Copyright 2009 by Eric Cressey, Bill Hartman, and Mike Robertson. All Rights Reserved.

Transcription

1

2 Copyright 2009 by Eric Cressey, Bill Hartman, and Mike Robertson. All Rights Reserved. No portion of this manual may be used, reproduced or transmitted in any form or by any means, electronic or mechanical, including fax, photocopy, recording or any information storage and retrieval system by anyone but the purchaser for their own personal use. This manual may not be reproduced in any form without the express written permission of Eric Cressey, Bill Hartman, or Mike Robertson except in the case of a reviewer who wishes to quote brief passages for the sake of a review written for inclusions in a magazine, newspaper, or journal and these cases require written approval from Eric Cressey, Bill Hartman, or Mike Robertson prior to publication. For more information, please contact: Indianapolis Fitness and Sports Training 9402 Uptown Drive, Suite 300 Indianapolis, IN Phone: Website: 2

3 Disclaimer The information in this book is offered for educational purposes only; the reader should be cautioned that there is an inherent risk assumed by the participant with any form of physical activity. With that in mind, those participating in exercise programs should check with their physician prior to initiating such activities. Anyone participating in these activities should understand that such training initiatives may be dangerous if performed incorrectly. The author assumes no liability for injury; this is purely an educational manual to guide those already proficient with the demands of such programming. 3

4 Table of Contents Section 1 Introduction... 7 Section 2 The Assessment Purpose of the Assessment The Effect of Posture The Effect of Asymmetry Static assessment Head Posture Shoulder Posture Thoracic Spine (upper back) Posture Lumbar Spine and Pelvic Posture...20 Flat Back and Swayback Posture Lateral Tilt of the Pelvis Lower Extremity Alignment Foot Alignment Side View - Arms Overhead Hands Behind Head with Hip and Knee Flexed...28 Rear View - Hands on Hips Rear View - Arms Overhead Active Assessment Neutral Spine Test Cervical Flexion Range of Motion...33 Thoracic Spine Rotation Range of Motion Pectoralis Minor Length Test Pectoralis Major Length Test (clavicular head) Pectoralis Major Length Test (Sternal head) Shoulder Flexion Range of Motion Shoulder External Rotation Range of Motion Shoulder Internal Rotation Range of Motion Scapular Upward Rotation Supine Straight Leg Raise Supine FABER Supine Hip and Knee Flexion Seated Hip and Knee Flexion Quadruped Rock Back Prone Knee Flexion Thomas Test Supine Hip Abduction and Adduction Seated Hip Internal Rotation Seated Hip External Rotation Prone Hip Internal Rotation

5 Prone Hip External Rotation Closed Chain Ankle Dorsiflexion Single-Leg Squat Single-Leg Bridge References Section 3 The Corrections Supine Straight Leg Raise High Knee Walk Single-Leg RDL High Knee Walk To Forward Lunge Kneeling Rockbacks Squat-to-Stand Goblet Squats Prisoner Squats Pulsed Hip Flexor Mobilizations Wall Hip Flexor Mobilizations Overhead Lunge Walk Reverse Lunge with Posterolateral Reach Side-Lying Leg Raise Split-Stance Kneeling Adductor Mobs Walking Spiderman Walking Spiderman with Hip Lift Walking Spiderman with One-Arm Overhead Reach Seated 90/90 Mobilizations Cradle Walks Split-Stance Kneeling Adductor Mobs Split-Stance Hip Swivels Hip Airplanes Kneeling Glute Mobs Cross-Behind Overhead Reverse Lunges Lying Knee-to-Knee Pull-ins Prone Windshield Wipers Split-Stance Hip Swivels Hip Airplanes Supine Bridge One-Leg Supine Bridge Wall March Isometric Hold Bowler Squats Hip Abductor Wall Slide X-Band Walks Side Bridge Wall Slides Bowler Squats Side-Lying Clams

