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Learning how to breathe and use your core through the Dead Bug

Breathing efficiently and bracing your core go hand in hand

Have you heard “brace your core”?  it has been around for a while.  When I started taking exercise more seriously and was given that particular cue  I would be lying if I say that I completely understood why or how I was supposed to do that.

To no surprise, my core engaging abilities were not the best. My particular interpretation of the cue involved sucking in my belly and holding my breath.  In my head, I think it went something like “suck it in”.

Most of us need to learn more efficient ways to breathe through exercise

I cannot recall the exact moment that I learned what bracing my core meant. But after some years of training and helping patients learn how to brace their own core, I have realized that more often than not we could still do a better job engaging our abdominal wall

In my experience, the majority of our patients have to be shown more effective ways to engage their core. However what I have more importantly realized is that our ability to breathe effectively is completely related to our ability to keep our core engaged.

How are core engagement and breathing-related?

Your intra-abdominal pressure (which changes throughout the phases of respiration) and abdominal wall contraction (core activation) are closely related.  Some researchers have found that the contraction of the diaphragm precedes the movement of the limbs in the body. In fact, it is your diaphragm that should contract first before the abdominal wall/core are engaged.

The diaphragm is designed not only for breathing but also has a major role in trunk stabilization.

Learning how to engage the core

Because of the importance of the diaphragm on trunk stabilization, all exercises that are intended to help you engage your core should be cue with proper breathing.

This is why we love the dead bug and its variations as a way to teach you how to breathe more efficiently through movement. In some cases, we start with plain breathing drills. But our goal is always to progress you to a breathing efficient dead bug.

A quick video on how to perform the exercise can be found on this link

 

A common and overlooked Upper Trap Pain

A Common Cause

Your upper trap pain can be a symptom of multiple causes. It is always better to get it assessed to find what is making it feel so “tight” or painful.

One common and overlooked cause is a previous shoulder injury.

Upper trap pain is a very common occurrence after a shoulder injury.

Even after you have gone through a program of shoulder strengthening exercises and there is minimal shoulder pain.  Trap pain is likely to occur.

Why is this so common?

Many times after you have had a shoulder injury there is no change in the way you are moving your shoulder.

After you have followed the prescribed rehab exercises. Muscles that were injured are now stronger on isolated movements (like external rotations with a band). Unfortunately, very little carryover is seen when your shoulder is challenged with weighted overhead movements.

This means that even if the rehabilitation was successful in getting rid of the pain. The strength of the shoulder is still compromised and therefore compensation from the trap occurs

Compensation from the upper trap happens as a way to “get the job done.” Whether that be pulling an object or placing a weight overhead.

Here is a table that shows how overactivated the upper trap can be on people with shoulder impingement.

Observation of Shoulder Blade movement

One way to assess if you have truly re-learned to move and stabilize the shoulder is to provoke these movements under load.

Normal shoulder blade glide can be seen when you raise your arms overhead. However, if challenged to stabilize a load an excessive pull from the upper trap is commonly seen.

This might lead you feeling a constant tightness and pain over the area. The upper trap is constantly being overloaded.

It is common to think that your traps need to be stretched and released so they are not so overactive.

However the true solution lies with the cause

There are two options:

  1. You need to stop doing movements that overload it and retrain a more stable position.
  2. You need a stronger trap that can actually support the weight

Two are Better than One

We use a combined approach. Re-learning how to properly move your shoulder blade and also strengthen the muscles that will be used to support heavier loads: the upper trap.

Although you might feel like stretching is  the thing to do. It can only provide you a momentary relief and keep you from addressing the cause of the tightness.

Always keep in mind that there are other factors that can cause this same symptom and every case is different.

Re-gaining rotator cuff strength might be the actual solution to solving that neck pain.

 

 

 

 

Common things we do that make Neck Pain Worse

On this blog we discuss the top common things that make neck pain worse.

Neck pain can feel sometimes like you are literally carrying the world on your shoulders. It tends to be a condition that slowly gets worse overtime. It is also heavily influenced by our habits. Things like how much we stand in front of computer, or use our phone or how long we drive make the problem slowly worse.

