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Archive for Exercise – Page 2

Shoulder Pain: Case Example Using Mini-Bands

By Peter Fabian · Comments (2)
Tuesday, February 22nd, 2011

Background

Shoulder problems are one of the big money makers for people in the medical field.  As with many problems there are many factors and different categories of these problems.  This statement of shoulder pain is a very poor title for discussion.  It is the common moniker that many of us use for a wide variety of different problems.  In other words, shoulder pain does not even describe the problem, only the symptom.  Only subsequent questioning and discussions can bring clarity to what is the problem.  Shoulder pain can be referred pain from other sources like the neck, ribs, heart and lungs and many other problems.  These origins of the shoulder pain don’t even have to be in the neighborhood of the shoulder.

Here I just wish to talk about a particular case illustrating some basic principles of movement and stability of the shoulder complex and using mini bands.   If you are experiencing painful shoulders, please do not limit your assessment to what is given below.  Remember what is said in the above paragraph.  First ask other questions.  If there is any doubt in your mind have your doctor clear you first before embarking on trying out a musculoskeletal approach only.

Case Example

This young man who works a sedentary job and participates in weekly yoga class had been noticing increasing discomfort  of both shoulders but especially the left one.  Simple lifting the arms above the head would reproduce his symptoms.  They would get better on the right with continued movements but not on the left.

A brief assessment showed the following.  His posture looked casually very erect.  (Although is head was slightly forward and his thoraco-lumbar area was over extended, and his scapula’s winged bilaterally).  His neck demonstrated limited rotation and sidebending bilaterally especially to the left, his more affected side.  His lower neck spinal mobility was more restricted in these movements.  His shoulder mobility was with a flexion deviation in abduction. End ranges in abduction and external or outward rotation were slightly limited.   Resisted testing was weaker in extension and external rotation with arm above the head.

His mid to lower thoracic mobility was restricted in rotation–his mid to upper thoracic  was restricted more in extension.

In all his shoulder mobility testing, he demonstrated poor initiation of the scapula, especially on his affected, left side

Basic Approach

We worked on basic joints and glands (calisthenic type) exercises and foam roller to help restore some of his spinal mobility.  He improved so that his mobility was more normalized in his spine and shoulder.  His most provocative test now was his resistance to external rotation of his left shoulder when his hand was above his head.

It is interesting to note that in the classic muscle test position of external rotation with his elbow at his side, he had no problem.  I find it always helpful to hunt around to see if different positions will provoke his symptoms.  Also during these movements the scapula had a lag or latency in it’s sequential recruitment.

Mini Bands

Since he was essentially not activating his scapula enough in order to move his arm, work on this provided the changes he needed.  By working on basic pulling activities and cueing the scapula to perform better he was able to complete his recovery.

One problem I find in recommending exercises is compliance.  The simpler and easier the exercise the more compliance you will have.  This is a real struggle for me as there are so many areas that a person needs to learn about to move effectively.  If you can start the movement and break it into pieces, you can sometimes deal with this compliance issue effectively over several sessions of training.

This photo shows the 9 inch long loop called the mini band in action.  Here we started with simple setting of the posterior shoulder muscles.  We can emphasize scapular retraction while loading more of the external rotators to act as stabilizers.  This movement reminds me of the ole chest expanders we used as kids.  (Hoping to become like Charles Atlas and rule on the beaches).

Mini bands are great.  I constantly refer my clients to an online store called Perform Better.com.  Here is the link to their mini-bands.  They are a closed loop and give you what thera-band still gives (sans the knot, tying the ends together).   I just find I use these a lot more and they are so easy, portable and just fit the bill so well.  (no I don’t have any financial relationship with this company–except when I give them my money for their products)

We used a variation of this set up that is shown in the above photo.  What you see here is the mini-band looped around his wrists while pulling on another band (monster band, listed under mini-bands in the above link)–this monster band is 20 inches vs 9 inches in the mini-band.  You can use them separately or together as shown here.

One of the advantages of using a closed loop to do any type of rowing movement is that you can develop two directions at once.  This combined movement is very good for activating the stabilizers in this case.  You see on regular rowing you work on mainly retraction/extension of the shoulder.  Here with a closed loop (and the addition of the mini band) you emphasize this external rotation with a variation of horizontal abduction.  Turning on multiple planes of movement will really drive the shoulder complex to be more stable with proper cueing.

Another advantage to this arrangement is that it is very simple to set up and take down.  Space and equipment considerations are minimal.  Just get in there and do the work.