6 10.2 Band Resisted Clams Bowler Squats Lying Psoas March Seated Psoas Holds Wall March Isometric Hold Standing Psoas Holds Rocking Ankle Mobs Wall Ankle Mobs Knee-Break Ankle Mobs Thoracic Extension on Roller Bent-Over Thoracic Spine Rotation Quadruped Extension-Rotation Point Extension-Rotation Yoga Push-ups Squat-to-Stand with Extension-Rotation Forearm Wall Slides Feet-Elevated Scap Push-ups Push-up Plus Hand Switches One-Leg Scap Push-ups Side-Lying Cross-Body Stretch Sleeper Stretch Prone Internal Rotation Dynamic Blackburns No Money Drill Side-Lying Extension-Rotation Side-Lying Internal-External Rotation Split-Stance Broomstick Pec Mobs Side-Lying Extension-Rotation with Perturbations Supine No Money Drill with Band Scapular Wall Slides Behind the Neck Pull-Aparts Reach, Roll and Lift Doorway Slides Forearm Wall Slides Prone Trap Raise (Y) Supine Chin Tuck Standing Chin Tuck Supine Nod and Lift Quadruped Chin Tuck

7 Section 1 Introduction 7

8 Almost four years ago, Eric and Mike introduced the Magnificent Mobility DVD. We originally intended for this research to be a collection of mobility drills and activation movements that individuals of all ages, ability levels, and athletic backgrounds could use to prepare their bodies for exercise. In reality, Magnificent Mobility turned into much more than that. Exercises that seemed ordinary in the context of what we do with athletes and clients every day made this resource more popular than we could have ever imagined. The DVD has been purchased by individuals in more than 50 countries to the tune of over 12,000 copies sold. And, we have received hundreds of s from individuals thanking us for accidentally helping them resolve chronic problems such as hamstrings strains, lower back pain, and annoying hip flexor tightness. People didn t just warm up; they taught their bodies to move more efficiently. Just over a year later, Mike and Bill introduced the Inside-Out DVD. While Magnificent Mobility focused primarily on the lower-body, with Inside-Out, we sought to achieve the same results in the upper body and the results were just as promising as with Magnificent Mobility. It s become a much sought-after product for those with shoulder and elbow problems, folks trying to fix their hunchback postures, and those who want to be prepared to for heavy bench presses and chin-ups. In spite of the success of these two products, we all knew we could do better particularly if we combined the skill sets of all three of us, and with several years of additional coaching experience with healthy and injured athletes alike. Eric has come to be known as a shoulder guy. Mike understands the knees incredibly well. And, we haven t met a physical therapist with as broad a spectrum of knowledge with respect to back pain as Bill. In the past few years, we ve all learned new drills to not only keep things fresh for the consumers who purchased the original DVDs, but also help them get to their goals faster. Additionally, we received and took to heart some valuable suggestions from previous customers on additions to the products that could make things even better. So, in planning the DVD you re viewing, we ve also gone to great lengths to outline appropriate progressions to enable you to attack flexibility and stability deficits in the most efficient manner possible. Before we ever get to addressing these inefficiencies, though, we re going to outline a series of self-assessments you can use to determine what areas are your weak links. Effectively, before we can give you corrective exercise, we have to identify what you re trying to correct. Accompanying this product is a collection of our favorite static stretches. The ideal time to use these static stretches is either immediately post-workout, or even later in the evening, 8

9 perhaps right before bed. If you have significant flexibility deficits and want to make some quick improvements, you can perform these drills right after your foam rolling drills, but before your dynamic warm-up drills. We ll also talk about how soft tissue work interacts with mobility and activation drills. Obviously, this refers to a variety of soft tissue treatments you d receive from a qualified manual therapist, but in the context of this DVD and the handout that accompanies it, we re discussing soft tissue work that you can do on your own with a foam roller and other simple tools. Now there are those that feel that these self-applied methods of soft-tissue treatment are ineffective and therefore unnecessary. We respectfully disagree. Fascial research shows that the fascial system is abundant with mechanoreceptors that when stimulated with manual pressure result in favorable changes in tissue fluid dynamics and relaxation of muscle both locally and globally as well as desirable changes in autonomic nervous systems tone. Couple this information with the vast volume of empirical evidence from strength and conditioning coaches and therapists who also use these methods and we believe them to be an effective tool to enhance and complement your mobility training. For further references, we suggest reading articles by Robert Schleip. As you can tell, there is certainly a science behind what we re doing with this resource, but as we move forward, we ll concern ourselves much more with the who, what, when, and how as opposed to the why. So, without further ado, we ll get to our first progression. 9

