I arrived back to Boston late last night from London and I’d like to say I woke up today well-rested and ready to wow everyone with some witty fitness prose.
I’d like to say that.
Not gonna happen today. I’ve got a ton of emails and programs to catch up on, but that doesn’t mean I don’t have any content prepared for you today. Andrew Millett, good friend and Boston based physical therapist/strength coach was kind enough to send along this baller post today.
You’ll love it.
It’s a Warmup, Not a Social Hour
I got the idea for this post after recently attending the Advanced Warm-Up and Recovery Workshop put on by Matt Ibrahim and Dr. John Rusin. I didn’t know what new things I may learn at the workshop, but after taking pages of notes and getting new ideas for my clients and patients, it was definitely worth it.
You walk into any gym or fitness facility and you will see people warming-up on the bike, treadmill, elliptical, or maybe even rolling around on the foam roller. It is great to see people putting in the time and effort to consciously warm-up their musculoskeletal, nervous, and circulatory systems prior to engaging in their exercise routine.
The key word in that last statement is:
Too many times, people warm-up without any direct goals or agenda in mind. They hop on one of the aforementioned cardio machines and watch TV or read a magazine and aimlessly pedal or step until they think they are ready to exercise. If they are on the foam roller, they probably roll around on it like they are rolling out pizza dough or look like a boy scout trying to start a fire with 2 sticks.
When you are working with a client or are performing a warm-up in your own gym routine, there needs to be a specific goal in mind while warming-up prior to your exercise session.
First off, we need to assess our clients to see what areas they may be lagging in. Here are a few quick and easy tests to see if there are any areas that need to be targeted for some type of self-myofascial release.
In the sagittal plane, the ankle needs to be mobile. It needs to be able to plantar-flex and dorsiflex for the demands of life as well as demands in the gym.
In order to perform a squat without compensations, the ankle must be able to dorsiflex and allow the tibia to translate anteriorly as the person descends down in the bottom position. To determine if someone has adequate ankle dorsiflexion, try the Knee to Wall Test.
Knee to Wall Test
You instruct the client to place their foot on the tape strip. On the tape strip, there are 4 lines, each 1-4 inches away from the wall.
Start with the client’s foot on the “4” line. Four inches is required for adequate dorsiflexion in order to perform the squat.
Tell the client to try and touch their knee to the wall without letting their heel come up. Also, make sure they are going into valgus or varus movements at the knee to potentially compensate for lack of dorsiflexion.
If someone cannot reach from the “4” line, then have them move up and determine where they can reach from. Then test the opposite side.
If they cannot reach, ask them where they “feel it.” If they feel they can’t go any farther due to tightness in the back of their ankle, then we know that some of the soft tissue structures on the posterior aspect of their lower leg could be to blame.
For that, some type of self-myofascial release (SMR) to the soleus, posterior tibialis, flexor hallucis longus/flexor digitorum groups could help to improve range of motion at the ankle.
If they feel a pinch on the anterior aspect of the ankle, that could potentially be a joint mobility dysfunction.
Try a Banded Ankle Mobilization.
Start by placing a thick superband around a post or squat rack; something that can’t move. Then place the band at the ankle joint, just inferior to the medial and lateral malleoli. Place a good amount of tension on the band. While maintaining this tension, recreate the same movement as if you were performing the knee to wall test. Go as far as you can comfortably go. Hold for 2-3 seconds when you can’t go any farther. Return to the starting point and repeat for 6-10 reps.
Then retest the Knee to Wall Test.
If it improves, then we know the Banded Ankle Mobilization worked. Whether it improved or not, it might be wise to refer out to a licensed healthcare practitioner to further assess the ankle to determine what may be limiting that motion.
If there has been an improvement in ankle mobility, we want to be able to control that “new found” mobility.
Try the Heel Raises with Single Leg Eccentric. I first saw this from Dr. Ryan DeBell of The Movement Fix.
– Perform the movement slow and controlled.
-When your foot is are parallel to the ground, slightly flex the knee and go slow and controlled towards the ground.
-Imagine like you are slowly pulling your heel to the ground.
At the hip, we need to determine a few different areas of mobility. Starting in the sagittal plane, we need to determine if the client has adequate hip extension. If the client doesn’t have adequate hip extension mobility, they will have a more difficult type using their gluteal musculature to perform some of the movements we ask them to.
In addition to not being able to effectively activate and use certain muscles, lack of hip extension mobility can place increased stress on the lumbar spine and the knees, as well as some other more distal joints. By ensuring the client has adequate hip extension mobility, then we know some of the other joints of the body will be able to function properly.
To determine if someone has adequate hip extension mobility, we have two different options. First off, you can perform the ½ Kneeling Hip Extension Test.
VID ½ KNEELING HIP EXT TEST
Have the client place one knee down on a padded surface and the other knee up. Instruct them to contract their gluteus maximus on the down leg side, brace their abs, and slowly bring the hips forward.
We ideally would like to see 30 degrees of hip extension on the trail leg. You can use the Inclinometer App on the Iphone to measure the angle.
You can also perform a Thomas Test. This is a test that is typically taught in physical therapy schools to determine hip extension mobility.