The two main causes of neck pain:

When people have bad neck pain it is usually because:

  1. They spend way too much time with their head looking down, creating bad posture or
  2. Because they have had a direct injury, like a car accident or a fall.

There are things that can definitely help, however, there are also things that make the problem worse and in some cases stop the healing process.

4 Common things that make neck pain worse

Here are the top things we recommend you stop doing:

Crack your own neck

Although you might feel like your neck is very tight and it just needs a “pop” to feel better, we recommend against it.  When your neck pops on its own, it’s considered to have too much joint laxity. It’s a sign that there is too much elasticity and not enough support on the structures that make up the cervical spine. It lacks proper stability for the discs that are on the spine. Moving the neck with force in a non-specific way can make the problem worse over-time.

The more laxity there is on the neck the more likelihood and severity of neck pain. A clinical study published in The Spine Journal found high correlation between people that have joint laxity with disc degeneration of the cervical spine and chronic neck pain.

Looking down on your phone

This is something that now makes solving a neck issue extremely challenging. Even if you are doing therapy and the necessary things to deal with your neck pain, when you spend hours on end looking down at your phone your neck curvature is bound to suffer and therefore signal pain.

The more hour s you spend on the phone the more detrimental changes you will have on your cervical spine.

Try to limit the time on your phone and if you need to use it, hold the screen at eyesight height.

How much weight is your spine carrying when you are looking down?

Prolonged Sitting

If your job requires prolonged hours of sitting down in front of a computer set up an alarm to take “standing up” or even better “walking breaks”. The more severe your neck pain is the more frequent breaks you should take.

Improper sleeping position

If you like to sleep on your back:
Holding your neck up with support might feel like it provides relief, however, using big pillows puts your neck in a flexed “looking down” posture. Creating this position for your neck will lead to more pain. It moves the head even more anteriorly which leads to bigger stress on your joints. It might be difficult to lay your head all the way down. You can use a cervical pillow to help create the right support.

If you’re a side sleeper:
Make sure your pillow is thick enough to accommodate the width of your shoulders in order to maintain the neck in a straight, neutral position. More importantly, you should avoid sleeping in the “fetal position” with your chin tucked to your chest. Sleeping with your neck bent to one side or in a forward flexed position can put pressure on the nerves that exit from the neck and down your arm, which could lead to numbness and pain.

Statistics show that approximately 75% of adults will suffer from neck pain in their lifetime. As you can see, if you reassess some of your daily habits, maybe we can prevent the pain from worsening over time.

What to Do when you have bad Knees

1The truth is that your knee pain rarely ever comes from a problem in the knee. Unless you have had a direct hit or blow to the knee.  Your knee pain is, more likely than not, the result of hip weakness or foot (ankle) problems. Therefore, unless these other two parts are assessed and addressed the knee pain won’t get any better.

Keeping that in mind. We have come up with the 4 main factors that can help you recover from bad knees

4 factors that influence your knee pain

#1 A Stronger and More Stable Posterior Chain

Are your quads stronger than your glutes and hamstrings?

Your strength difference between the front muscles of the knee (the quads) and the muscles of the back of the knee and hip (hamstrings and glutes) can play a major factor on your knee injury and recovery.

If your back (posterior chain) muscles are not stronger or significantly stronger than your quadriceps (anterior chain) your weight will be mainly carried by the front of the leg. This will cause your knee to be excessively loaded.

The hip muscles, i.e. the glutes, play a big role in stabilizing the knee.  If your glutes are weak the knee will not have proper stabilization and will tend to “wobble” throughout the movement and cause pain.

We show you how to test your glutes on this blog

#2 Foot position

How is your foot landing?

There is a proper and improper way that the foot and ankle should move and land against the floor. You may experience pain in the knee if you are running and landing on your heel instead of the balls of your feet.

People that strike the ground with their forefoot absorb more force at the ankle and less at the knee. Changing the way you run to load the ball of the foot upon landing instead of the heel will keep the knees from excessive load.

#3 Weight Gain

One way to make it very challenging to rehabilitate your knee is if you have had recent weight gain around the same time that you injured your knee.  Carrying the extra lbs. on your joints makes it extremely difficult for the knee to heal.