10 Section 2 The Assessment 10

11 Purpose of the Assessment The assessment component of Assess and Correct consist of two parts: static and active. The overall goal of the assessment in this program is to provide you with a tool that will allow you to identify limitations and asymmetries in your own posture and movement that may potentially limit your sport or exercise performance and influence your injury potential. The results of your assessment will provide clues as to which methods and exercises will be most effective to restore normal muscle and joint function and ultimately improve performance and reduce injury risk. In doing so, your assessment results will allow you to personalize your corrective mobility program and monitor your progress. We realize that performance and injury potential are multifactorial concepts, and therefore no single test or group of tests will ultimately determine your level of performance or injury risk. However, a review of the literature shows the influences of posture, asymmetries in joint alignment, flexibility, and balance, and muscle stiffness on many frequently experienced injuries by athletes and fitness enthusiasts. Malalignment alters body biomechanics and creates stresses that may hinder the athlete s ability to progress and do well in a given sport, predispose the athlete to injury, prolong the recovery time or even prevent full recovery. (26) THE EFFECT OF POSTURE Human posture, whether static or moving, is a synthesis of neuromuscular function, including proprioceptive, vestibular, and visual inputs, any disturbance in any function can adversely affect function elsewhere in the body. (19) If a muscle becomes facilitated or inhibited as a result of prolonged, undesirable posturing or repetitive movements, it can cause a distortion in posture extending up or down the entire kinetic chain. This can be the result of attempting to seek out postures to reduce tissue strain elsewhere (25). In other words, by changing the tension in one muscle or one joint, the entire alignment of the body can be affected. For instance, consider the relationship of the hip joint position in the case of an anterior pelvic tilt. An anterior pelvic tilt increases tension on the hamstrings, which may predispose an athlete to hamstrings strains (8). The hip joint will also be placed in a position of hip flexion, adduction, and internal rotation as a result of the anterior tilt. This will also predispose the foot to pronate excessively. The result is an increase in ACL injury risk (18). In single leg stance, there may also be a reduction in gluteus maximus activity if the knee collapses medially in a valgus position and the rearfoot drops into excessive eversion which can also increase ACL injury risk and predispose the athlete to anterior knee pain (17,18). 11

12 In the upper quarter, head, shoulder, and upper back posture will also influence performance and injury potential. A slouched or rounded shoulder posture with a forward head position limits upward rotation and posterior tilt of the scapula, reduces scapular and rotator cuff muscle strength, and increases superior translation of the scapula. All of these factors are associated with shoulder impingement (11,14). It s been shown that performing appropriately selected exercises, like those found in your Assess and Correct program, can reduce the potential for shoulder impingement (15,19). THE EFFECT OF ASYMMETRY Various right-to-left asymmetries that may be identified in your assessment have been shown to influence performance and injury potential. For instance, in regard to balance, single-leg standing balance asymmetry has been shown to result in a greater number of ankle sprains in football, soccer, and volleyball players (28). Hip range of motion and strength play an important role in physical performance and injury potential. Hip range of motion deficits or asymmetrical hip rotation potentially reduces hip extension strength, hip adduction and/or flexion strength (22), and increases frontal plane excursion. Such findings are common predisposing factors for lower back pain and anterior knee pain (3,6,22). Deficits in hip strength are commonly associated with groin strains, iliotibial band syndrome, hamstring strain, patellofemoral pain, and ACL injuries (23). Hip abduction weakness specifically is associated with increased pronation of the foot, patellofemoral pain, and ACL injury (9,17,18). In the shoulder, deficits in internal rotation and horizontal adduction have been shown to predispose athletes to internal impingement (1). Asymmetrical scapular positioning, sometimes referred to SICK scapula syndrome, is frequently associated with glenoid labrum or rotator cuff injuries (2). Over time, depending on prolonged posturing and selected activities, tissues have been shown to lengthen, shorten, and increase or decrease in stiffness. Asymmetries in hip muscle stiffness and shortness can result in functional leg length discrepancies often at a high rate. Strong correlations exist with leg length discrepancies and pain and injuries including chronic/recurrent sciatica, unilateral hip pain, and therapy resistant lower back pain (5,24, 27). These examples represent just a small portion of the information available regarding the influences of posture, flexibility, and mobility on performance and injury potential. The takeaway is that many of these issues can be identified before they become problematic, limit training time or performance, or turn into real injuries. 12

