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Sports Chiropractor Shoulder Rehab Seattle

Sports Chiropractor Shoulder Rehab Seattle

My favorite hobbies of crossfit, kettlebelling, tussling my children and moving my patients can be hard on the body. Especially with a history of a torn right labrum. See LINK. I understand the importance of ongoing shoulder stability rehab as well as anybody. Life and training do get busy so it is critical to integrate shoulder rehab as seamlessly as possible into your existing strength training and accessory work. This modified banded face pull is best used as a series of long fast reps not to exceed 100 total. Add this in after max effort shoulder training days and see your shoulders recover faster and your lifts improve.

Barbell Alternative to Side Plank

The Barbell Alternative to Side Plank should be used in two separate sessions per week, two sets each day. Over the course of 6 weeks, add weight each week and stay within the 30-45 second time domain on each set.

Knee Pain and the Kipping Handstand Pushup

If your knee is hurting after last week’s 16.4 workout, don’t be so quick to blame the wall balls.  Your kipping handstand pushups may be to blame.  

When an athlete does a good job of recruiting the hips in the hspu kip, a violent end range knee extension at lockout is the result.  This differs from the crisp knee extension in other movements such as the kettlebell swing because the lower extremity meets no resistance making it an open chain movement with with zero resistance to guide the normal screw-home mechanism of the tibia.  The result can be repetitive hyperextension of the knee through the course of say 55 handstand pushups.  Add the fact that leaning into the wall to achieve a legal rep further levers the knee into extension, and it should be no surprise that many athletes are limping their way into week 5 of this year’s Open.  

Biomechanics of knee extension in hspu-

The likely source of knee pain following a set of kipping handstand pushups is the anterior cruciate ligament.  The ACL comes to tension when limiting anterior translation of the tibia at end range flexion.  In hyperextension, the ACL is vulnerable to impingement by the intercondylar notch roof of the femur.   See article HERE.

The Take Home-  Explosive knee extension in a kipping hspu is different than in other movements.  The legs are flailing into the sky without any resistance to prevent hyperextension.   The result is like the ACL getting slammed in a door.

Presentation-

The result of this repetitive ACL impingement is inflammation within the joint space and pain at end range flexion.  The inflamed joint feels unstable, clicks and pops but should not lock up or give way.  Getting into the bottom of a squat is very difficult in the week that follows this injury as the joint is swollen on the posterior side and the aggravated ACL is at tension at end range flexion of the knee.

Preventative measures-

Knee sleeves and Rock Tape

  • Neoprene knee sleeves
  • Hamstring Rock Tape
    • Adds some tactile awareness of knee end-range

Joint Prep-

  • Coactivation Exercises-  Russian Swing/ Power Swing
    • Focus on coactivation of glutes with quads to avoid end range extension.
  • Hamstring prep-  Death March/ Kang Squat

Technique-

  • Coactivate glutes, hamstrings, and quads during knee extension.
  • Stay on the wall.  Striking the heel into the wall at the top of the motion increases hyperextension forces.  If possible, glide the heels up the wall as the knee approaches lock out.
  • Closer hand placement-
    • The further the hands are from the wall, the greater the knee is leveraged into hyperextension at lockout.

Recovery-

It is unlikely that serious mechanical damage has taken place.  If you have apprehension or are experiencing locking up or giving way of the joint, have it assessed by your local knee specialist.  Otherwise you are dealing with painful inflammation of the ACL.

Inflammatory measures-  4-7 days

 Heat / Ice contrast therapy.  6/1 ratio

Normatec vasopneumatic compression

  • 20 minute sessions level 8

Wobenzyme Proteolytic enzymes

  • 3x/day on empty stomach

Voodoo Floss

  • The poor man’s normatec

Pray that there are not pistol squats in 16.5.

Clubbells and Indian Clubs: Legit Rehab Tools or Passing Fitness Fads?

For thousands of years Indian Club training has made guys in their underpants way stronger than you are.

If this is the first time you’ve heard about Indian Clubs or Clubbells, you’re a little behind the curve.  They’ve been used as training tools for fighters from all around the world from Russia to Iran for thousands of years.  You could argue the case that the club has been around as a weapon and training tool for about as long as the opposable thumb.  

Pehlwani wrestlers popularized club training in India in the early 1900’s.  To this date The Great Gama is the only wrestler in history who has remained undefeated his whole life which was substantial, as his career had spanned more than 50 years.