Your knee joint (and ligaments) may just not be strong enough to support that weight. Changing your nutrition is the first step towards healing the knee and preventing it from getting worse.

#4 Ankle Mobility and Stability          

Sometimes you might have knee pain that actually comes from a problem in the ankle. The ankle joint is supposed to absorb most of the load when the foot hits the ground. When it’s unable to stabilize due to poor movement or other ankle stability issues the load is transferred to the knee.  A bad ankle sprain can make your knee unstable without you even knowing it.

You might think that you just have “bad knees” from past injuries and development of wear and tear in your knees (i.e.  arthritis) but the real cause of the problem does not stem from your actual knee joint; it comes from one (or more) of these four factors that perpetuates the cycle of pain and injuries.

Pain in the front of the shoulder after exercise

Do you get pain on your shoulder after doing overhead movements?

Correcting your overhead position is one of the best things you can do to keep your shoulders healthy. Pain in the front of the shoulder after lifting occurs when the shoulder is unable to move in a straight path overhead but instead moves front.

Shoulder injuries are extremely common; like we discussed in our last post, it is not so much of a shoulder problem, but is the result of poor posture and therefore improper movement.

Keeping the bar on a straight overhead path instead of pushing the weight to the front will keep the shoulders from being in pain or injured when doing overhead work.  Improving both mobility in the mid back and stability in the shoulder blade will prevent you from recurrent shoulder pain.

Does it feel right?

Here is one quick drill to teach your body and brain how the movement should feel. This is the first step in improving or correcting anything you want to fix. Learning how it should feel is a must. You do not always have someone watching you do an overhead movement and telling you if you are doing right or not. Therefore we aim to teach you what you should be feeling:

Drill

 

Why your Low Back Pain is not a Low Back Problem

The reason why your low back pain is not a low back problem is actually a pretty simple reason.

Not What You Think It Is

You might be experiencing pain in a specific part of your body. However, that doesn’t really mean the problem is coming from there. Contrary to what common sense might tell you most root causes of pain are not where the symptoms are at.

For instance, common sense would have us think that our low back pain is a low back problem. But this could not be further from the truth. Pain is not a good indicator of what is causing the pain. Instead, it is an indicator of how your body is compensating for dysfunction. Pain shows us how your body is dealing with another part that is not working so well.

A low back pain is most often times a hip problem with no obvious signs of dysfunction. Or perhaps a mid-back issue with also no signs of specific pain, except for the seemingly uncorrelated low back pain.

Which might leave wondering how, or why is this case?

Every part of the spine and the rest of the body has one primary function: that is either for STABILITY or for MOBILITY.

Your neck, low back, and knee should be stable first and foremost. You might feel tight or present with pain, but the reality is these symptoms are present because these areas have to compensate for the lack of movement in another area of your body.

Most of the pain that people present with it’s at these parts of the body, and it will be  natural to assume that their pain is the problem area, however, let me show you why this is not the case:

 

 

 

 

How Poor Hip Movement leads to Low Back Pain or Tightness

low back pain hip mobility
low back pain is most common a hip problem not a low back problem

When you lose your ability to move your hip through a full range of motion, you will start using your back instead. This leads you to experience low back pain or a constant sensation of tightness from overuse.

Find out how your hip hinge is related to your back tightness

How Poor Mid-back Posture leads to Neck and Shoulder Pain

a similar case is observed with a lack of mid-back mobility, leading to constant neck tightness and pain. Poor thoracic extension leads to terrible shoulder issues

As you can see, the root cause of the issue is often times missed by focusing on where the pain is at. Do not get me wrong, pain does need to be addressed but unless postural issues are addressed the root of the problem will persist and keep causing the same issues or compensating for a lack of function somewhere else.

 

Fixing a Winged Shoulder Blade

Fixing a winged shoulder blade can be one of the most challenging things to accomplish. Depending on the severity of the case. You might not realize that  An unstable shoulder blade can be the cause of shoulder pain, wrist pain, and even trap/neck pain.

 

The main job of your shoulder blade is to stabilize the shoulder when you move your arm. Without this stability, the shoulder joint is under great stress.