13 We recommend that you periodically repeat the following procedures in your Assess and Correct Assessment to monitor your progress and make adjustments to your personalized exercise program. For each test, you ll be instructed on how to properly perform the test and what an ideal result should look like. Should your test result in failure compared to the optimal, a reference to the appropriate corrective exercises will be provided. 13

14 Static assessment To provide objectivity and accuracy in regard to the static component of your selfassessment, we recommend that you take a series of photos. These photos will not only establish your initial alignment, but by retaking them regularly, but they will also provide a reference for improvements in alignment and for making adjustments to your programming as your body adapts. Front tall and relaxed Left side tall and relaxed Left side arms overhead Left side hands behind head, right hip and knee flexed Rear tall and relaxed Rear hands on hips Rear arm overhead Rear hands behind head, right hip and knee flexed Rear hands behind head, left hip and knee flexed Right side tall and relaxed Right side arms overhead Right side hands behind head, left hip and knee flexed 14

15 Understanding Your Static Assessment Your static postural assessment is designed to provide clues as to specific areas of concern for imbalances among muscle groups that may result in at the very least impairment of normal movement and at worst injury. While no one may truly possess perfect posture, working toward the recommended ideal can improve joint range of motion, joint function, and movement efficiency (16). Your Relaxed Views In Muscles: Testing and Function, Kendall has identified a representation of ideal postural alignment with the use of plum lines as such: The line begins at the ear Midway through the shoulder Through the lumbar spine Slightly posterior through the hip joint Slightly anterior to the axis of the knee joint Slightly anterior to the ankle 15

16 Standing posture from the front or back would ideally be divided into symmetrical right and left halves. Appling gridlines or a straight edge to your own photos will allow you to approximate your posture to the ideal. Simply use specific landmarks such as the end of your clavicles, the hips, knees, and ankles. Keep in mind that asymmetries are commonly found on the dominant side of overhead athletes. For instance, healthy baseball and tennis players may be found to have scapulae that are internally rotated and anteriorly tilted as pictured at left. (J athletic training Nov-Dec; 43(6): ) 16

17 HEAD POSTURE Optimal head position finds the head centered equally between the shoulders and with the ear directly over the midline of the shoulders. It is common to see shortening of posterior neck muscles and weakening of the deep neck flexor muscles; this can result in a forward head position. Forward head posture Shortened Muscles Suboccipital muscles strenocleidomastoid Lengthened Muscles Deep cervical flexors (12,13,20,21,24) Potential corrective exercises to address forward head posture: SHOULDER POSTURE In the side view, the position of the shoulder girdle is strongly determined by the position of the scapula. The scapula should rest against the ribcage such that the plum line reference passes through the midline of the shoulder. If the shoulder rests well in front of the plum line, this may indicate shortening of the anterior shoulder girdle musculature and lengthening or weakening of the scapular musculature. 17

18 From the rear, the scapulae should rest symmetrically at an equal distance from the spine of about three inches with the scapular muscles relaxed. If one scapula sits a significant distance from the spine, it is considered to be abducted. This is commonly a result of shortened or stiff pectoralis major and minor muscles Abducted Right Scapula Shortened Right Pectoralis Major Shortened Muscles Pectoralis major Pectoralis minor Subscapularis Lengthened Muscles Middle trapezius Lower trapezius Infraspinatus Supraspinatus (12,13,20,21,24) Potential corrective exercises for scapular positioning: 14.1, , ,

