Preventive Therapy: Levator Scapula Stretch

The levator scapula is a small banded muscle responsible for upperward rotation of the shoulder blade during arm function. However, this muscle is usually very tight and full of trigger points due the modern lifestyle and poor posture. Stretching this muscle can decrease headaches, trigger points, sore neck & shoulders, and even prevent repetitive injuries.

1. Place your right arm behind you.
2. Tilt and turn your head to your left.
3. Gently nod your head forward. You should feel a stretch on the right side and back of your neck.
4. Bring your left hand over the top of your head and pull gently leftward and downward.
5. Hold this position for 30 seconds and take slow deep breaths.
6. Reverse the directions to stretch your left side.

Remember, stretches must be held for at LEAST 30 seconds to create physiological change. This takes a minute of your time to stretch both sides of your neck. Doing this stretch every hour will absolutely change the way your neck and shoulders feel on a day to day basis.

Dr. Fung’s Five Fingers Experience

From a cursory glance on the web, social media, streaming channels, and on the running trail – one can quickly notice the growing trend of barefoot running and the minimalist shoe movement. Currently, the “Five Fingers” fascination is in relative infancy and predictably, as with any emergent phenomenon, is under initial skepticism and scrutiny which is well matched by fandom and craze.  Caution to new explosive trends is wise as many entities in the past have tried to pass their own version of the magic pill, secret serum, or superman exercise apparatus – each debunked over time. As time passes, controlled trials and repeated research will be combined to give the public a middle ground conclusion on the matter which will be revisited every decade or so with gentle sways in the valence of support or caution. Despite the science, there is a very human element that needs to be addressed in the world of human movement and physical health.

As a clinician, I hold myself to the standard that I will never ask my patients or clients to do anything I wouldn’t do myself or ask of my loved ones. Since the minimalist trend has piqued my interest, I’ve been looking for a way to satiate my curiosity of the “five fingers” experience. My interest in barefoot mechanics stems not only from clinical curiosity, but also from my early life experiences in martial arts and my background in surfing - both which are primarily done in barefoot or minimalist footwear. Additionally, there are a good number of high performance sports of which athletes participate or train barefooted, or, in minimalist footwear.

Thanks to a Twitter connection with @MoveFowardPT and Pacers Running Stores (@RunPacers), I was finally able to procure a pair of Vibram® Treksport and experience it for myself.

The first thing I did once I got my Vibram®’s was take a quick trot around the neighborhood. I noticed immediate differences in my gait and running mechanics. I then decided to test it for some prolonged ambulation. 6400 steps later (according to my pedometer), I noticed definitive activation of my foot instrinsics and that much of my weight bearing occurred in the forefoot. Additionally, I felt that my weight acceptance during each stride was much more evenly distributed over time; it felt as if was I walking “softer” and “smoother” – my family stated in jest that I was walking around like a ninja.

I followed this little experience with a basic pair of flat sneakers to compare the difference. While the only “strain” I noticed using the Vibram®’s was increased forefoot use, I noticed in less steps an unsettling experience in left hamstring/gluteal fatigue, poor eccentric control during heel strike, lazy posture, and bilateral medial arch & hindfoot soreness. I did not expect such a pronounced difference between the two types of footwear.

For high mileage bipedal travel, I typically wear running shoes and use a custom foot orthotic due to my generously flat medial arches. However, what tends to happen with orthotics is that my feet are simply supported by the device - much like a sling or a splint. The difference I specifically noticed with my “finger shoes” is that the device was able to work WITH my feet; the subtle tension when wearing my Vibram®’s gave me the perception of increased proprioceptive sensitivity.  This was a familiar sensation for me. It actually reminded me of when I train kettlebells, barefoot in the sand. I was compelled to mix the two to top off my Five Fingers Experience and find out for sure. Indeed, training kettlebells, using Vibram(R)’s allowed for a more sensitive proprioceptive experience during exercise. For those of you who haven't tried performing heavy snatches or windmills in the sand - try it! It will blow your mind.

It may be too early to make a definitive judgment of the Five Fingers Experience, however, I offer an analogous anecdote in my experience with kettlebells. It goes without saying that I highly support the use of kettlebell exercise as a mode for fitness, physical therapy, and corrective exercise. However, I do not prescribe kettlebell exercise to ALL patients or clients; only those who are appropriate and would benefit from the exercise receive instruction.  Similarly, my initial impressions of the Five Finger’s experience is that it certainly has its place in the world of fitness, health and wellness. For my own two feet, the Five Fingers experience was definitely a positive one; I traded out soreness at the medial-arch & hindfoot for increased use of my instrinsics and a slightly sore forefoot.

