Doug Kelsey's Blog

The Staff Lunge

The Staff Lunge is a form of the Overhead Lunge (typically done with a barbell or dumb bells), also sharing its form with the Crescent Lunge from Yoga, but is performed with a  dowel about 1.5 inches in diameter and three to four feet long.

To perform the Staff Lunge:

• Stand with your feet about shoulder width apart.
• Grasp the staff with hands slightly wider than shoulder width. 
• Raise the staff over head with elbows straight.
• Brace the abdomen as if you're about to get hit in the stomach and hold the brace throughout the drill.   
• Step forward into a lunge position focusing on maintaining balance and keeping the leg from wavering in or out (see image). 
  •  Keep the arms straight overhead. 
• Return to the starting position by pushing the heel into ground like you're trying to drive the ground away from you. 
• You've completed one repetition. 

This drill is surprisingly difficult. You might think that holding a wooden dowel would be just a bit harder than holding match sticks but it's not the dowel that makes it more difficult. It's the position of your arms and disturbance in balance.

When you perform a standard lunge with arms at your sides, the load of the arms adds little to the drill since the arms are so close to the body (center of gravity). But, with the arms overhead, the load increases by about 6-8% of your body weight. So, in my case weighing in around 200 lbs, the dowel adds about 12 lbs of extra load.

With both arms overhead, your balance is challenged especially if you have any flexibility limitations in your thoracic spine, or hips. To maintain your balance, your muscles contract quickly in multiple areas adding to the level of fatigue.

Of course, using a barbell and adding weight magnifies the difficulty. I suggest mastering the Staff Lunge first especially if you struggle keeping your arms overhead. You'll not be able to manage any additional load very well if the arms move forward during the lunge.

CONSIDERATIONS

Cervical Spine: Any time you lift your arms overhead, you increase the pressure in the cervical spine due to contraction of the deep spinal muscles and the more superficial scapular muscles such as the Levator Scapulae. People with degenerative disc or joint disease may need to start with one arm over head then progress to one arm with a light weight.

Shoulder: The last 20 to 30 degrees of shoulder flexion come from the thoracic spine. So, if the thoracic spine is relatively inflexible, when you perform the lunge, you may have difficulty holding the staff over head; the shoulders may drop some (from fully flexed to a less flexed position). The cure for this is to improve thoracic flexibility; not stretch the shoulder.

Lumbar Spine: Tight hip flexors on the side opposite of the lunging leg may increase compression in the lumbar spine by tethering the pelvis in a relatively anterior position. Pay attention to the curve of the spine. It should be smooth with no sharp angulations. Bracing the abdomen protects the spine so pay attention to fatigue in the brace. Improving the flexibility of the hip flexors will help but you may have to shorten the lunging step in the meantime.

Hip, Knee, Ankle: Your joints must tolerate body weight force, at least, for this drill to not overload one or more joints. If your hip is weak, the femur will rotate (adduct or abduct) during the lunge. If you lack talocrural dorsiflexion, pronation will increase usually in the forefoot which may also cause some femur motion. 

The Push Up

Why do a push up? Well, it's simple, portable, and stresses multiple body parts. You develop strength in the arms, trunk, neck, and lower back.

But, push ups, like any exercise, can can help you or hurt you depending on how you do them.

To perform a push up properly:

• Assume a hands and knees position on the floor with your hands aligned beneath and just outside your shoulders; fingers pointing straight ahead.
• Get up on your toes with your feet together; knees straight; hips in line with the trunk and knees.
• Look at the floor but keep your head in a straight line with your trunk, hips, and legs. 
• Brace the abdomen as if you're about to get punched and hold the brace through the drill.
• 
• Lower your self to the floor.
  • Keep your elbows from moving past a 45 degree angle to your trunk.
  • Stop the motion when your upper arm is even with the side of your chest (the drawing shows the elbows past the chest which in my opinion is too far; the head is also sagging too much).
• Push your self back to the starting position - that is one repetition.
  
• Repeat until
  • You cannot maintain the form or,
  • You cannot complete a repetition.

Form failure is common. If you allow the elbows to flare out form the side, the push up becomes easier but the stress on your shoulder joint goes up. If the exercise is too hard, you'll either allow your trunk to sag between your arms or you'll drop your head toward the floor or your lower back will sag (picture at the right has all three). Many trainers teach that you should touch your chest to the floor but, for most people, this places the humerus into extension under significant load and provides an unnecessary risk of injury to the shoulder.

