The Best Position for the Stack – A Case Report

Many times if you don’t get the result you are looking for movement-wise, it is often related to losing the stack (and not talking to Zac). How do you know where the failure occurred? That’s exactly what we sift through in this video. In it, we walk through a failed case, and look at where tweaks could be made to improve the outcome. Watch it to learn more! Looking at each component of the stack In this case of a person with shoulder pain, we look at some of the big limitations this person had: Decreased shoulder internal rotation biliaterally Decreased left shoulder external rotation Narrow infrasternal angle From here, you then need to look at each piece of the stack to determine how to design the activity with the best possible chance of success. What are those components? I’M GLAD YOU ASKED!! Here are the pieces we focus on for the stack in order of importance (though fam, you need to build it all!): Pelvic positioning Full exhale Pause and inhale with ab tension and relaxed upper thorax Reach without crunching Now based on what we need to maximize this person’s movement options, we can then engineer exercises with a high probability of increasing available movement. The keys we need to respect are restoring external rotation before internal rotation, respecting their anthropometric structure, and address asymmetry (shoulder rotation limitations indicate this person has a right rotation bias). Therefore, we can engineer activities that can create high odds for success:

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Improving Hip and Shoulder Internal Rotation WITHOUT STRETCHING!

Having shoulder and hip internal rotation is kind of a big deal. What if you could get it as quickly as possible without a single stretch? That’s exactly what we did in this case. I work with someone who is unfamiliar with my techniques, and in 3 moves (1 of them a failure), we were able to increase shoulder and hip internal rotation. Watch the video below to learn what we did. Case overview The “patient” is my nephew, Brad. He’s a football player and wrestler who is just a stiff bro. No pain. Objective findings Brad’s main initial findings were the following: Test Left Right Infrasternal angle narrow Shoulder flexion 155 155 Shoulder external rotation 95 95 Shoulder Internal rotation 90 50 Hip flexion 95 95 Hip external rotation 60 60 Hip internal rotation 10 10 Straight leg raise 65 65 Intervention selection Given the findings above, are major keys to focus on were making the infrasternal angle dynamic and restoring internal rotation. Brad appears to be a classic narrow infrasternal angle. Lewit tilt I chose this move because the 90 degree angle at the hips biases internal rotation. The supine position promotes lateral ribcage expansion, which is great for narrow infrasternal angles. If you want a super in-depth reasoning for this move, check out this post. After performing this move, B’s test results were as follows (improvements are bolded): Test Left Right Infrasternal angle narrow Shoulder flexion 155 155 Shoulder external rotation 95 95 Shoulder Internal rotation 90

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Movement Analysis and Breathing Strategies for Pain Relief and Improved Performance

Chris, a high level mountain biker, at first didn’t believe someone could help him move better over the internet. He had back issues for a hot minute, what the heck was an online consult going to do? A couple consults later with me, and Chris is pain-free, back to doing all the wild and crazy things he was doing before without issues. Chris was so juiced up about his results that he wanted to learn more about my thought process and what I do that he had me on his podcast. Chris Kelly is the owner of Nourish Balance Thrive, a really cool site that brings several great practitioners together to help clients remotely with whatever their goals are. Despite Chris technically not being in the field, he’s one of the best interviewers I’ve had the pleasure of podcasting with. He asked some great, unique questions, and we got into a wide variety of topics. Here are some of topics we discussed on the podcast: Ben House and Flō Retreat Center in Costa Rica How I got into physical therapy. The influence of Bill Hartman. Working with NBA basketball players. The influence of Dr. Bryan Walsh. Sleep and performance How to treat pain Assessing movement Movement variability The online assessment process Pain vs. tissue damage How we improved the host’s chronic lower back pain The importance of the pelvic floor What is considered normal breathing How to promote behavior change in our clients Applying the principle of minimal effective dose

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Wrist Pain, Dry Needling & Taping, and Should I Become a PT? – Movement Debrief Episode 90

Movement Debrief Episode 90 is in the books. Below is a copy of the video for your viewing pleasure, and audio if you can’t stand looking at me. Here is the set list: Why does wrist discomfort occur with weight bearing? What limitations could contribute to wrist discomfort? What modifications can I make to improve wrist discomfort? What regressions are useful for wrist discomfort? Do I use dry needling or taping? If and when do I find these modalities useful? Is it worthwhile becoming a physical therapist? What is it really like being a PT?

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Refer In: When Trainers Can Work with People in Pain

It is a common recommendation to immediately refer clients in pain to a medical practitioner. However, immediate referral is oftentimes not warranted, and in certain cases is discouraged. But as a trainer, how do you know when a client’s pain is a medical problem, and when is it not? With today’s podcast, I hope to answer that question for you, as well as give you tips on working with people in pain, and collaborating in a manner that is in your client’s best interest. Enjoy, and check out the modified transcript below                  Modified Transcript If you are a trainer, and your client has pain, what should you do? Well I’m glad you asked. Many people on the interwebz will make the claim that if your client has pain, you should refer. The reason why this claim is made is 1) because you do not want to make your client problem worse; 2) you also want to cover your ass. If you do something and your client’s problem gets worse, you could potentially get sued. That’s why people say “when in pain, refer out.” I think that this claim is bullshit, and here’s why. Reasons why immediate referral can be problematic There are three negative consequences when you pull the referral trigger too early. Pain does not equal tissue damage This claim assumes that pain and tissue damage are synonymous. If you listen to my talk, Practical Pain Education, you would find that

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Social Media Resources

I was asked recently about how I utilize social media.  Namely, who I follow, why I follow them, so on and so forth. Up front, I do the best I can to limit my time on these platforms exposure. As we all know, it is very easy to get sucked into a rabbit hole of walls, posts, cats of Instagram hashtags, etc. Before you know it, it’s been four hours and you missed the most recent episode of “Days of Our Lives.” Secondary to the inevitable timewarp that you can be pulled into on social media, I utilize each platform with various goals in mind. This helps me stratify my consumption, and provide me the most relevant information.

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Thoracic Outlet Syndrome, New Grad Advice, and Interview Questions – Movement Debrief Episode 21

Movement Debrief Episode 21 is in the books. Here is a copy of the video and audio for your listening pleasure. Here were all the topics: The step-by-step process of treating someone with Thoracic Outlet Syndrome How to leverage your strengths as a new grad searching for a job Why new grads need mentors My favorite questions to ask interviewers and to find out about a company If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 8:30pm CST. Enjoy.                  Here were the links I mentioned tonight How to Design a Comprehensive Rehab Program All About Jobs – Movement Debrief Episode 20 “The Briefcase Technique” by Ramit Sethi Join my mentorship program, get a movement consultation, or let me design an online fitness program for you. Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:   Thoracic Outlet Syndrome New Grad Advice Interview Questions

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