touch-your-toes-options-to-train-the-posterior-chainThe deadlift is an awesome movement for developing brute strength.  It emphasizes the posterior chain consisting of the glutes, hamstrings, spinal erectors, as well as trains the upper back and abdominals.

Far too often, people think they can deadlift from the floor, but they can’t.  Whether it be a mobility, motor control, or just plain sub-par technique issue, not everyone is made to deadlift from the floor.

If you haven’t already, make sure to check out my guest post, Everyone NEEDS to Deadlift on Tony Gentilcore’s site found here.  It made Best Fitness Article of the Week and made the list for one of the Best Fitness Articles of the Year in 2016 for the Personal Trainer Development Center (PTDC).

With that being said, a quick and easy test to see if you should be deadlifting from the floor is:

Can You Touch Your Toes?
Now, before the hate e-mail and comments start flying about touching your toes is not the same as deadlifting, here me out.

I first heard of this test from the people over at Functional Movement Systems.  The Toe Touch test is not a test of hamstring flexibility or the way you should be deadlifting.

It is much more than that.

The test determines whether or not you have the ability to posteriorly weight shift.  The posterior weight shift aka the hip hinge, is imperative to be able to perform for deadlifting from the floor.

If you can’t touch your toes, here are some quick and easy drills that can improve your toe touch.

Toe Touch Progression
Key Points:
-Place towel roll between knees.
-Perform slow and controlled.
-Make sure to squeeze towel roll throughout the movement.
-Focus on pushing your hips backwards.

Leg Lowering Progression

Supine Core Activated Active Straight Leg Raise
There are also many other exercises to assist with the toe touch assessment, but these are just a few.

Now, if you performed one of those movements and now you can touch your toes, get after deadlifting from the floor, as long as you can do it with proper technique.

If your toe touch improved, but isn’t ideal OR you still can’t touch your toes, all is not lost!

There are still ways to train the posterior chain without deadlifting from the floor.

Here are a few options:

Rack Pulls

Trap Bar Deadlifts

Barbell Hip Thrusts

Glute Ham Raise



Cable Pull Thrus

Kettlebell Deadlift

Kettlebell Elevated Deadlift

Barbell Supine Bridges

Just because you can’t touch your toes and/or deadlift from the floor doesn’t mean you can’t train the hip hinge pattern.  There are a multitude of movements that you can perform to get a great training effect without placing increased risk on your body.  The toe touch assessment is a quick and easy tool to determine your starting point.
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<![CDATA[Hip Pinch with Squatting? ┬áIt May Not Be Your Hip!]]>Tue, 03 Oct 2017 09:33:47 GMThttp://andrewmillettpt.com/blog/hip-pinch-with-squatting-it-may-not-be-your-hipThe squat is a foundational movement pattern that can be useful for building strength, speed, endurance, and decreasing risk for injury.  Many times, athletes will complain of a tightness in the front of their hip at the bottom of the squat.

So, more often than not, they go and stretch their hip flexors to try to alleviate that tightness.  Then, they go and squat again, but the tightness is only temporarily relieved or there has been absolutely no change whatsoever.

Then, they keep trying to stretch it, squat through it, or try some other remedy.  

For potential reasons near the hip that may be contributing to this “pinch”, check out my guest post at Dr. John Rusin’s website, here.

You can also check to see if you have full hip flexion mobility. To do that, lie on your back and place one foot flat on the ground.  Then, bring the other knee up to your chest while keeping your back flat on the ground.
If you cannot bring your thigh to your ribs, you may be limited in your hip flexion mobility.  Even if you can and you feel the pinch in your hip, tissues may be irritated.

But, if after reading that post, you are still experiencing the same hip pinch, we need to look elsewhere.  

It may not be that hip/lumbopelvic complex is contributing to that pinching sensation.

So then, what could it be?

Well, check the ankle!

A quick and easy test to see if you have adequate ankle mobility for squatting is the Knee to Wall Ankle Mobility Test.
Key Points:
-Start with your 1st toe 4 inches away from the wall.
-Make sure not to overpronate.
-Try to touch your knee to the wall without letting your heel come off the ground.