Another biomechanical fault, but one you can't see your self, is a winging scapula. You may be able to hold the head, trunk, hips and knees in a straight line but the scapula could still be tilted off the chest wall. When this happens, the scapula also tilts anteriorly and increases the risk of impingement in the subacromial space.

The push up uses about 70% of your body weight as resistance and I think that until you can do at least 30, there's no need to do things like bench presses (and I question the value of it at all). A push up forces you to control more of your body and is plenty of load.

If you can't do a push up or can't do very many, start at an incline (e.g. on stairs). Find the angle where you can perform 15 repetitions. Do three sets of these every other day until you feel that 15 has become only moderately difficult (and you'll know this because you won't scrunch up your face or make noises). Then, lower your self down a step. Repeat this until you get all the way to the floor.

I've also used a Total Gym (the newer models have handles on the side of the sliding board) to reduce the push up load. I like the position - hands are under the shoulders; wrists are neutral; elbows tend to not flare out to the side. I helped a friend go from 0 push ups on the floor to 10 in under six weeks using the Total Gym. 

How many should you do? Well, that depends on your age and gender. I'm 52 and to place in the 90th percentile, I should be able to do 30 push ups; women should be able to do 25 modified push ups (on the knees instead of the toes). So, if you're younger, shoot for 40 or 50; older aim for 20 to 25.

And, what about speed? Some people claim you should perform push ups slowly (4 seconds down and eight seconds up for exmple). I don't know of any evidence that says a slow push up is any better than a faster push up. I prefer to use a "fast as you can" approach which means speed without sacrificing form.

CONSIDERATIONS

The wrist:

• I also like to use push up stands to place the wrists in a more neutral position. Most joints don't like to be stressed repeatedly at the end of range which is what push ups ask the wrist to do. Mid-range is less stressful.

The elbow:

• Hand positions that use internal rotation of the shoulder will create much higher forces in the elbow and should be avoided.

The cervical spine:

• Degenerative joint and / or disc disease of the cervical spine can be aggravated by the loads created in the cervical spine during a push up. The force of gravity wants to pull the head into flexion which is actually a rotary force. Your cervical muscles combat this rotation which increases stress on the cervical spine joints. And, the levator scapula muscle, which arises from the cervical spine, assists in abducting the scapula but to do this, it uses the cervical spine as a base from which to pull the scapula. This creates increased pressure in the neck and may create neck pain.

The shoulder:

• For people who have a history of multi-directional instability of the shoulder or posterior impingement, push ups can create too much posteriorly directed force in the glenohumeral joint. Make sure that the scapula is well positioned and that there's no sign of the humerus migrating posteriorly during the push up.

I'm on Twitter...

I'm tweeting these days. And, if it's new to you, it's equally new to me.

Twitter. What can I possibly have to say in 144 characters that you'll care about?

Twitter is what I first thought about blogging. Who cares? Who will read it? Who wants to know what I think or know or do? I was really wrong about blogging so there's a good chance I'm wrong about tweeting.

I joined Twitter in May 2008. I squeezed out one tweet and then thought, "This is stupid. Who cares?"

Well, you and I might be surprised. I'm not sure if you care about knowing that I just finished brushing my teeth, but you might care about how coffee is good for your brain (my latest tweet).

You can follow me on Twitter here.

DK

Details on Thoracic Spine Flexibility

Reader Jim asks:

"A couple questions about this.  I tried it this morning (after my body had had a chance to warm up a bit from sleeping).  I got to about 120 degrees.

1. I assume that I want to keep all of the arms, elbows, hands, etc. tight up against the wall and not moving out away from the wall throughout the stretch, right?
2. Do you recommend going as far as I can, and holding that position for 5-10 seconds, then lowering?
3. How many repetitions?
4. And finally, as a non-practitioner, what are the benefits of flexibility in the thoracic spine?  You seem to suggest that there are benefits associated with having flexibility there, but I don’t know what they are.

 I have to say that it was a “good” stretch.

 

Thanks.

 

Jim

---

Great questions - Thanks, Jim, for sending them in.

For #1, yes, the objective is to keep the hands and arms, etc. up against the wall and when you notice that you cannot do that, you're at the end of your flexibility. This test/stretch not only effects the thoracic spine but also the shoulder. If you have tightness in the subscapularis, pectoralis minor, for example, you'll have difficulty keeping the arm on the wall through the stretch.

Move your arms up as far as you can and hold the stretch for 5 slow, deep breaths and then release the tension a bit, rest for three breaths and move up again. This cycle will take about 30 seconds. If you can repeat it 5 to 10 times, you'll see substantial improvement. But, listen to your body - which is why I suggested 5 to 10 reps - if you feel tired, or you just feel that you should stop, stop.