Only time will tell what the scientific literature makes of the barefoot movement - not to mention what prolonged use of the "finger shoes" will do to my body (you can be sure I will blog on that experience when it comes). If history is any measure, there will always be several trains of thought regarding the minimalist footwear experience. However, when it comes to application, it all comes down to matching this experience to the right person, in the right manner, for their best outcome.

Cyber PT collaboration with Kettlebell Therapy™

Cyber PT has been kind enough to publish one of Kettlebell Therapy's most popularly read articles, "Restoring Movement with Natural Physics" by Dr. Ben Fung, PT, DPT.

Kettlebell Therapy^TM: Restoring Movement with Natural Physics

As a Physical Therapist, I have used kettlebells to rehabilitate and promote health in individuals with low back pain, shoulder impingement, ankle sprains, medial knee pain, myocardial infarction, mitral valve replacement, and much more. Who would have thought that a cast iron ball would be so clinically effective and versatile?

Like most people, when I first saw a kettlebell, I was simultaneously confused and amused. My first exposure to kettlebells happened at a martial arts seminar in San Diego when one of the instructors lugged out a 53 pound iron-wrecking-ball with a handle fused to the top of it. He called the object a “kettlebell” – it looks like a tea kettle and it swings like a church bell. He began a demonstration and spoke on the benefits and martial arts applications of kettlebell exercise. I had little interest in new trends and was much less inclined to try it out myself – that is, until I saw one of the seminar leaders struggle with the most basic and foundational exercise, the ballistic kettlebell swing.

The rest of "Restoring Movement with Natural Physics" is available on Cyber PT at:
http://www.cyberpt.com/kettlebell_therapy.asp

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Swinging Away Back Pain

I'm pleased to present another Kettlebell Therapy™ article on the Physical Therapy Web Space titled "Swinging Away Back Pain".

There have been estimations stating that 80% of Americans will experience back pain some time in their life¹ (Web MD, Mayo Clinic). Choosing an appropriate therapeutic corrective exercise to address back pain can be quite the conundrum. One of the many goals in addressing back pain with movement is not only to modulate the pain, but to keep the pain at bay during functional activities. Of the many therapeutic exercises available to address back pain, preserving functionality can be a challenge. Correction during specific and isolated movements is more easily achieved than it is maintained during an actual functional performance.

As therapeutic relief and maintaining correct movement are central goals in movement based therapy, an ideal exercise for a back program would be that which both relieves pain and prevents further injury by fortifying functional spine mechanics. Kettlebells have recently garnished considerable attention in the world of Physical Rehabilitation. Despite the kettlebell being nothing more than a cast iron wrecking ball with a handle on top, there have been studies exploring kettlebell exercise for lower extremity sports rehabilitation², musculoskeletal health³, and cardiovascular exercise response^{4, 5}.

Read more at http://physicaltherapyweb.com/articles/kettlebell-back-pain.php

The Kettlebell Connection

Before I begin this post, I want to thank all of my readers, followers, friends, and of course my family, for the overwhelming love and support you’ve given during this time my wife and I have been dealing with our recent miscarriage. In our age, the social connections we make go far beyond that of physical presence; the willingness to bond across these new digital frontiers truly demonstrates the generous capacity to share the human experience in ways we are only beginning to understand. One thing is for sure: this experience can be shared at the deepest and kindest levels of sympathy.  Again, all my thanks to YOU!

Last week, I had the pleasure of sharing energizing hours of conversation & interaction across two separate days with Dr. Tim Olson, PT, DPT, CSCS.  Dr. Olson and I found in our discussions a common passion for functional movement, physical performance, and innovative systems for the Physical Therapy profession at large.  Of course, when talking with yours truly, you can hardly get away from the inevitable conversation about kettlebells. Naturally, the topics included the physical rehabilitative qualities of kettlebell exercise, the physics of the kettlebell tool itself, and the various treatment diagnoses of which kettlebells are of benefit.

During my time with Dr. Olson, I found him to be an exceptional expert of human movement and outside-the-box thinking.  From the stimulating discussion and several challenging questions, my eyes were opened to some expanded concepts of integrating kettlebells and Physical Therapy.