If you can touch the wall, you have adequate ankle mobility for squatting.

If you can’t, check out my other guest post at Dr. John Rusin’s website found here .

The reason that ankle mobility is so important if a hip pinch is present is that if the ankle can’t dorsiflex adequately throughout its range of motion, another joint in the body has to move more to descend into the squat. 

Enter the hip!  If there is limited ankle dorsiflexion, the hip may have to flex more in order to get to depth in the squat.  The hip may have full mobility when assessed passively, but if the ankle is not moving properly, the hip may have to go into excessive ranges of motion.  In turn, causing a pinch in the front of the hip.

So, if you are dealing with a hip pinch with squatting, check out my guest post above, but don’t forget to make sure your limited ankle mobility isn’t beating up your hip joint.
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<![CDATA[5 Ways to Train Chest with Shoulder Pain]]>Tue, 26 Sep 2017 09:06:25 GMThttp://andrewmillettpt.com/blog/5-ways-to-train-chest-with-shoulder-painMost people will have some type of shoulder pain.  Whether it be a one time shoulder “twinge” that has come and gone or something that we are continuing to try and improve and help feel better, most of us have had something like this.

Shoulder pain can limit many things from day to day activities to activities in the gym such as bench pressing, overhead pressing, squatting, etc.

Even though you may have pain with certain movements at the gym, you are injured, but you are not dead!

Now, I am not telling you to push through shoulder pain or other types of joint pain.  But, you need to find ways when you are hurt or injured, to be able to continue to train pain-free so that you can continue to make improvements as a whole.  Not only will this improve issues elsewhere, but it will make you feel that you are still able to do something at the gym.

*Disclaimer*: If you are trying these options and still dealing with shoulder pain, seek out a licensed medical practitioner for a full evaluation.

1. Adjust Your Pull/Push Ratio


Anytime an athlete or client is dealing with shoulder pain, we typically like to adjust their push-pull ratio.  Ideally, 2:1 Pull/Push ratio is a good place to start.  If someone is dealing with shoulder pain, I recommend going to a 3:1 ratio.  

Pushing movements are usually emphasized more in the gym setting vs pulling.  This can affect the shoulder as well as other joints.  By adjusting the pull/push ratio, this can help alleviate some symptoms.

Here is an example:

If you do 3 sets x 6 reps of push-ups (pushing), you would want to do 3 different exercises of some other pulling variation such as:

Horizontal Rows (1 or 2-arm variations)

Vertical Pulling (Pull-ups, 1-arm pull-downs), etc.
By adjusting the pull/push ratio, this can help to decrease pain at the shoulder as well as improve muscular imbalances throughout the upper body.

2. Incorporate Limited Ranges of Motion

A way to train “around” shoulder pain is by shortening the ranges of motion in which you are lifting.  Instead of performing a full-range barbell or dumbbell bench press, shorten the range of motion.

Variations can include:

Barbell Floor Press

Dumbbell Floor Press

Most injuries occur at end range or the end position of a joint’s range of motion.  By limiting the range of motion of an exercise, you can decrease the strain on the joint, etc. and still get a training effect.

3. Closed Chain vs Open Chain

When we think of pushing movements, we think of bench press, etc.  Push-ups, etc. are also considered a pushing movement.  The only difference between the two is that one is closed chain (push-up) and the other is open chain (bench press).

Push-Up

Bench Press
I’m sure there is research out there, but anecdotally, I have found that people have improvement in shoulder symptoms when they perform closed chain movements as compared to open chain movements.

One potential reason behind this is the increased recruitment of the upward scapular rotator muscles (serratus anterior, lower trapezius, etc.). Also, in an closed chain exercise, the scapula is allowed to move.  Allowing the scapula to move allows for fluid movement and can minimize the chance that the humerus and the scapula run into each other.

Push-ups are often seen as “too easy.”  For those who have trouble doing them from the floor, try performing them elevated.
For those who do find them too easy, there are a multitude of ways to load them such as:

Band Resisted Push-Ups

Chain Push-Ups

The benefit of Band Resisted and Chains for push-ups is that it provides accommodating resistance.  What that means is that the resistance is not constant throughout the motion.  As you progress into the hardest portion of the movement, the resistance becomes the least challenging. Then as you progress through easier parts of the movement, the resistance increases.