How can you know if you have stability on your shoulder blade?

The first part of answering that question is to observe the movement of the shoulder blade when you move your arm:

As you move your shoulder overhead it should do 2 things:

  1. It should Rotate up and to the side
  2. It also should Stay securely in the back:

You should not see the bone “come out” or protrude with any movement like push-ups, overhead movements or by putting your hand on your back.  see here

One common root cause of chronic shoulder pain comes from the shoulder blade not providing the support that is needed.

Besides shoulder pain, other symptoms of instability are a shoulder blade that “clunks”, or moves out of place. At times these painless clues are red flags that stability, more than mobility is needed.

An unstable shoulder blade will eventually lead to shoulder pain, wrist pain and even trap/neck pain.


How can we re-train shoulder blade movement?

Re-training your shoulder blade movement can be challenging depending on how much of the movement is compromised, how long have you had the problem, and how often are you loading the shoulder.

Nevertheless, it can be done even in the most challenging cases.

The key to fixing the problem lies in the ability to teach the body how to contract the right muscles to move the blade into the right direction.

We do this with 3 important steps:

  1. We adjust the spine, and sometimes the rib cage to decrease pain and improve the joint position of the mid back. A “hunched” posture leads to poor shoulder blade function.

  2. To help improve the right movement of the shoulder blade with overhead movements we can use a muscle stimulator like a Russian stim or Power Dot:

The muscle stimulator helps contract the muscle to secure the blade into position as it moves through the range of motion.

This is a great way to warm up before rehabilitation exercises or overhead movements. The idea is to help create the “right sensation” of how the shoulder blade should move to secure/stabilize the shoulder.

 

  1. We start with simple exercises that ensure the correct movement. This is very important because it is pretty easy to make the problem worse with exercises that “should” help but make it worse.

Everyone is different. Keep in mind that an exercise that might work for a patient might not work so well for you.

 

Is a Wing Scapula Serious? and What Causes it?

winged scapula serious causes

a Winged Scapula, is it Serious? What are the Causes?

A winged scapula can be serious, but it depends on the causes. There can be two main types of “injuries” that could cause you to have a winged scapula. Both of the injuries have to do with your serratus anterior. A muscle which its job is to “glue” your shoulder blade towards the midline so it doesn’t “wing-out” during shoulder movement:

What are the causes?

It could be NEUROLOGICAL, a nerve issue.

The most serious and rare reason is an injury to the nerve that activates the serratus anterior muscle. If you are suffering from nerve damage (which again, is rare) your muscle will lose its ability to contract. Therefore, there will be a winging on the shoulder blade as the muscle is unable to keep it “glued” to your back.

There are 17 different muscles that attach to your shoulder blade. At times it is not just an injury to the long thoracic nerve but an injury to other nerves that come from your neck that will lead to it. A big sign is if your winged scapula is very noticeable on overhead movement.

 

The most common cause is weakness

Weakness in the muscles that stabilize the shoulder blade will cause your scapula to move where it should not move. It will give you the appearance of a winged scapula.

Common therapy procedures are targeted towards strengthening the serratus anterior. However, sometimes the exercises that are prescribed are not efficient at solving the issue because the problem is usually more complicated than just a weakness of one muscle.

Furthermore, if the body does not know how to activate the right muscle it will compensate and use the wrong muscles to get the task done. So you might think that you are working out your serratus anterior but other muscles are taking over and the exercise is ineffective.

A common complaint is heard:

My right scapula pops out of my back continually, despite how much I work my serratus anterior; which I’m told is the cure. How can I fix my problem?

The treatment needs to be targeted towards proper muscle activation and postural correction. If your chest muscles are too tight from rounded shoulders, the shoulder blade will constantly be pulled out of alignment. If there is a rotator cuff injury, it needs to be addressed as well.

Tight shoulders are highly correlated to this condition, find out if your shoulders are tight

Fixing a winged scapula tends to be more complicated because it greatly differs from patient to patient. It could be a nerve, the shoulder blade muscles or like many times a combination of the two. You need a full movement analysis to determine the pattern that causes or aggravates the condition. Moreover, the exercises that are actually going to help fix the issue.

