Hip Mobility and Strength for Ultimate

Outdoor ultimate season is upon us.  Hip mobility as well as hip strength are important parts of both performance and injury prevention. I had the pleasure of running this part of the injury prevention clinic for new and intermediate players with Ultimate NL this week.

Great hip function is a necessity during sprinting, direction changes, jumping and lunging. This comes from a combination of the passive flexibility to achieve the positions needed but more important the strength and coordination to control those positions. Trying to achieve or control positions you don’t already own is a recipe for poor performance and eventually injury.

The mobility and strength drills in the video above are not for everyone and you may not feel comfortable performing each and every one. There should be no pain during or after the movements. You should feel better when they are done compared to when you started them. Loose, relaxed and comfortable. Take the simplest variation or make modifications so they can be completed comfortably and successfully.

A simplified balance

Talk to a nutritionist and their most simplified approach to weight loss is that if the calories you use up exceed the calories you take in you’ll lose weight. Flip that equation and you’ll gain weight. Often you can simplify injuries to this level as well. Every activity places a certain level of demand on your body and everyone has a certain physical capacity. If the demands exceed the capacity you’ll eventually hurt yourself. If you flip that equation you may enjoy an injury free existence.

 

Demands greater than Capacity = Injury

Understand demands and capacity

Your body is constantly adapting to the demands consistently placed on it and will be expertly prepared for those demands. If your life consists of getting up, driving to work, sitting all day and then watching tv for the night your body will only remain strong enough to roughly keep your body upright while standing or sitting. If you only expose yourself to small physical demands you’ll only maintain a small capacity. If you always take the elevator you’ll always get tired climbing stairs.

Infrequent activities do not last

You stress your body, maybe you do 10 lunges. Your muscles and connective tissues are stretched and strained. The repair process takes 24 to 48 hours and your body adds some extra muscle and connective tissue fibers in case you need them for the next time you do 10 lunges. After a couple of days if you don’t do any more lunges those fibers may not be maintained and are re-absorbed and their materials used elsewhere. 2 weeks later you do 10 lunges and they’re no easier.

Organized demands

You do 10 lunges. 2 days later you do 10 more lunges. Every 2 days you take the new tissue your body has added and stress them. In turn your body adds more tissue and you stress that tissue. Suddenly you have greater muscle strength and connective tissue that can better resist that stress and strain of 10 lunges 2 weeks later you do 20 lunges and they feel as easy as 10. More importantly when you decide to move a few heavy boxes in the basement you’re less likely to injure yourself thanks to this new capacity.

 

10-15 minutes of smart physical activity done every other day is a great starting point to reduce your risk.

 

The blunt truth

You need to give your body a capacity beyond the demands you may place on it. If you’re facing a physical demand that you know is greater than your capacity; expect injuries. Maybe not the first time but you’re poking a sleeping bear. You don’t need to hit the gym and squat 300lbs. You need to be good at movement, you need to be practiced at lifting, pushing and pulling things that weight as much as things you interact with regularly. This could mean a shovel full of snow, a basket full of laundry a couple 2 by 8 boards or a heavy bag far in the back your car trunk. If you’re not preparing for the demands, prepare to call my office.

Joint Alignment

In my experience most patients are inherently aware of this concept before they ever set foot in my office. There is also a very large contingent of doctors and therapists who don’t appreciate or understand the importance of joint alignment.

The feeling of misalignment

At some point in your life (maybe your day) your knee, shoulder, wrist, elbow, ankle, hip, back, neck etc. has suddenly become limited in their normal motion. You feel resistance, locking, pain or pressure right in the joint preventing you from moving further. Maybe you try to check your blind spot and you feel like something in your neck blocks you. You try to squat down and stiffness quickly develops in your knee to prevent you from completing that movement.

Many times (by many health professionals) this gets chalked up muscular tightness. You can’t turn your neck because the muscle is tight or is in spasm. You can’t complete a squat because your quads are tight. This might explain mild cases where you can feel a stretch develop and slowly work through that tightness. You typically don’t feel that pain at the joint.

Altered Joint mechanicsPosterior Knee joint

This can be a complicated topic and is often missed during assessments. Your knee joint makes for an excellent example with a lot of research behind the concept. It’s construction leaves it to act much like a door hinge, pivoting primarily around just one axis with some extra cushioning inside. If the top and bottom of the joint line up well the movement is typically free of crunching or creeking and at the end of bending or straightening there are two cartilage surfaces still in contact with one another. If the door hinges are installed correctly there’s good contact between the metal pieces and they slide well over one another.