*Disclaimer*: First off, you need to ask your client if they are okay with you placing your hands on them to assess their hip mobility.
Self Thomas Test (and Sick Beats)
You are going to have the client lie supine on the side of a table or bench. Have them hold their knee at 90 degrees of hip flexion, or at hip height. Place your thumb on their Anterior Superior Iliac Spine (ASIS).
Using your other hand, slowly lower the leg the client is not holding with their hands.
If you can lower their leg to the level of the table and their ASIS does not translate anteriorly, then we know they have adequate hip extension mobility.
If you lower the client’s leg and their ASIS DOES translate anteriorly prior to the leg reaching the level of the table, then we know there is some muscle group limiting hip extension.
To determine, which muscle group, then we need to change the position of the lower leg.
If we extend the knee and perform the same test, this will place tension on the Psoas and Iliacus muscle groups. If you lower the leg with the knee extended and the ASIS translates anteriorly, then we can determine Psoas and Iliacus are to blame for decreased hip extension mobility.
If we lower the leg and the ASIS doesn’t translate anteriorly, then the only other muscular group to blame would be Tensor Fascia Latae (TFL).
To test for this, we slightly abduct the hip and perform the same test. If the ASIS translates anteriorly, then we know TFL is to blame.
If we run through all of these tests and each test with the knee extended doesn’t cause anterior translation of the ASIS, but when the knee is flexed it does, then we can determine that Rectus Femoris is to blame.
To improve hip extension mobility, try SMR to whichever area you determine to be problematic.
SMR w/ Lax Ball to Iliacus/Psoas & TFL
SMR to Rectus Femoris
SMR to Vastus Lateralis & TFL
Then re-test to see if any of these SMR variations improved the client’s hip extension mobility.
Once someone’s hip mobility has improved or is normal, we want to make sure they can stabilize in that mobility.
The Cook Hip Lift is a great movement for accessing and stabilizing hip extension mobility.
-Place a ball in your hip crease.
-Use non-stance leg to keep ball in hip crease.
-Lift hips up off ground. Do not let ball fall out
-Perform for 8 repetitions per side.
The thoracic spine is another area of the body that needs adequate mobility. If it doesn’t present with adequate mobility, areas of the lumbar and cervical spines and the shoulder can be affected. It is one of the most influential areas of the body because of the impact it can have on so many different areas.
To determine if your client has adequate thoracic spine mobility, it is best assessed in quadruped using the Quadruped Thoracic Rotation Test.
Normal thoracic rotation in the general population should be 50 degrees. To measure this, use the Inclinometer app and place it ½ way between both shoulders on the thoracic spine.
When you are passively bringing them through the movement, make sure there is no lumbar movement such as sidebending occurring as this will skew your measurements. Also, gently rotate the client. Don’t try to force rotation on someone that may not have it.
If the client does not have 50 degrees of thoracic rotation, there are various thoracic spine mobility drills that can be performed such as:
A-Frame T-Spine Mobilization
Side Lying Thoracic Rotation
Side Lying Rib Roll
If the client has 50 degrees or more of passive rotation, but less than 50 degrees of active rotation, a thoracic spine motor control drill can be performed.
Drills such as:
Quadruped Assisted Thoracic Rotation
-Perform slow and controlled.
-Make sure not to side-bend through your spine. Make sure to rotate through mid-back.
Seated Assisted Thoracic Extension
-Squeeze ball between your knees.
-Slightly turn away from where band is attached.
-Slow and controlled, allow band to rotate body.
The last pertinent area of the body to address in a warm-up is the shoulder. Limited shoulder mobility in shoulder flexion, abduction, or internal/external rotation can affect function at the shoulder, cervical spine, thoracic spine, and even the lumbar spine.
To assess the shoulder, movements such as:
Supine Shoulder Flexion Test
Supine Shoulder ER Test
If there are limitations in mobility, performing self-myofascia release as shown below can help:
Once mobility has been improved, now we want to make sure we can use that mobility. Performing movements such as:
Back to Wall Shoulder Flexion
-Maintain low back flat to the wall.
-Raise arms up and when the reach shoulder height, gently reach 1 inch in front of your finger tips.
-Continue this gentle reaching as you continue to raise your arms overhead.
Forearm Wall Slides
-Slide arms up the wall.
-When your elbows get to shoulder height, gently press into the wall/push your trunk away from the wall.
-Maintain the pressure on the pinkie side of your hand as you slide up the wall.
Quadruped Assisted Reach Roll and Lift
-Perform slow and controlled.
-Slowly reach out. Rotate palm up to the sky. Slowly raise arm up.<
Yoga Push-Ups Sans Pushups
-Think of pushing the ground away from you with your hands.
-Should be felt in your upper back and out and around your rib cage.
If you have no mobility limitations in any of the aforementioned areas, feel free to use the motor control or stability drills to help primer your nervous system to prep you for your lift.
There you have it! Create a plan for your warm-up, do said plan, and then go and get after your training!
About the Author
Andrew Millett is a Metro-West (Boston) based physical therapist
Facebook: From The Ground Up