Progressions

The mini bands come in a variety of resistance.  I often have my clients purchase the yellow, green and blue mini bands.  Also buying the 20 inch loop (called a monster band with in the mini band section), will give you a large variety to try many different things.

  1. First I will start with a yellow or green band in the upper body for sedentary folks
  2. Next I will add the two bands as in the second photo
  3. For people who have issues in grip–whether arthritic hands or other problems, you can easily use the loops around the forearms
  4. Also the loops placed more proximal will reduce the force needed–this makes it very doable for anyone–I even use these ideas with a 93 yo woman who is progressive working just with the mini bands and also a 40 inch loop.
  5. This rowing movement for those who have issues of rotatory instability with the arms above their heads need to further progress.
    1. We start from simple rowing movements where the elbows are pulled closer to the sides while the forearms are more parallel to the floor
    2. Next we work into getting around a 90/90 degree position of shoulder abduction with external rotation while the elbows are around 90 degrees
    3. I’m not too strict here about the 90/90, just having them move towards this position and have their forearms more vertical works quite well

Summary

Retesting will clearly show if we are in the right direction.  I will immediately retest their provocative movement pattern.  If it is better, that is stronger, better movement of the scapula/humerus and thoracic spine–I know this has been a good choice.

There are of course many ways to deal with this problem of instability.  Try out this variation if you haven’t.  Let me know what you find.

Best in training.

As always, contact me if I can be of further assistance–Peter

Comments (2)
Categories : Exercise, Uncategorized
Tags : exercise, exercise compliance, mini bands, mobility and stability, monster bands, performbetter.com, shoulder instability, shoulder pain, stabilization

Effective Exercise

By Peter Fabian · Comments (0)
Tuesday, January 11th, 2011

Strong Mind and Body

Do we get the best results from our exercise selections?  How do we select which exercise to perform?  Besides matching the proper exercise for the problem we have, what else is important?

Is being effective due to:

  • The proper selection of the correct exercise?  or
  • How we do that exercise/movement?

Effective Exercise

First we must congratulate ourselves because we are doing exercises.  Next we have usually identified some reason for putting down the remote and/or getting out of bed.  Now let’s move quickly on to someone who wants to perform their particular task or skilled movement better.  It could be that they want to jump higher, cut quicker on the field, get into better shape/condition or simple perform a yoga posture that is particularly challenging.  Let’s take the latter case to illustrate several of these points on how to effectively exercise.  (We are expanding the definition of exercise and bending the definition of yoga asana here to make some points, knowing that the purists may start off disagreeing too early here)

Yoga Asana–Chakrasana

This is not a complete description of how to do Chakrasana.  We are using this posture/asana as an example of some one who wishes to do an exercise or asana effectively.  (This example could be extrapolated into many of the “corrective exercises” being given and performed today.

Let’s start with looking at a typical example of someone wanting to be more flexible.  They have taken up Yoga asanas in a class.  At some point the teacher has progressed to this pose called Chakrasana or wheel.  It is fairly vigorous for many, as can be seen by the picture above.  Again this could be an example of someone wanting to jump higher and get stronger in their legs who at some point starts doing one leg squats.  It really doesn’t matter the movement activity by itself.  It is again looking at how to exercise effectively.

Truly in exercise/movements it would be best if we knew ourselves well.  (Know thyself–OK, end of philosophy).

  • Where do we move well–actually where and in which directions do we have ease and dis-ease
  • What movements are strong/stable/powerful and have endurance (both in mobility and in stability)
  • Which tasks and/or skills do we prefer and which ones do we stay away from
  • Do we move smoothly and in a coordinated fashion
  • Do we breathe or frequently hold the breath with frequent efforting
  • Can we stay focused and pleasant in our mind or just the opposite

These are just some of the aspects or questions to ask in order to get to know HOW we move and therefore better know ourselves.  Knowing ourselves better will allow us to move better.  We can take full advantage then of the exercises or movements being selected.

Maybe Chakrasana (or single leg squats) are not the best exercise at the moment.  Maybe the way in which we do them is not allowing the benefits of those movements to create the tremendous results that await us.

Where (location and direction) and how do we move well (and where/how we don’t)

We need to look at large patterns of movement.  We want to see and feel how the body moves in all directions from the major areas of the body while performing a variety of movement patterns/tasks/skills.