Quite commonly misalignment will develop at the knee joint where the shin bone is turned outwards compared to the thigh bone. This is commonly seen in Helfet’s test when the tibial tuberosity (center-line of the shin bone) is too far lateral compared to the center of the knee cap. Because of this subtle twist the cartilage surfaces don’t align perfectly and so towards the end of straightening or bending those cartilage surfaces slide off one another forcing your to stop your movement. Those cushions between bones are being repeatedly pinched. Now one half of the door hinge is slightly angled. It creeks as it opens since now only parts of the hinge are touching with far greater pressure.

Normal reactions to joint pain

Joints have powerful control over their surrounding muscles. They contain nerves that are highly sensitive to any compression or stretching of it’s tissues or cartilage. Joint misalignment compresses and tensions those tissues causing signalling to muscles in the area to relax or tighten to try and improve the joint position. This is where many assessments start and finish. “You can’t squat fully and your quads have become tight, they must be preventing you from squatting fully. Let’s do some stretches.” Too often the underlying issue is missed. Correct the knee alignment and the signalling to other muscles fades. Quads get back to a normal length and tension without unnecessary work.

Long terms changes

Quite often misalignment develops without traumatic injury. A long day at costco, vigorous hike or a hard leg day can often be enough. This will leave people assuming their joint is unaffected despite their pain because there was no trauma. So they deal with the issue for weeks or months. They stretch, they exercises, they deal with the pain. That joint has been signalling surrounding muscles to fire harder or stop firing for days or weeks. The tissues of the joint have been bearing higher than normal tension and the cartilage has been repeatedly rubbed hard in certain places. Why do you think it’s so common to develop arthritis in just one knee even if you’ve never had a significant knee injury?

 

No pain, no gain.

This is a very slippery slope that I strongly hope you’re not sliding. I especially hope your personal trainer or therapist isn’t pushing you down that hill. You really only have two options when thinking about pain. You either have pain or you don’t have pain.

I have pain. So therefore no pain, no gain.

Let’s say that lifting your arm in the air gives you shoulder pain. A very unique feeling that you could easily identify and would probably avoid certain activities to prevent. For now think of that as Pain. It is the signaling from valuable tissue in your shoulder that its very integrity is compromised. There is an injury and the way you just moved worsened it. You should stop. So how in this scenario could more Pain be of any value? Listen to your body.

Sometimes things aren’t that simple. Sometimes Pain doesn’t develop for a few hours or a even a day. That same shoulder Pain arrives 3 hours after you’ve unloaded the dishwasher and did laundry. The cumulative effect of those activities compromised the integrity of that very important tissue in your shoulder and now it’s signalling your brain with Pain. This really isn’t different, that injured tissue is compromised either by 1 movement or many movements and could be felt immediately or delayed.

Your rehabilitation should follow this concept. Movement does some amazing things. Even the slightly pull on tissue stimulates the production of connection tissue, new cell production and repair of existing tissue. Pain isn’t a requirement. Being able to perform movement that doesn’t create immediate or delayed pain should be a very simple definition of rehabilitation.

I don’t have pain. So therefore no pain, no gain.

Congratulations you’re pain free. Now you’re probably thinking about performance improvements. What is pain telling you about your performance? Let’s get back to tissue integrity. If you’re feeling genuine Pain, you’ve managed to compromise the integrity of a tissue. This doesn’t mean appropriate stress through microtrauma. This means damage. Injury. Sure it will likely heal over a few days and maybe even trick you into thinking that’s how ‘good’ sore feels. It’s not. Performing a movement that causes pain means you’ve exceeded the integrity of a tissue either by applying too much load or stretch. Maybe the movement was too fast, heavy, awkward, unpracticed, inappropriate (i.e. the continental lift) or you’ve progressed too quickly. That part could have many answers. Pain has one answer: stop, reassess your approach to learning/improving that movement and begin a new approach after you’ve healed.

Maybe you’re reading this and thinking if people stopped training a movement every time they approached pain their training would suffer. I completely agree. Wolfe’s law. Tissues respond to stress. Efficient training means getting tissue very close to the point of failure without crossing that line. I’m talking about to the person who feels their hamstring grab on deadlifts, whispers to themselves “no pain no gain” and bangs out 2 more sets. The person who progresses their squat weight too quickly and needs five days to recover before they can train again. If you’re training hard you will occasionally become injured and feel Pain. If you do re-read the previous section of this article then try not to make the same mistakes.