19 THORACIC SPINE (UPPER BACK) POSTURE In the side view, the thoracic spine has a mild backward curve. If the curve is excessive, an increased thoracic kyphosis, the chest may appear flattened or vertically aligned and the upper back may be visible in addition the scapula being more prominent. Normal thoracic spine curve Increased thoracic spine curve This distortion of posture which includes a forward head, increased thoracic kyphosis, rounded shoulders, and internally rotated upper arms is commonly referred to as upper crossed syndrome (13,20). An upper crossed posture results from a combination of muscles that tend to shorten and others that lengthen as a consequence of daily activities, imbalanced exercise program, and frequently assumed postures. Shortened Muscles Cervical erectors Pectoralis major Pectoralis minor Upper trapezius Scalenes Levator Scapulae Lengthened Muscles Deep cervical flexors Rhomboids Serratus Anterior Lower trapezius Middle trapezius (12,13,20,21,24) Potential corrective exercises for excessive thoracic kyphosis:

20 LUMBAR SPINE AND PELVIC POSTURE The lower back and pelvic alignment are intimately related, as altering one will affect the other. An optimal lumbar curve will have a slight inward curve and the pelvis will be relatively level to a slight anterior tilt of about 10 degrees. The pelvis can tilt forward or backward excessively resulting in an increase or decrease of the lumbar curve respectively. In the case of an anteriorly tilted pelvis, increased lumbar lordosis, and flexed hip, this posture of commonly referred to as lower crossed syndrome. The lower crossed syndrome results from a combination of muscles that tend to shorten and others that lengthen as a consequence of daily activities, imbalanced exercise program, and frequently assumed postures. Shortened Muscles Lumbar erectors Psoas Iliacus Rectus femoris Sartorius Adductors Tensor Fascia Latae Lengthened Muscles Abdominal muscles Hamstrings Gluteus maximus Gluteus medius Gluteus minimus (12,13,20,21,24) Potential corrective exercises for anterior pelvic tilt: , 4.5,

21 FLAT BACK AND SWAYBACK POSTURE The flat back posture is essentially the opposite of the lower crossed posture. The pelvis is tilted posteriorly, which reduces the lumbar curve. The swayback posture is a combination of two adjustments at the pelvis. It combines a posterior pelvic tilt and anterior shift or sway of the entire pelvis. This pelvic alignment increases the distance forward of the hip from the plum line in a side view of standing posture. Flat back Sway Back Shortened/Overactive Muscles Lumbar erectors (sway back) Hamstrings Gluteus Maximus Abdominals Lengthened/Weakened Muscles Lumbar erectors (flat back) Psoas Iliacus External obliques (sway back) (12,13,20,21,24) Potential corrective exercises for flat lumbar spine: 1.3, 2.1, , 13.4,

22 LATERAL TILT OF THE PELVIS If the pelvis is seen to have a lateral tilt, it appears that one leg is longer than the other. More often than not, it is due to lengthening of muscles on the outside of the hip (the hip abductors), and a shortening of the muscles on the inside of the hip (the hip adductors) on the high side of the pelvis. It s quite simple to confirm the muscular imbalance around the hip versus a true leg length discrepancy by assuming a widened foot stance. This effectively shortens the hip abductors on both sides, which will level the pelvis. Right pelvis high Shortened Muscles Hip abductors (low side) Pelvis level Lengthened Muscles Adductors (high side) (12,13,20,21,24) Potential corrective exercises for lateral pelvic tilt: , , , 7.1,

23 LOWER EXTREMITY ALIGNMENT Lower extremity alignment tends to follow that of the pelvis in predictable patterns. If the pelvis alignment is neutral, the legs will appear to be relatively straight with the knees facing forward and the feet pointing straight ahead to slightly outward about 15 degrees. In the case of anterior pelvic tilt, the hip will tend to be flexed, internally rotated, and adducted. This will also influence the knee alignment in favor of a valgus alignment or knock-kneed alignment. Shortened Muscles Tensor fascia latae Adductors Semitendinosis Semimembranosis Lengthened Muscles Abdominals Gluteus maximus Gluteus medius Gluteus minimus Biceps femoris (12,13,20,21,24) Potential corrective exercises for valgus knee alignment: 3.4, , ,

24 In the case of a posterior pelvic tilt, the hip will tend to be extended, externally rotated, and abducted. This will also influence the knee alignment in favor of a varus alignment or bow-legged alignment Shortened Muscles Hip external rotators Biceps femoris Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia latae Lengthened Muscles Adductors Semimembranosis Semitendinosis (12,13,20,21,24) Potential corrective exercises for varus knee alignment: 1.3, 2.1, 7.1, 7.15, 7.3, 8.4 As a side note, there are cases where there may be a torsion or twist in a bone that results in a similar appearance to the varus knee. This photo shows a torsion in the left tibia or shin bone that creates a bowed leg. A short iliotibial band may contribute to such an alignment. 24