As for the benefits of thoracic spine flexibility, the top three are:

1. Positioning of the head relative to the rest of the body.
2. Improved clearance in the subacromial space of the shoulder.
3. Optimal length-tension relationship of the rotator cuff.

When your thoracic spine is relatively stiff, it tends to force the head forward leading to increased pressure in the middle to lower cervical spine. In other words, it's hard to sit or stand up straight.

The subacromial space is a very narrow opening between the acromion and the humerus through which certain tissues must pass (like the supraspinatus tendon). As you lift your arm up over your head, the final 20-30 degrees of motion come from the thoracic spine moving into extension and the scapula sliding back and around on the chest wall. This helps maintain clearance in the subacromial space.

The rotator cuff muscles, the supraspinatus, infraspinatus, teres minor and subscapularis, are influenced by the thoracic spine. People whose thoracic spines are stiff usually have a bit more of a forward curve in the spine. This pushes the scapula to the outside of the chest wall and alters the length of the muscles. All muscles have something called a length-tension relationship. There's a length at which the muscle can produce the highest tension and the lowest. Generally, longer and shorter muscle lengths produce less tension. So, a stiff thoracic spine can shift the relative length of these muscles which in turn alters when the muscles produce optimal force. This tends to overload the cuff and create impingement in the subacromial space.

I'm glad you got a "good" stretch. Keep it up.
DK

Is Your Upper Back Holding You Back?

An easy way to check the flexibility of your thoracic spine and associated muscles is this:

• Sit down on the floor with your back up against the wall or a door.
• Bend your hips and knees up as far as you can. This tightens the latissimus dorsi and counter-curves (in this cases reduces the lumbar lordosis) the lumbar spine making it difficult for that region to move.
• Place your arms against the wall with your elbows bent like you're taking an oath (with each arm).
• Now, slide your arms up the wall as far as you can. 
• Note the angle of your shoulder where you have to stop. 

You're shooting for a shoulder abduction angle of 150 degrees (the upper arm will be close to your ear) with about 90 degrees of shoulder external rotation. The first time I did this several months ago, I barely made it to a 90 degree angle and I thought my thoracic spine was going to explode - it was so tight. 

You can use the test as a drill to improve your flexibility. If you have a partner who can help you, ask him or her to provide some resistance under your arm so you can pull down while also lifting up (yes - you can do that despite theories of reciprocal inhibition). Some people increase motion more quickly although the research suggests that there's not too much difference between the two types of stretch.

If you find that you just cannot get your arms up much past 90-100 degrees, try just one arm at a time. In a few weeks, you'll loosen up considerably.

DK

Hamstrings - Diving In

I heard Florence Kendall speak at a conference many years ago and she said that she chose one muscle of the body each day and studied that muscle; testing it on every patient she saw whether the patient had a problem with that muscle or not. She felt that by doing this she could remember the details and identify problems more quickly.

I like that idea of diving into one thing, exploring it, looking at it from different perspectives. You learn a lot. So, from time to time, I'll write about a muscle or group of muscles, a joint, a drill, a physiologic principle, a biologic tissue, among other things, to review some of the basics and then dive in to explore it from a functional perspective.

Today, hamstrings.

The hamstring muscle group is composed of three individual muscles - Semimembranosus,  Semitendinosus, and the Biceps femoris. The semimembranosus and semitendinosis arise off the ischial tuberoisty and insert on the proximal medial aspect of the tibia. The Biceps Femoris has two heads (reason for the "bi" in biceps). The Long Head of the Biceps arises off the ischial tuberosity and inserts on the head of the fibula and lateral tibial condyle . The Short Head arises from the Linea Aspera of the femur and inserts on the head of the fibula and the lateral condyle of the tibia.

These muscles cross two joints: the hip and the knee. Anatomy textbooks teach that the hamstrings bend the knee and extend the hip as their primary function in a non-weightbearing position. Of course, there's little in life that focuses on non-weightbearing activity. And, muscles know nothing about origin and insertion. We developed that nomenclature to better understand muscles. So, let's look at what the hamstrings do for you when your foot is on the ground.

When you walk (and running is an exaggerated form of walking), as your foot is swinging through the air approaching the ground, the hamstrings decelerate the lower leg and foot. As your foot hits the ground, gravity wants to pull your leg down, in, and around: flex, adduct, internally rotate. The hamstrings help reduce the amount your hip flexes and adducts while also controlling how fast and how much your tibia internally rotates. Once your foot is flat on the ground, the hamstrings now have to shift to propulsion and extend your hip and externally rotate the tibia. All of this happens faster than you can think about it.