The Great Gama

Club training clearly worked for Gama.  If you are looking to dominate the Pehlwani Wrestling circuit you would be a fool to leave clubs out of your routine.  The more relevant question is whether or not this training has a universal application.  Are Clubbells merely a fun way to mix up the routine and run the house in obscure Indian Wrestling circuits, or are they useful tools for adding stability to injured shoulders and strength to competitive olympic lifters and kettlebell competitors?  I just began working with clubs recently.  The following are my initial observations:

PROS

  • I’m Not Good At Clubbelling.  This is good.  Beginers make progress fast, progress that may transfer over to stability and strength in other areas.
  • Accuracy-  You must be precise when performing a clubbell move.  A wrist angle slightly off is amplified by the length of the club bringing an otherwise acceptable snatch crashing down onto your shoulder. 
  • Grip-  In many moves, you are throwing the club away from the body and stopping that momentum with the strength of your grip.  This move is called The Mill.  When performed with the proper intensity, it replaces an athlete’s hands with what feel like monkey claws.

  • Variety-  Due to the specific angles that can be created at the wrist with this long lever arm, there are infinite applications and movements to train.  
“The night time is the right time. . . “

CONS

  • Perhaps due to their perceived Indian roots, many feel compelled to attach a psuedo-spirituality to the teaching and practice of clubbelling.  See photo.

Plan:

  • Master a few basic clubbell moves that address my shoulder weaknesses (mills, casts etc.)  
  • Add these moves as a supplement to my typical crossfit training
  • As an experiment, compete in a USAW olympic lifting competition and an IKFF Kettlebell Competition in September and see if the clubs lend some universal strength and stability

    If it works for this guy. . .

    You think Mastodons Used Tubing For Shoulder Stability? Dude, They Didn’t Even Have Hands.

    I once had the bad habit of partially dislocating my shoulder.  An MRI revealed a torn labrum in the right glenohumeral joint.  The solution- surgery.  I wasn’t too keen on this as I was a young man bent on playing rugby every weekend.  I decided to give it six months of conditioning (and rugby) to see if I could avoid the surgery and stabilize the joint on my own.  It was the success of this experiment that  led me to where I am today. 

    From my many years spent breaking and fixing myself and subsequent years fixing others, this is what I’ve learned: 
    1)  Isolation movements are boring.
    2)  Things that go unused are not effective. 
    For these reasons, there is only one simple criteria for determining the single best exercise someone should do:   The one that they will perform regularly and with intensity.

    Done regularly, with intensity and over a sustained period of time tubing isolation exercises for the rotator cuff might be the world’s best stabilization exercises ever.  EVER!  The problem is that they are mind numbingly simple and no one has ever EVER stuck with them long enough to be preventative.  When the pain goes away, so does the tubing.  Look at this image below.  Does she look to be having a great time?

    Exactly.

    In your shoulder you want a strong flexible joint, but what the shoulder gains in range of motion, it often compromises in stability.  To maintain the balance of stability and flexibility, you’d be well served to use movements that demand both.  Enter Kettlebell Conditioning.

    I like that Kettlebell movements begin in what is call the Warrior Stance.   The humeral head is pulled deep into the socket accentuating the depth and stability of the labrum.  This is easy to do but difficult to remember.  Stand as far away from a wall as you can and still reach it with your fingertips.  Now keeping your arm straight and without pulling your shoulder up toward your ear, draw your hand away from the wall by retracting your arm deep into the shoulder socket.  Easy right?  Now keep it that way while you perform the following movement:

    The Arm Bar

    This guy’s form isn’t great, but he’s huge so he’s in the post.

    Could you picture this mastodon rocking hard to 80’s glam rock while pounding his external rotators with tubing exercises?  Perhaps he left his medical tubing and his disappointment in the trunk of his car next to his World’s Largest Person trophies and he’s just making do with the Arm Bar in a pinch.  

    If you own KB’s you already do Arm Bars with the KB you own right?  So if this posting is useful for you, you can’t do anything with the information for lack of equipment.  Solution? 

    The Broomstick Arm Bar

    What makes a kettle bell superior to a dumbbell is that the weight is off center.  For that reason when substituting a stick for a bell you don’t hold it in the center.  The longer the stick the greater the stability demands on the shoulder.

    After the press set your arm deep into the socket (warrior stance.)  Keep the stick parallel to the floor and at a 90 degree angle to your torso.  I do it like this:  3 sets on each side without a rest between, just a reset period as you saw above in The Arm Bar clip.  The time spent in the position is determined by the weight you use.  Stay there for several moments beyond your comfort level and rest when it begins to wobble and sway.

    If it takes several minutes to get to that point of fatigue, it is time to make a change.  3 arm bars + 1 Turkish Get Up followed with 2 more arm bars all on the same arm before switching to the other side. That should do the trick.