25 FOOT ALIGNMENT Foot alignment is a subject of great complexity. Because this is not a program about the only the foot, we ll take a very simplified view of foot alignment. The pronated foot is often identified by collapsing the arch of the foot resulting in a flat foot. While there are local structural issues within the foot that may influence the appearance of excessive pronation, it often a consequence of the relationships of the joint positions of the lower extremity. For instance, an anterior pelvic tilt promotes hip internal rotation, the internal rotation of the femur (thigh bone) drive the tibia (shin bone) into internal rotation which ultimately results in pronation of the foot Bilateral pronation Shortened Muscles Gastrocnemius Soleus Peroneals Hip Internal rotators Right foot pronation Lengthened Muscles Tibialis anterior Tibialis posterior Intrinsic foot muscles Hip external rotators (12,13,20,21,24) Potential corrective exercises for pronation: , , ,

26 The supinated foot is often identified by a high arch. While there are local structural issues within the foot that may influence a supinated foot, it often a consequence of the relationships of the joint positions of the lower extremity. For instance, a posterior pelvic tilt promotes hip external rotation, the external rotation of the femur (thigh bone), which drives the tibia (shin bone) into external rotation and, in turn, ultimately results in supination of the foot. It is also not uncommon to see supination of the foot as a compensation for pronation in an attempt to change lower extremity alignment from the ground up. Based on the pelvic alignment and that of the knee, the expectation at the foot may be pronation, but instead, the compensation of supination is seen. Supination Supination as compensation Shortened Muscles Tibialis anterior Tibialis Posterior Extensor digitorum longus Extensor Hallucis longus Medial Gastrocnemius Soleus Hip external rotators Lengthened Muscles Peroneals Lateral Gastrocnemius Potential corrective exercises for a supinated foot: 7.1, 7.15, (12,13,20,21,24) 26

27 SIDE VIEW - ARMS OVERHEAD The side view with arms overhead photo provides more information about your upper body mobility and confirms several of the active tests that will follow your static assessment. The key points to identify: The shoulder should flex to 180 degrees (straight up) without an increase in your lumbar curvature. The lower ribcage should not be more prominent than in the side view relaxed. The inferior angle of the scapula should reach the midline of the trunk with upper back extension. A. Limited shoulder flexion with limited upper back mobility and prominence of lower ribcage B. Improved shoulder flexion with improved upper back mobility and reduced prominence of lower ribcage A B Potential corrective exercises: , 16.2,

28 HANDS BEHIND HEAD WITH HIP AND KNEE FLEXED The hands behind head with hip and knee flexed photos provide information about general strength and stability in the trunk and hip as well as hip flexion and extension flexibility. The key points to identify: Hip flexes to >90 degrees as indicated by knee reaching a level higher than hip Support leg is fully extended Spine remains in neutral alignment similar to side view relaxed A. Weak hip flexors and limited support leg hip extension. B. Poor stability in support hip and weak hip flexors causing substitution of quadratus lumborum and trunk side bend. A B Refer to corrective exercises: 1.2, 1.4, , 4.3, 4.5, 6.2,

29 REAR VIEW - HANDS ON HIPS The rear view - hands on hips photo provides information regarding the muscles that stabilize the scapulae. In this position, there should be low intensity activity of the scapular stabilizers that keeps the scapula resting symmetrically and flat against the ribcage. The key points to identify: Scapulae are equidistant from the spine. One scapula does not rest significantly higher or lower than the other (note: dominant side may be slightly lower which is normal) Scapulae rest against the ribcage without any bony prominence. A. Scapular winging (medial scapular border prominence) as a result of pectoralis major and minor shortening, posterior shoulder shortening, and weakness of lower trapezius and serratus anterior. A B. The scapula is tilted anteriorly, making the inferior angle of the scapula prominent. The rhomboid muscle is also dominant, and this leads to downward rotation of the scapula. B Potential corrective exercises: 14.1, , , ,

