thebodymechanic.ca

the science of kinesiology

Shoulder Impingement Rehabilitation: Part One

by Greg Lehman

Categories: Patient Exercise Sheets, shoulder dysfunction

Tags: impingement, pain, shoulder

Comments: 1 Comment

Published on: January 18, 2021

Audience: Health Professionals and Patients

Source of Information: Paula Ludewig, Ben Kibler, Ann Cools, Rafael Escamilla, Mike Reinold, Kevin Wilks

Disclaimer: The information below really just scratches the surface. References at the end of post are excellent. The point of this post is to get people to think more about culprits of dysfunction when it comes to the shoulder rather than just labeling shoulders with victim diagnoses (e.g. bursitis, tears, “tendinitis” - I hate that word - a future post will address my disdain).

Shoulder Impingement is not a diagnosis. It is a finding and can be both a cause and the result of dysfunction. Impingement is pretty much what it sounds like - something is getting pinched. Ever reach into your back seat or reach to put your coat on and feel a sharp pain somewhere around your shoulder (and often down to your elbow). That is impingement. Some structure under the shoulder blade is getting pinched and does not like it. Who likes to get pinched? (more…)

Stu McGill’s Big Three Exercises for Spine Stability

by Greg Lehman

Categories: low back pain, Patient Exercise Sheets

Tags: No Tags

Comments: 1 Comment

Published on: January 13, 2021

Bird Dog

Audience: Patients, Trainers & health professionals

Utility: Exercise sheet handout for basic spine “stability” training

What exercises: Bird dog, side bridge, curl up

Stability is in quotes because you can certainly debate whether these exercises actually increase “stability”. Or more accurately make the stable system more Robust. What these simple but great exercises definitely do is work the entire trunk and hip musculature without imposing a large compressive or shear load on the spine. The initial research justification for those exercises (almost 16 years ago but they have only been catching on for the past 5 or so) is that they train the spine musculature but do so in a manner that does not increase the injury risk. Many exercises can train the spine musculature (e.g. double leg raises, back hyperextensions) but do so in a manner that might increase your risk of injury. These exercises avoid this which is ideal in a low back injured population. Athletes are a separate kettle of fish. (more…)

Patellofemoral pain syndrome exercise sheet

by Greg Lehman

Categories: exercise biomechanics, Knee Pain, Patient Exercise Sheets

Tags: exercise, gluteus medius, knee pain, physiotherapy

Comments: No Comments

Published on: January 7, 2021

Attached is a basic exercise protocol as part of a large physiotherapy regime I might use for someone with some lower extremity dysfunction. Many of these exercises would be used for non specific knee pain (PFPS, ITB syndrome). The nordic hamstring exercise could be skipped but should certainly be used for anyone with posterior chain weakness/dysfunction. I use that ol’ nebulous word ‘dysfunction’ when something is wrong (e.g. pain) but I’m not willing to commit to some BS therapist jargon about the cause of the problem. You could put in the same room 5 great therapists (physiotherapists, chiropractors, massage therapists, sport med docs) who could all get someone better but they would each explain the problem completely different and often contradict each other. So, I use the general word dysfunction. (more…)

Scapular Retraction/Protraction Exercise Sheet

by Greg Lehman

Categories: Patient Exercise Sheets, shoulder dysfunction

Tags: No Tags

Comments: No Comments

Published on: January 6, 2021

Attached is a simple one page exercise sheet to train the lower/mid trapezius (scapular retraction) and the serratus anterior. The assumption is that these exercises, along with other training and physiotherapy (ART etc), will position the shoulder blade in a better position. Ideally, avoiding forward tilt and a position that may be related to impingement.

Below is the pdf file:

thebodymechanic shoulder retraction basic

Adios,

Greg Lehman

Neuromuscular knee control exercise series

by Greg Lehman

Categories: Knee Pain, patellofemoral pain syndrome, Patient Exercise Sheets

Tags: chiropractic, knee pain, physiotherapy, toronto

Comments: 1 Comment

Published on: January 5, 2021

Audience: Patients

Format: Patient Handouts

Topic: Trunk, hip and knee motor control exercises to improve control of knee position

This post is a handout that I give to patients. As with all exercises they should be done under some supervision (physiotherapist, personal trainer, chiropractor) and always with a health professionals guidance. In no way are these exercises stand alone. They should be tailored to each patient’s needs and progressed or modified accordingly.