  • Bending and reaching
  • Twisting
  • Pushing and pulling
  • Squatting and kneeling
  • Rolling and crawling
  • Sitting and standing
  • Walking, running, hopping and jumping

Where in the body do we move a lot and where are we stiffer.  Often this inquiry stops here.  It is insufficient.  The shoulders may be tight in lifting them above our head but have a lot of movement in the opposite direction.  Especially important is to notice difference from side to side and up to down.  Maybe our hips are able to extend (backward bend) well but our shoulders cannot open in that same direction.  Maybe one shoulder does more opening that the other–do you see that in Chakrasana then you would create a rotation of the trunk.

Look at the picture again and you see that the hips are opening well in backward bending.  The lower back spine is bending a lot.  The rib spine or thoracic spine is not backward bending at all in the mid to upper back.  The shoulders are also tight in this same direction.

Isn’t it interesting to note that this person is doing the general direction of this Wheel pose.  It is just HOW they are doing it that is of note here.  Therefore they will be over using hips and low back (and neck) and under using shoulders and mid-upper back (and wrists).

What if we knew where we moved and didn’t.  This might totally change what we do and how we do it.  Of course the results would be vastly different.  Our learning then and what we pay attention to would be expanded.  The changes across many different systems could be facilitated (musculoskeletal, fascial, nervous system, respiratory, immune, etc)

What movements are strong/stable/powerful

Again looking at this picture, we can ask several questions.  I know it would be better if we actually had a video.  Then truly we could appreciate the movement qualities better.  This picture and discussion will at least highlight the points of this article.

Looking at the two ends of this Wheel pose–which end, the leg or arm end, looks most stable?  You can see how the weight of the body is carried behind the arms.  Are the shoulders weak or only stiff?  or both?  Address whatever is involved with a more appropriate regression of this pose first.  Identify weakness and lack of stability of the shoulder complex with the arm above the shoulder level.  There are many ways of doing these tests/movement regressions.  We will not go into that detail here.

Looking at the middle of the body and seeing how the front of the lower back (the belly) over lengthens.  The lower back  over shortens.  How much of this over extension of the low back is a mobility problem of the thoracic spine in extension?  (or/and does it involve lack of stabilization of the anterior belly region.)

First you would have to decrease the challenge of this activity.  Take them out of trying to do this asana.  Place them on the floor and have them roll from belly to back with only the arms and head.  Do they activate their belly enough to transmit the rolling through the trunk from the arms.  Could their shoulders and thoracic spine be so stiff as to even impede this movement. Further investigation would be warranted.  This again is just to highlight a perspective of looking and asking questions.

By looking at more of these larger movement patterns, it will become clearer.

Which tasks and/or skills do we prefer and which ones do we stay away from

I wonder if this person loves to do backward bending movements where the shoulders are not flexed near their end ranges (that is over head position, above shoulder level).  So let’s make up a scenario that I see frequently in the clinic.  They would do  easily cobra or lying on their stomachs with arms by their sides.  Even Camel pose (tall kneeling and bending backwards to place hands on heels) would be available.  Any superman type position or boat pose would be done with substitution and difficulty.  They would never practice hand stand as it is too tiring.

If this lack of using the extremities over the head (in Chakrasana) causes such stress, then it may need to be regressed or made easier.

This easier movement may allow the proper awareness and adjustments to overusing and underusing that is being outlined here.

Do we move smoothly and in a coordinated fashion

This examination of coordination and agility reinforces many of the above observations.  Again whatever we move well and strongly, those are things we do.  We always use what we have even when trying to do something else.

Let me digress from this example to talk more of our preferences and avoidance’s in general movement.  We use the same patterns of movements and habits even in opposite directions.  It is not unusual to see someone who is trying to sit on the floor and has a lot of left knee pain (for example–in a cross leg, sukhasana pose).  Sometimes in looking at them you see their weight shifted to their left hip, although they are leaning a bit to their right.  You find they are in right sidebending of their trunk.  When you ask them to sit on a chair and turn right and left they still have most of their weight on their left sit bone.  In other words they do their movements of rotation and still maintain their right side bending of their trunk.  Their coordination remains dysfunctional even though you would give them a movement to change it.

This latter dysfunction a very important point to discover.  Our movement habits often remain and don’t change just because we are doing some corrective asana or exercise.  The WAY we move becomes also very important.

Do we breathe or frequently hold the breath

OK, breathing is so important.  It is a barometer of our mind and nervous system.  Sure at the beginning one may fine this breath rhythm disturbed.  The habitual and repetitive nature of an interrupted breath is very detrimental to our learning and proper response to the exercise.  A jerky breath relates to a jerky focus of the mind and all the other negative effects in all systems.