You need a full movement analysis to determine the pattern that causes or aggravates the condition and more importantly the exercises that are actually going to help fix the issue.

Is Low Back Pain and Soreness common after Deadlifts?

Yes. Low back pain is common after deadlifts. It is extremely common to hear people complain about low back pain after a session of deadlifts. However although common it is not ideal or normal.

You can definitely feel back soreness and pain after a session of deadlifts but many times the pain is not intense enough for you to seek help. This is unfortunate as it puts you at risk of injury.  Also, keep in mind that the muscles that you are “working out” are not being targeted properly. By using your back instead of your hips, core, and legs, you are compensating and not achieving the “full potential of the lift”.

Fixing it

The most common faults on the deadlift are:

  1. The Set-up
  2. Hip Hinge/Hip Mobility
  3. Using the wrong variation of deadlift for your body type

#1 The Set Up:

Most people set up for the deadlift with an already rounded back and then try to correct it right before they start the movement. Instead attempt to come down to the bar in an already “chest up” posture:

 

Hip Mobility:

If you are unable to push the hips back with minimal knee bend, your body will compensate by using the low back to pull.

You can read more about hip hinge here

Body Proportions

Depending on each individual’s body proportions there is an ideal form to deadlift to not only protect your back but target the muscles that should be activated through the lift.

Here is an idea

One of the most common assumptions we make is that the proper or “acceptable” form is the one used by experienced lifters on their one max rep attempt. However, this “one-rep max form” should not be the standard for training weight.

Compensations will occur when we lift a weight that we have never lifted before. However, this should not be the form we are using with lighter percentages and higher reps. This only leaves us prone to injure our back and also train the wrong muscles.

 

How to correct the knees going inward during the squat?

 How to correct the knees going inward the squat

In this follow up blog (see part 1 here) we are going to show you how to correct the knees going inward during the squat. Because finding the reason behind the problem is 50% of the solution

The main 2 reasons

There are two main reasons why the knee will move in throughout the squat movement:

#1 Mobility

Lack of mobility in the ankles will not allow for proper hip loading. Therefore, it will limit you on proper hip stabilization. The most common mobility fault, and quite honestly often overlooked, related to this problem of the knees going inward is ankle mobility. Lack of ankle mobility leads to improper load using mainly your quads or legs instead of the appropriate hip muscles:

ankle mobility knee cave inwards
knees cave in due to poor ankle mobility

 

#2 Poor Stabilization

Poor stabilization of the hips from weak glutes or a weak transfer of weight into the hips from the core. In other words, proper core stabilization will activate the gluteal muscles and provide stability in the hip. If there is poor transfer from the core, the gluteal muscles will not be cued to fire.

glutes stabilize the weight through proper core transfer
The hip muscles, specifically glutes stabilize the weight

Important clarification is the difference between knees collapsing and the “knee valgus twitch”

Here is an example of knees collapsing:

What is Knee Valgus Twitch?

Advanced lifters seem to briefly “twitch” by a slight knee “going in” when at the bottom of the squat. It is seen the most as they initiate the “coming up” part of the squat. However they usually revert back to having their knees out after they pass the sticking region.

On the other hand, just like in the video knee collapse happens throughout the movement.

What can be done?

If you already have pain in your knee, IT-band or in the side/front of the hip, the pain needs to be addressed. Exercise won’t fix the pain. The pain needs to be treated first before the poor movement pattern can be corrected.

Once the pain  has been treated we can move to correct the movement pattern. This is usually how we correct it (in order of importance):

  1. Correct the pelvic rotation.  Mobilizing or adjusting the hip will balance out the pelvis and lead to better loading into both legs.
  2. Improve Ankle mobility. If your ankle mobility is poor you will never be able to properly bear the weight in the hips since it limits the depth of the squat.
  3. Creating a stronger core by doing things like side planks, farmers carriers and counterbalance squats will lead to better weight transfer, banded push-pull.
  4. Stronger glutes or glutes that match the strength of the front of the legs (quadriceps) will create an ideal hip and knee stabilization.