So, a muscle that functions to reduce flexion, adduction, and internal rotation is a muscle that functions in one more than one plane and at the same time. Why then do we stretch this muscle and exercise it primarily in one plane (sagittal) such as hamstring curls or a runner's stretch?

Stretching the hamstring should include rotation of either the leg or the pelvis and should also include some amount of abduction (If you go back and look at the origin off of the ischial tuberosity, you'll find the the origin is medial to the femur. So the muscle angles from medial to lateral.).

One option for stretching is:

• Place your foot on a chair that raises and lowers so you adjust the degree of stretch.
• Stand tall keeping a slight arch in your lower back.
• Pull your foot up toward you.
• Push down into the chair with your heel and maintain the pressure through out the stretch.
• Lean forward keeping the arch in the back and actively turn your leg (or your foot) in and out.
• Maintain the stretch for up to 30 seconds.
• Then, hold your leg in place and turn your upper body and pelvis right and left for up to 30 seconds.
• Lean forward a little more and repeat. Keep going until you can no longer bend forward while maintaining the arch in your lower back.

One the best options to strengthen the hamstrings is to perform squats or lunges. The key is to follow the definition of a repetition. The movement faults would be the things the hamstring is trying to control so look for too much adduction and internal rotaiton of the leg and too much trunk flexion instead of hip flexion. When you perform a lunge properly, you'll feel the hamstrings working.

DK

Three Steps to Better

I've come to a conclusion. After spending a lot of years studying, teaching, making mistakes, having some wins, some losses, I think there are just three major steps to getting better at, well, anything.

1. Introduce your self.
2. State your intention.
   
3. Commit.

By introducing your self, it means you're not alone. It means you know who you are. To get better at something, you have to know and be aware of your self.  Getting better at anything all by your self is extremely difficult to do. You need support, feedback, laughter. You need people to push you and to slow you down and hold you accountable. You need people.

Your intention is to get better - at something. So, say it. Out loud. To the people you're working with. To acknowledge you want to get better, you're declaring the truth out loud. You're giving it a voice. By declaring your intention, you open your self up to admitting you don't know everything; you don't have all the answers. Maybe you're skill is not what you want it to be, or you don't know certain things like you thought you did, or you don't have what you really want. State your intention clearly and simply. I want to get better at ______________________.

Commit means you give your self entirely to the task. You're taking ownership of your results. You stick. No one else owns the responsibility. Others may support you, help you, but you do the work. When you commit, you take action. You give attention to your intention and create action. You're willing to do what it takes to get better and because of those actions and behaviors, you get better.

Introduce your self.
State your intention.
Commit.

Get better.
DK

Using Exercise to Mobilize the Ankle

I can mobilize a rather stiff ankle and foot, even just jiggle the ankle, subtalar joint, forefoot, for a few minutes without regard to methodology, with mild to moderate force, and measurably increase the motion. The force is far too light and too short in duration to have changed any of the supporting structures (ligaments) since the ankle ligaments are quite strong and a few minutes of joint mobilization will largely go unnoticed by those tissues.

So, the effect of the manual technique is partly the contact (the intensity of my hands on the client's body) and the reflexes associated with it, the pain reduction, and the specificity of movement. Using my hands, I can direct motion into any of the three planes or a combination of planes. The shifting of the joint can break collagen cross-link adhesions that form from a decrease in glycosaminoglycan content and improve the viscosity of the synovial fluid in the joint. The compression and distraction movements can also reduce any edema.

How could I achieve the same effects using exercise?

With a person who has a stiff ankle following immobilization (and if they have had some type of fixation, we have another set of issues), I have used a variety of drills to improve motion. Here are some of them:

• Squats supine position, on a Total Gym, at a low load (typically levels 2 or 3 on a ten rung machine). The client places his/her feet at the top of the platform. Squat to the end of motion, pause, oscillate for 10 seconds, and return to starting position. Repeat for ten minutes. Perform 3 sets.
  • In this drill, you can expect about 400 to 600 mobilizations of the joint. A lot more than what you could achieve with ten minutes of manual mobilization.
• Squats supine position, on a Total Gym, at a low load (levels 2 or 3) with the symptomatic side up. Place a small wedge (this could be a folded wash cloth) under the lateral part of the foot. This increases the relative amount of eversion. The client squats and slightly adducts the limb to create a combined internal rotation and eversion in the subtalar joint. I usually use the same dosage as above.
• If the client tolerates full body weight loads, and for this example let's assume it's the left foot that is the symptomatic side, I place a small wedge under the lateral part of the foot. Step back with the right leg to create a staggered stance. Now perform a squat to about 70 degrees of knee flexion and rotate the trunk and arms to the left. This should drive the left leg into internal rotation and adduction and also stress dorsiflexion. You have to repeat this several times and often clients fatigue in the leg or foot muscles. If so, I unload them using a pulley system by attaching a waist strap to the client and then connect it to the pulley (so the pulley is pulling up and back on the client).
• Use a Pro-Stretch. Have the client sit in a chair and place both feet on a double Pro-Stretch. Now, rock the Pro-Stretch back and forth (which creates a side to side motion). This is an excellent drill for talocrural osteoarthritis or subtalar motion restrictions. The client can perform 10, 15, 20 minutes or more of the movement yielding 100's of mobilizations.

Do you have drills you like to use to increase motion of the foot?

DK

Repetitions

What's a repetition?

I know you're probably thinking, "Why is he writing about something so mundane?"

I once suffered from a little known syndrome called "familiaritis" (I'm making this up so you won't find it on Google). This occurs when you hear a word or a phrase that you think you know; that sounds so familiar that you think you actually do know when, in reality, if you had to explain it in detail, you might not know as much as you think.

So, when I first heard terms like "degenerative disc disease" or "osteoarthritis" or even more common "back pain", I recognized the words from my training and schooling, had a weak mental picture of it but that's as about as far as I could take it. If you had asked me to explain the disease process, the tissue damage, what makes the tissues healthier, what are the stories that people tell with these problems, I would have little sound coming from my mouth.

Now that you know about familiaritis, let's go back to the word "repetition".

What's a repetition?

Some definitions are:

• the act of doing or performing again.
• the number of times a motion for an exercise is completed.
• one complete movement of an exercise from start to finish.

But, these definitions are missing something important - how the movement is performed. You can complete a movement with your body flailing about or you can complete it under control. A well performed repetition is one performed under control. In other words, a repetition is one complete movement of an exercise from to start to finish with good form and control.

Why is this important? With any exercise, you're training the central nervous system; developing habits. Some of these habits, like learning how to control movement, will then transfer into your life. How you lift a trash can, carry your daughter, shovel snow - they all involve movement that you have to control to prevent injury and function optimally.

So, what does, "good form and control" mean? Biomechanically, it means controlling the axis of motion of all joints involved whether those joints are moving or not. When you control the axis of motion, the movement pattern appears smooth, graceful, and pleasing to the eye. You know a beautifully executed dance by watching it. When you fail to control any individual axis, the total pattern degrades.

A good example of this is squatting on one leg. The ankle, knee, hip, pelvis, and trunk all must be controlled. You may be able to squat one one leg without pain. But, if your pelvis drops to one side or sways or you have more movement in your hip than your knee, you have not performed a repetition. You performed something; I just wouldn't call it a repetition.

Pay attention to how you perform movements and make sure you (or your client) control the axis of rotation to qualify for a repetition.

You Become What You Do

Your body adapts and learns from what you do and doesn’t tell you about it.

A few years ago, my friend and business partner Ryan Smith, was in town visiting for a few days. We started talking about basketball and before long we had decided to go to the park at the end of the street and shoot some baskets. Just a friendly game of H-O-R-S-E.

Well, the game of H-O-R-S-E turned into a few games of one-on-one. I hadn’t actually played basketball in years; hadn’t really even played H-O-R-S-E in years either.

I was determined to not less this guy, nearly twenty years younger, beat me. We played hard. I was exhausted when we finished but was triumphant. I felt great.

Until the next morning when I could barely walk down the stairs. I thought I had just “over done it” and the pain and stiffness would pass. It didn’t. I had injured both Achilles tendons and had a bad case of tendonosis for months. About nine months. All from three or four games of one-on-one.

Your body is inherently lazy by design always seeking the lowest level of energy expenditure to get the job done. This is why you do not need to be fit to be alive. Your body can function at a very low level of fitness because of its ability to adapt.

But, your brain doesn’t know much about your fitness level.

You might think you can still run five miles, or play basketball, or ski the black runs at Vail even though its been years since you’ve done any of those things. So, like me, one day you decide to give it go. Most of the time, it doesn’t go well.

You become what you do. Train your body to play basketball or ski or run and you’ll enjoy it, do it with much less damage, and feel a lot better.

You become what you do.