4.  Switch Out the Barbell

Instead of trying to push through shoulder pain and continuing to press with a barbell, try using dumbbells or kettlebells.

Using different implements can change the shoulder position.  Dumbbells and kettlebells allow for more degrees of freedom unlike the barbell which locks you into an internally rotated position at the shoulder.  With dumbbells and kettlebells, the shoulder is allowed to move and in turn can decrease stress/strain at the shoulder.

Variations can include:

Kettlebell Bottoms Up Incline Press

Dumbbell Bench Press
Or use kettlebells in place of dumbbells during the bench press.

5.  Incorporate Slow Eccentrics/Pauses

Another option you can try is incorporating slow eccentrics or pauses into your training.  When there is pain in the body, it doesn’t always mean there is structural damage or inflammation.  If the Central Nervous System (CNS) perceives that there is a threat to the body, it can create pain to force the body to stop/mitigate that threat.

In the case of the shoulder and bench pressing, if someone can’t control the bench press properly, the body can create pain due to the threat of not being able to control the movement.

With that being said, incorporating slow eccentrics or pauses into training can potentially help.

Slow Eccentric Push-Ups

Slow Eccentric 1-Arm DB Bench


Bench Press with Pause

By incorporating slow eccentrics and/or pauses, it can help train you and your body to control the movement to not only decrease pain aspects of the movement, but also to increase strength as well.

If you are dealing with shoulder pain, you are injured, not dead.  There are ways to continue to train when dealing with aches and pains.  Try:

-Adjusting your Pull/Push Ratio
-Limiting Ranges of Motion
-Closed Chain Movements
-Using dumbbells or kettlebells
-Slow Eccentrics/Pauses

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<![CDATA[3 Tips to Clean Up Wrist Pain with Push-Ups]]>Tue, 19 Sep 2017 20:05:58 GMThttp://andrewmillettpt.com/blog/september-19th-2017Push-ups are a movement that can be done relatively anywhere.  It can be performed with body-weight, resistance, or regressed for beginners.  One common complaint with push-ups is wrist pain.

With a push-up, the wrist is put into a extended/hyper-extended position.
This can be a difficult position to tolerate for some people.  Whether it be from a previous injury or not utilizing that mobility throughout their daily lives, loaded end-range wrist extension can be uncomfortable and even painful.

Here are 3 tips help improve wrist pain with push-ups!

1. Improve Your Wrist Mobility

If the wrist doesn’t have adequate extension, then when loaded, it can create issues at the wrist and higher up the kinetic chain.

If getting into or attempting to get into end-range wrist extension is bothersome, try performing self-myofascial release (SMR) to the muscles of your forearm.
After performing SMR, check and see if your wrist mobility for the push-up feels better.  If not, try some joint mobility drills.  Mobility drills such as:

Mobilization with Movement Wrist Extension
Key Points:
-Place one hand on top of the other as shown.  Use the web space of your hand and bring it right up against the back of your wrist.
-Maintain the pressure of your hand on your wrist.
-Move your body over your hand moving your wrist into extension.
-Pressure should be felt in the wrist.  If there is increased pain, stop.

Sometimes, people will experience improvement with the opposite to compression as shown before.  A wrist distraction mobilization can help.

Wrist Distraction with Mobilization
Key Points:
-Stabilize one hand with the other.
-Gently use body to pull arm away from the floor and move into wrist extension.
-A slight stretching sensation should be felt in wrist.
-If it becomes painful, stop.

Wrist extension mobility is often limited in people who weight train due to the constant gripping of dumbbells, kettlebells, barbells, etc.  A good mobility drill to do is the Quadruped Wrist Extension Rockback.
Key Points:
-Stretch should be felt in the forearms.
-If a pinch or pain is felt in the wrist and doesn't subside with increased reps, stop.