Caveats

[almost] Nothing is absolute. If you’re “into pain” or want to feel pain to better relate to others in pain my advice may not apply. There are treatment techniques that can be pretty painful. Shockwave treatment comes to mind. I do numerous muscle/tissue releases and adjustments that can at times be painful. Brief fleeting moments of pain applied by a qualified practitioner are an exception.

The vast majority of people out there aren’t qualified to make those exceptions so in your own rehab and training listen to immediate or delayed pain, assess the cause and work to keep moving without pain.

Why tight hamstrings matter part 2

In Part 1 we looked at the function and physiology of tight muscles and how progressive lengthening and strengthening can improve your rehabilitation and performance. Part two of this series looks at the bio-mechanical implications of tight hamstrings.

The mighty Hip Hinge

This action is arguably the most important movement for a healthy low back but also for force production through your hips. To simplify: hinging at the hip is what should happen when you bend forward at the waist. In an ideal movement your torso maintains a neutral (picture 2) posture while almost all of the forward bend occurs around your hip axes. A poorly performed forward bent shows limited change in the hip angle with excessive bending through the low back. hip-hinge

 

Poor movement or posture in this forward bend excessively loads your spine and intervertebral discs. It also destroys any mechanical advantage meaning our muscles have to fire harder when we bend forward and return to standing. Think through how many times in the run of a day would you bend forward and return to standing. Imagine you work in a plant or factory where you spend the majority of your day leaning forward over an assembly line or work table. How long before this excessive loading starts to wear on the joints and tissues of your back.

Back to hamstrings. They are one of the strongest limiters for this hip hinge. In a proper hip hinge you take your hamstrings through considerable lengthening. If you lack flexbility in your hamstrings you will quick stop pivoting about your hips because your hamstrings have pulled tight. If your haven’t reached the end of your required movement then you will likely bend through your spine to make up the difference.

Why tight hamstrings matter Part 1

Understanding muscle physiology and biomechanics can make a world of difference to a person training but also to their recovery when injured. These concepts apply to any muscles but with the prevalence of hamstring strains being one of the highest this might hit home with more people. Since they’re fairly large ideas we’ll start with my favorite concept the length tension relationship.

Length Tension curve

This should ring a bell with anyone who has studied exercise physiology. The concept explain how and why a muscle can produce different amounts of force as it progresses from long to short and short to long. Your fingers can be a great example of how the many small fibers of any muscle interact; a key foundation of the concept. Interlock your fingers (like the photos below) and imaging thousands of tiny hooks on the fingers of one hand that will connect with thousands of hooks on the other hand. The greater the area of contact between fingers then greater the number of hooks that connect and give you the greatest strength. This follows a simple pattern: as you slide your fingers together the area of contact increases to a peak (middle image) then slowly decreases as your fingers overlap too far and slide behind your hand (third image). The curve below shows how that area of contact directly affects that muscle’s strength. I’ve added dotted lines to show the area of overlap, notice how that area of overlap directly relates to the strength curve below.

length-tension-fingers

So now apply that concept to your hamstrings but this time we’ll run the concept in reverse order, short to long. Imagine lying flat on your back and think about the length of your hamstrings. In that position they are pretty short. Probably close to that fully shortened position from the pictures above (on the right). Now imagine one leg being lifted straight in the air until your foot is directly above your hips. As your leg moved from the floor to straight up in the air it passed from near fully shortened (too much muscle fiber overlap), through mid length (optimal overlap and max strength) to near full length (minimal fiber overlap and weakness). The key is that you are not equally strong at all lengths. You have the best strength and lowest likelihood of injury in that middle 50% of the movement.

length-tension-SLR

So here is the real magic. Hopefully this turns a light bulb on. Let’s get back to tight hamstrings. If yours are tight you have probably realized that you can’t actually lift your foot all the way above your hips. If you could you’d have a fairly large range of that motion where you are acceptably strong (highlighted in green). Instead, inflexible one, you have a very narrow window (shown on the right image in green) where you are usefully strong surrounded by two equally large ranges where you are weak and susceptible to injury.

Improving your length and strength

When you get right down to performance or recovery you want a larger range of motion through which you have useful strength. Adding length to a muscle through rigorous stretching will give you greater range but all you’ve really done is spaced out those hooks. You’ll also introduced new ranges of motion that your nervous system hasn’t experienced so you can expect to be fairly uncoordinated. Proper improvements come from slowly increasing the length of a muscle while performing strengthening exercises that progressively challenge that new range of motion. This will encourage your muscle to build more hooks and train your nervous system to control this new found range.