30 REAR VIEW - ARMS OVERHEAD The rear view - arms overhead provides information regarding the ability to fully flex or abduct the shoulders and shows how far the scapulae will upwardly rotate at full shoulder flexion/abduction. The key points to identify: Shoulders flex/abduct to 180 degrees (straight upward) Scapulae upwardly rotate to approximately 60 degrees No excessive shrugging of shoulders Shoulder flexion and abduction are limited. Scapular upward rotation is limited and asymmetrical. Potential corrective exercises: , 16.3, 17.1,

31 Active Assessment Please refer to the DVDs for active demonstrations of the active assessment tests. 31

32 NEUTRAL SPINE TEST Purpose To assess your ability to achieve a neutral spinal alignment. Set-up Result Corrective Exercises Back up to a wall with your feet about 12 inches away. Make 3 points of contact on the wall with your tailbone, the upper back between the shoulder blades, and the back of the head. If you have to tilt your head backward to make contact with the wall, bring it away from the wall to make the head level. To assess the lower back curve, slide one hand along the wall behind the back. An optimal lumbar curve should allow you to slide your hand behind your back to about the knuckles. If you can t keep the head level and easily make contact with the wall, you most likely have a forward head. If you have too much curve behind the back and a forward head, you will most likely have too big a curve in the thoracic spine (upper back). If you have too much curve, your hand will slide further than the knuckles. If your curve is too flat, you won t be able to get the hand behind your back. Forward Head correction: Thoracic Spine corrections: Increased lumbar curve correction: , 4.5, Decreased lumbar curve Correction: 2.1, , 13.4,

33 CERVICAL FLEXION RANGE OF MOTION Purpose To assess your active cervical flexion range of motion. To test your cervical flexion, simply bend the head forward. Result You should be able to touch your chin to your chest with your teeth closed. If you re unable to reach your chest with your chin, you most likely have shortened posterior neck muscles and weak deep flexor muscles in the front of the neck. Corrective Exercises

34 THORACIC SPINE ROTATION RANGE OF MOTION Purpose To assess your thoracic spine rotation. Assume a seated position with the arms crossed across the chest holding a stick evenly across the chest. Keeping the spine tall, turn your shoulders to the right as far as possible while keeping your weight even on both hips. Repeat to both sides. Result You should be able to rotate approximately 60 degrees based on the position of the stick as you turn. Corrective Exercises

35 PECTORALIS MINOR LENGTH TEST Purpose To assess the length of the pectoralis minor muscle. Lie face up on a firm surface. Measure the distance from the posterior aspect of the acromion to the surface. Result A measurement of 1 inch or less indicates a normal length for pec minor. Anything greater than one inch would indicate a short pec minor. Corrective Exercises 14.1, , ,

36 PECTORALIS MAJOR LENGTH TEST (CLAVICULAR HEAD) Purpose To assess the length of the clavicular head of the pectoralis major muscle. Lie face up with the arms abducted to 90 degrees with your palms up. Result You should be able to make full contact with the arms to the floor without the shoulder joint shifting forward. Corrective Exercises 14.1, , 17.4,

37 PECTORALIS MAJOR LENGTH TEST (STERNAL HEAD) Purpose To assess the length of the sternal head of the pectoralis major muscle. Lie face up with the arms abducted to 135 degrees with your palms up. Result You should be able to make full contact with the arms to the floor without the shoulder joint shifting forward. Corrective Exercises 14.1, , ,

38 SHOULDER FLEXION RANGE OF MOTION Purpose To assess shoulder flexion range of motion which is influenced by latissimus dorsi length, pectoral muscle length, and thoracic spine mobility. Lie face up and raise both arms fully overhead and attempt to touch the floor above your head. Result You should be able to reach overhead a full 180 degrees without the shoulder internally rotating as indicated by the palms facing upward or the elbow pointing outward. Corrective Exercises ,

39 SHOULDER EXTERNAL ROTATION RANGE OF MOTION Purpose To assess shoulder external rotation range of motion which is influenced by shoulder internal rotators such as the pectorals, lats, subscapularis, and anterior deltoid. Lie face up with your arm abducted 90 degrees and your elbow bent 90 degrees. Rotate the shoulder to bring the back of your hand to the floor. Result You should be able to lay the entire arm on the floor to achieve 90 degrees of external rotation. Corrective Exercises 15.4, ,