Greg (more…)

Why the side lying hip abduction exercise is way overrated.

by Greg Lehman

Categories: Muscle Function

Tags: EMG, exercise, gluteus medius, hip, hip abduction, physiotherapy

Comments: No Comments

Published on: January 3, 2021

Audience: Health professionals

I used to be a researcher (exercise biomechanics, physiotherapy, chiropractic) - one of my goals was to quantify how hard muscles worked during different exercises. This was important for determining which exercises may be best for targeting a certain muscle or determining how modifications to exercises (e.g. doing it barefoot or on a wobbly surface - for a simple paper look here) changed the targeted muscles response.

I used surface EMG which quantifies the electrical activity of that portion of a muscle that was under the electrodes. Surface EMG is messy and you are required to process the crap out of it to get something meaningful. (more…)

The Side Bridge: The best exercise. ever.

by Greg Lehman

Categories: exercise biomechanics, physiotherapy

Tags: hip, physiotherapy, sidebridge, sideplank, toronto

Comments: 3 Comments

Published on: January 3, 2021

Intended Audience: anyone who has not already been doing this for years

OK, OK. There is not just one perfect exercise for everyone. But this one comes close and for reasons you don’t expect. The side bridge is an exercise that is typically thrown into the category of the “core” and people think it is just done as a replacement for oblique ab crunches. While yes, it is a great replacement for that exercise it provides so much more. (more…)

Running Biomechanics - insight into hip flexor function

by Greg Lehman

Categories: Muscle Function, running biomechanics

Tags: No Tags

Comments: No Comments

Published on: December 20, 2020

I just got excited with this old paper by Eva Andersson and my graphic designs (not really) with Adobe Illustrator. Below are some graphics that explain the muscle activation workings of the hip flexors during running. Figure 1 shows muscle activation and hip range of motion during running at 4 metres per second (about a 20:50 5km run). Please note, raw EMG does not look like my blue scribbles - it is just a schematic so back off. As physiotherapists we love to talk about analyzing gait. But I am not sure we really know much about it. I often hear some brutal concepts about running that fly in the face of some pretty old research. This post along with a million to follow will slow build some good foundations of running biomechanics literature.

Figure 2 shows when all of the hip flexors are active during the running gait cycle. (more…)

Jewels from Juker (1998). Insight into the Psoas Part One

by Greg Lehman

Categories: running biomechanics

Tags: exercise, physiotherapy, toronto

Comments: 1 Comment

Published on: December 20, 2020

Stu McGill was an author on this paper when it came out back in 1998. At the time, I was one of Stu’s grad students putting electrodes onto anyone I could find for the price of Gyro sandwich. I even burned (chemically and transiently) the thigh of a girlfriend at the time. I knew how to treat the ladies. Unfortunately, I never really picked Stu’s brain about this paper. It was only relevant to me at the time because we were strongly questioning the necessity of double leg lifts as an exercise for the “lower abs”. We felt they were unnecessary to recruit the lower abs and too costly because of the compressive and anterior shear component applied to the lumbar spine. Our argument was that there is no difference between the upper section of the rectus abdominis and the lower section. I still stand by it and the paper is here ( http://ptjournal.apta.org/content/81/5/1096.full ). Regardless of my youthful oversight, I still love the paper and the ideas of sticking needles into the psoas. It must feel awesome hence the “n” of only 5. Below are a few tidbits that will lead into future posts on psoas function. (more…)

The danger of hip extension - self care for Labral tears.

by Greg Lehman

Categories: hip pain, physiotherapy

Tags: chiropractic, hip pain, physiotherapy, toronto

Comments: 2 Comments

Published on: January 28, 2021

Audience: Therapists, Strength Coaches and Patients

Purpose: Pointing out that not everyone has tight hip flexors and stretching the Psoas may be a very bad thing

Anterior hip pain is common and many of us feel a pinching, catching or inside thigh pain with squatting and other hip movements. Physiotherapists and chiropractors will see this everyday and it is often challenging to treat due to its multifactorial cause. This pain can manifest during walking, squatting (a pinching sensation felt during a squat) or during different exercises. There are certainly many causes and one possible cause of this anterior hip pain is stress applied to the anterior capsule of the hip joint. In severe cases this can lead to what is called a labral tear. Functionally, you can refer to the dysfunction as excessive anterior femoral glide. (more…)

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