    The Arm Bar isn’t the only thing out there but it gets results because it’s a challenging functional movement that pushes stability demands and flexibility limitations in the same movement.  Before the next time you sit down to dutifully knock out a long cycle of elastic band rotators ask yourself:
    “What would a mastodon do?” 

    WWAMD?

    Visualization and Mental Practice- Take Off Your Shirt and Charge Around Like You Are On Fire. The Wold Cup Goal Will Be Soon To Follow.

    My first experience with mental training came in the second grade.  I was at recess playing my first game of rugby.  We were uncertain of the rules and it took me only 10 minutes to find a way to break my collar bone.  Clavicle fractures are common and pretty painful.  Where the x-rayed clavicle once held smooth margins it was formed into the shape of a jagged X.  I wore a butterfly brace and initially a sling too.  After a couple of weeks, the orthopedist called my parents to schedule a time for me to come into the office and begin moving the arm again.  My parents were delighted to tell him that I wasn’t available because I was on the mound pitching for my little league baseball team.

    My parents love that story.  They take full credit for my rapid healing due to the fact that they had me practice a healing visualization each night as I went to sleep.  As I remember it I pictured a video game similar to Centipede where I blasted bits of material into the cracked bone.
    

    An example of an effective visualization for manifesting butterflies.

    The world is full of successful people who have built empires or defeated diseases who will tell you that positive visualization was pivotal to their success.  If you think the guy in the picture above got where he is today without some solid mental practice think again.  Bill Starr recently published an article detailing the techniques he successfully implemented in competitive olympic lifting for decades.  Now that he has retired he continues to use these same visualization techniques every night to prepare for for running errands the next morning.  That may appear a little OCD for most people who would rather being doing instead of visualizing but does it really work, and if it does why? 

    The overwhelming majority of research on the topic of mental imagery/ mental practice is supportive and is statistically relevant.  From healing times in stroke victims,(1,2,3) burn victims, (4) depressives (5) to performance based outcome measures,(6,7,8) mental practice has been well studied and its utility validated.

    Based on these studies and many others we could say that Mental Practice “works,” but research is never very good at explaining why something works.  For that, you have to turn away from the measurables of research labs and into the touchy feely world of metaphysics and philosophy.

    Visualization is a skill that improves with practice.  There are many different approaches and step by step models to follow that all basically revolve around visualizing yourself accomplishing a task with as much detail as is possible without getting distracted during the process.  Techniques involve engaging as many of your senses as possible to effectively create the scenario and engage your nervous system. 
     
    It was proposed by Geshe Michael Roache in The Diamond Cutter and in popular New Age films such as What the Bleep Do We Know, and The Secret that any technique can work but only if it effectively convinces some part of your conscious or subconscious mind that the event visualized actually occurred.  This establishes a pathway and a neurological precedent that the body can use and replicate.  Proponents of this theory would tell me that the reason why my Centipede visualization sped my clavicle recovery was because during those visualizations I effectively tricked myself and “felt” as though I was healing faster giving my body no alternative but to go ahead and heal faster.
     
    Also at work here is an idea that the physical world or objective reality is the construct of our internal subjective experience.  Have you ever noticed that some people have it easy because things always turn out well for them?  This idea proposes that it’s the other way around.

    The take home here is not the old “Fake it til you make it.” The intent of which statement is to mislead others about your success until you eventually embody that success.  Instead, the goal is to “Fake it in a way that some part of you believes it.”  The point is to manipulate and mislead yourself so that you will get out of your own way.  Still lost?  Try this out.  To manifest a successful visualization you simply skip the struggle and go straight to the celebration.  Here is an example:

    Only suckers wait for objective reality.  Fire your kids’ soccer instructor.  The four step process of scoring a game winning goal in the 2014 World Cup is simple: 
    1)  Remove Your Shirt.
    2)  Throw Said Shirt Into the Stands.
    3)  Run In Circles As If Engulfed In Flames.
    4)  Wait for objective reality to conform to this otherwise irrational behavior.

    1-http://www.ncbi.nlm.nih.gov/pubmed/21073100
    2-http://www.ncbi.nlm.nih.gov/pubmed/20022993
    3-http://www.ncbi.nlm.nih.gov/pubmed/19608100
    4-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2502071/?tool=pmcentrez
    5-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672052/
    6-http://www.ncbi.nlm.nih.gov/pubmed/16368636
    7-http://www.ncbi.nlm.nih.gov/pubmed/20508474
    8-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2525972/

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