2. Change Your Hand Position

If you still want to train the push-up and your wrist is still bothering you, try changing the position of your hands.  Either doing knuckle push-ups or using dumbbells can place the wrist in a more neutral position to decrease the demands for end-range wrist extension.
3.  It’s Not Your Wrist

If you have pain in a joint, the root cause may not be stemming from that specific joint itself.  In the case of the wrist, there could be mobility or stability limitations higher up the kinetic chain at the elbow, shoulder, neck, or thoracic spine.

For the brevity of this post, motor control or stability issues at the shoulder specifically, can drive issues at the wrist.

Try performing your push-ups with a resistance band around your wrists.  By adding a band around the wrists, it can increase rotator cuff and scapulo-thoracic stability and in turn improve wrist stability.
Key Points:
-The resistance band is attempting to pull your arms together.  Actively think of "pulling out against the band."

Also, make sure you have adequate shoulder mobility and thoracic spine mobility prior to performing push-ups.  Quick tests for adequate shoulder/thoracic spine mobility and stability are:

Normal:
-3rd digit to opposite inferior angle of scapula.
Normal:
-3rd digit to opposite superior angle of scapula.

Even though you aren’t going into end range shoulder or thoracic spine mobility, limitations here can send a signal to your nervous system and can affect elsewhere throughout the kinetic chain.

Try performing self-myofascial release, self-joint mobilizations if needed, changing your hand/wrist position, or using a band around your wrists.


With all that being said, if you are having wrist pain that won’t go away with any of these tips, find a licensed healthcare practitioner to be evaluated.
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<![CDATA[4 Ways to Progress a Plank]]>Wed, 13 Sep 2017 09:10:47 GMThttp://andrewmillettpt.com/blog/4-ways-to-make-progress-a-plankThe Plank, also known as the prone bridge to some, is a basic core strengthening movement.  Walk into any gym or fitness facility and you will see someone performing this movement or a variation thereof.
The plank can be a great movement to work on core strengthening.  As with any movement, the plank can become too easy for some people.  Many times, clients or athletes will just hold the plank longer and longer to try and make the position more challenging.  Eventually, at some point, their technique falters and the benefits of the exercise diminishes.

Instead of just holding the plank longer and longer, here are some ways to make the plank harder without having to hold it longer.

Ways to Make Progress Planks

1. Stop Holding Your Breath


When clients or athletes are trying to attain maximal core tension, they will have a tendency to hold their breath.  In movements such as deadlifting, squatting, etc., using the breath and maintaining it are vital for maximal core tension to help buttress the spine against shear forces.

But, when performing a movement such as a plank, holding your breath can be working against you by making the movement easier.  By holding your breath, you are using intra-abdominal pressure to maintain a neutral spine instead of using the musculature of your core to do the job.

Instead of holding your breath, try breathing when you are performing a plank.  This will make the exercise that much more challenging.
Key Points:
-Maintain a neutral spine.
-Take a deep belly breath and breath 360 degrees into your stomach, back, and sides of your body.
-As you breath out, the exercise will become harder.  Make sure to maintain your neutral spine position.

Attempt to perform for 3-4 breaths and then take a break.  You can perform for multiple reps and sets.

2. Change Your Base of Support

Another way to make a plank more challenging is by altering your base of support.  This can be accomplished by taking away a point of contact with your arm and/or leg.
By taking away one of the 4 points of contact in a plank, it will decrease the amount of control over the position and in turn, make it more challenging.  It would be similar to taking away one of the legs of a table.

3.  Incorporate Movement

When performing a plank, we want the lumbar spine to be in a position where it doesn’t move.  This doesn’t mean other aspects of the body or spine can’t move.  When performing a plank, try incorporating some type of movement into the exercise to increase the difficulty.
4. Make Your Body Longer

Besides resorting to medieval torture devices to attempt to make your body longer, to create a longer lever arm, and in turn make a plank more challenging, you can try this:
The bodysaw can also be used with a foam roller, TRX suspension trainer, slideboard, etc.

If you are performing planks while working out or training and they are just becoming too easy, try breathing, changing your base of support, incorporating movement, and/or using a bodysaw variation to make them more challenging.


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