Three Lessons from the Kettlebell Connection with Dr. Olson:

• In addition to the Natural Physics of kettlebell exercise, kettlebells have an innate property to produce proper form during and after exercise. The kettlebell tool itself also acts as an ongoing source of biofeedback (visual and somatosensory) which can produce superior movement when other sources and techniques of facilitation and instruction have been exhausted.  This is most convincingly seen in exercises such as Bottoms Up activities and the Turkish Get-Up. Unlike dumbbells, barbells, cables or resistance bands, the distance between the handle and the center of kettlebell mass provide an additional kinetic chain where the gravitation pull on mass is off-center when grasped. This causes the body to continually adjust and re-adjust with every movement and acts upon the body in a manner which seems to serve as it own form of proprioceptive neuromuscular re-education. This discussion lead to lesson #2.

• Sometimes the simplest approach is the best approach (ie. K.I.S.S. – Keep It Simple, Stupid).  Many times, the threshold for over-thinking, over-repetition, and over-facilitation is far lower than one would otherwise anticipate. Many times, conscious body movement is its own greatest enemy when aspiring to improve functional performance. Training movement in simple, automatic terms rather than attempting to force the body in sequentially complex arrays often yields superior results in a time efficient manner.  That being said, the kettlebell is arguably one of the simplest exercise tools ever conceived. And yet, in an age of technological wonder, the breadth of potentials when using a simple kettlebell is plain impressive.  The simplicity of the kettlebell’s design and the numerous available applications pose an interesting question when faced with availability of advanced technological complexities: Could it be that the humble tools pave a clearer path to the serenity of human performance?

• Simplicity in design demands wealth in wisdom. Dr. Olson pointed out that many kettlebell exercises seem related if not overly similar when seen at a glance. In general, kettlebell exercises can be categorized by the emphasis on the focused attention or combination of: ballistics, power techniques, dynamic stability, core strengthening, mat based exercises, prone based exercises, sports specific, and tactical. Of these various categories, each branch holds a core familiarity of technique and form. An obvious example is how the dead lift progresses to the pre-swing which progresses to the swing, then the clean, then a high pull, then a snatch. I have always held the operational definition that “Wisdom is knowledge applied.”  The ballistic progression for kettlebells is a great example of how multiple principles of exercise science sublimely unite during application:

1. Overloading Principle: Kettlebells are dense heavy objects which tend to be heavier than objects manipulated in every day life. Additionally, the exercise techniques used with kettlebells are done in movements far more explosive and intense than that of normal every day life.
2. Individual Response Principle: Kettlebells must be customized to each individual per exercise and per progression. Kettlebells which are too light allow for individuals to “cheat” and “muscle” the kettlebell to mimic proper form. An easy way to check if a beginner is cheating on the swing is to add another kinetic link to the swing itself by looping a towel or rope around the handle of the kettlebell. If the beginner is indeed cheating, the bell will droop downward with gravity as the individual can no longer death grip the kettlebell into submission during the swing itself.  This principle holds true in the opposite extreme; kettlebells which are initially too heavy for beginners are simply dropped during exercise or self-limiting due to form.
3. Adaptation Principle: While many kettlebell exercises may seem similar at a glance, the intricate biophysics for each variation is highly different as experienced by the body.  With careful instruction, a small circuit of the various categories of kettlebell exercises can prove to be an extremely challenging feat even when performed by the most veteran of kettlebellers.
4. Specificity Principle: As discussed in my “Restoring Movement with Natural Physics” article, a major advantage of working with kettlebells is that we train our bodies in the same physics as the functional activities we strive to improve upon.  This training effect carries over for better performance during function and can be easily adapted for each specific sport, activity, tactical situation, functional movement, or activity of daily living.

My time with Dr. Olson was a refreshing and rejuvenating experience.  To strengthen oneself, one must sharpen iron with iron; being challenged is as important as being inspired. Many times, they are one in the same.  My interactions with Dr. Olson generated for me a deeper consciousness of human movement and functional performance. I express my sincere appreciation and humble thanks to Dr. Olson for his time, his thoughts, and his passionate dedication to his profession, his colleagues, and his patients.

Dr. Tim Olson, PT, DPT, CSCS provides a holistic Physical Therapy service through METROSPORT Personalized Physical Therapy. For more on Dr. Olson and his unique private practice, please visit: http://metrosportpt.com/ and follow Dr. Olson at @timolsonPT.