Try moving only so far as the breath can flow well.  This does not mean that you can’t cause strain.  That is ridiculous.  As one continues to do repetitions or hold the pose, the breath should be noted to start to flow well.  Otherwise there is not practice.  One is just violently stimulating the system.  Of course you have some changes even with the breath always being strained.  This abnormal breath rhythm though is very limiting and over the long term is detrimental to health and well being.

Can we stay focused and pleasant in our mind

Alright, take off the music headphones.  Pay attention to what you are doing and what you are feeling.  A good barometer like the breath is to ask whether you are pleasant in your mind.  GEEZ, you mean we have to be smiling all the time.  OK, less drama here.  Just note what happens to your overall sense of tensing and effort when you notice that your mind is not pleasant.  Whenever I ask this question in class or to individuals, I never fail to see an easing of tension, even a  : o )

Also when the mind is more pleasant–often you will notice an ease in the movements.  Try it just like you would try breathing with more awareness and ease.

Whew

So now when you exercise, you can ask more questions.  Effective exercise is creating the proper effect you want and/or that is available in the stimulation of the movement done well.  Effective exercise involves BOTH the selection of the right exercise the proper way of moving–

  • The Body
  • The Breath
  • The Mind

So before and during your next exercise session, take time to pay attention.  Use the movements to create opportunities to sense and breath.  Train hard up to your capacities.  To know your capacities, you must practice a lot.  You would benefit by coaching or skilled guidance.  Try using these principles–pick one, like having a pleasant mind.  Then go find a skilled coach/teacher and get some quality feedback.

Best of luck in your effective exercise.

Feel free to comment or contact me directly for a consultation.

Comments (0)
Categories : Exercise, Physical Therapy
Tags : asana, attention, awareness, body, breath, breathing, Chakrasana, dysfunction, exercise, fitness, instability, mind, mobility and stability, movement awareness, pleasant mind, posture, practice, strong body, strong mind, thoracic dysfunction, training, Wheel Pose, yoga

Strengthening Your Pull

By Peter Fabian · Comments (2)
Thursday, August 19th, 2010

Pulling

One of the major functional divisions in movement is pulling.  The pullup is one of the great bench marks of this activity.  Many cannot do even one–been there and done that.  Well there is a lot of help to work on this simple and very effective movement.

Pullups

There are lots of intructional videos and information out there.  Just wanted to post on two places to acquire simple gear to help you in accomplishing a pullup.

Check out:

  1. PerformBetter.com for their Superbands a low tech offering that gets the job done.  They can be used for many other things and they are on sale as of August 19th, 2010.
  2. LifelineUSA.com for their Pullup Revolution a recently released new product–looks interesting.

Follow up

In today’s world of complexity and high tech gadgetry–it’s nice just to have something so simple yet so effective as pulling.  Of course horizontal pulling is a great way to start for many.  Also the other complimentary movements of pushing, squatting, lifting, etc are to be considered.

Now go out and pull your weight around (vs push your weight around–pun intended–in many ways)

Comments (2)
Categories : Exercise
Tags : exercise, exercise equipment, pull up, pull up assistance, strength, training, training equipment

Training into your later years

By Peter Fabian · Comments (2)
Thursday, May 20th, 2010

61 year old woman breaking world records in Olympic Lifts

You have to read some of these real amazing people’s web sites–like Dave and Laree Draper

Check out their page on this amazing woman (and amazing trainer–Glenn Pendlay) who just started learning Olympic lifts at 55 yo

Working towards being healthy, without injury and having a proper perspective of training goes a long way, it seems

(Maybe there is a place for yoga and it’s sister science Ayurveda.)

Comments (2)
Categories : Exercise
Tags : ageing and exercise, Laree Draper, training

Gentle social support increases exercise compliance

By Peter Fabian · Comments (2)
Tuesday, May 18th, 2010

There is an interesting study done by Standford University on exercise.  It shows how social support can positively affect the outcome of someone maintaining their weekly exercise program.

There were three experimental groups:

  1. Human advice–Study participants received a phone call from a trained health educator every two weeks and then monthly
  2. Automated advice–where the group received a similar phone call but it was an automated computerized interface
  3. No advice–where they had the same initial contact as above but received no follow up

All three groups were studied over a year.  Significant improvement was made in increasing the average time spent exercising each week for both the human and computer supported programs.   Even the ones not receiving any advice improved by 28%, because it was thought that they improved as there was going to be a check, though only at the end.

Is this social support being helpful or just being involved in a study.  Definitely social support in this context by humans showed the most increase in maintaining ones exercise.  Just being involved in some way also was helpful.

We are certainly a social animal, er human.

Comments (2)
Categories : Exercise
Tags : exercise compliance, social support
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