40 SHOULDER INTERNAL ROTATION RANGE OF MOTION Purpose To assess shoulder internal rotation range of motion which is influenced by stiffening and shortening of the posterior shoulder musculature. Lie face up with your arm abducted 90 degrees and your elbow bent 90 degrees. Rotate the shoulder to bring the palm of your hand to the floor. Result You should be able to achieve 70 degrees of external rotation. Corrective Exercises ,

41 SCAPULAR UPWARD ROTATION Purpose To assess scapular upward rotation which is influenced by serratus anterior strength, lower trapezius strength, pectoral muscle length, and shoulder external rotation range of motion. Stand facing a wall with shoulders externally rotated, elbows bent and the pinky side of your hand against the wall. Slide your arms up the wall in a Y shape to 135 degrees of abduction without shifting the body away from the wall or arching the back. Result You should be able to reach 135 degrees, lift the arms away from the wall without shrugging the shoulders, or arching the lower back. Corrective Exercises , 16.3, 17.1,

42 SUPINE STRAIGHT LEG RAISE Purpose To assess the extensibility of the posterior aspect of the lower extremity and hip flexor strength. Result Lie supine with your hands behind your lower back. Your hands should fill the natural curve of the lower back, and you should actively maintain it throughout the test. Raise a straightened leg as high as possible without bending the knee or allowing the back to flatten on the hands. Once you are unable to maintain a neutral spine, estimate the angle of the leg to the floor. A normal result would be approximately 90 degrees of leg raise. If you re unable to achieve at least 70 degrees of straight leg raise, it may also indicate weakness of the hip flexors. Corrective Exercises ,

43 SUPINE FABER Purpose To assess the stiffness of the groin muscles and your ability to flex (F), abduct (AB), and externally rotate (ER) the hip. Lie supine and place your foot on top of the opposite knee. Allow the bent knee to lower as far as is comfortable. Result A normal result will have the bent leg achieve a position parallel to the floor without any pelvic movement Corrective Exercises , ,

44 SUPINE HIP AND KNEE FLEXION Purpose To assess the stiffness of the hip in flexion without the limitation of the posterior leg musculature. Lie supine with your hands behind your lower back. Your hands should fill the natural curve of the lower back, and you should actively maintain it throughout the test. Begin the test by flexing the hip and knee without allowing your back to flatten onto your hands or the opposite leg to lift from the floor. Once you are unable to maintain your neutral spine or if the opposite leg cannot remain in contact with the floor, estimate the angle of hip flexion achieved. Result A normal result is 120 of hip flexion. Corrective Exercises , , 4.3, 4.5,

45 SEATED HIP AND KNEE FLEXION Purpose To assess hip flexor (primarily psoas muscle) strength. Start by sitting tall with the hips and knees bent 90 degrees and place on hand on the lower back to monitor your lower back alignment. Flex the hip as high as possible without altering your neutral back alignment. Result You should be able to achieve 120 degrees of hip flexion as in the Supine Hip/Knee Flexion test. If you were able to achieve 120 degrees of hip flexion in the supine test but cannot in the seated test, your hip flexor muscles are weak. If you are able to achieve 120 of hip flexion in the seated test, apply a downward force on the thigh. The ability to hold 120 degrees of flexion against resistance is a normal test and no correction is needed. Corrective Exercises , 1.4,

46 QUADRUPED ROCK BACK Purpose Result Corrective Exercises The first part of the test involves the alignment of the spine, neck, and head. The spine should be able to achieve a neutral alignment with a slight lumbar curve, slight outward thoracic curve, and a slight inward curve at the neck. The second part of the quadruped test involves assessing your hip flexion in a bilateral pattern much like a squat. Part 1: To determine your alignment, you can place a stick along the spine and it should make 3 points of contact. One at the tailbone, one at the thoracic spine between the shoulder blades and one at the head with the head in neutral alignment and not tilted back to the stick. Part 2: Start the test from your neutral spinal alignment in quadruped with the hips at 90 degrees of flexion. Shift the weight posteriorly by flexing the hips and the knees. Part 1: If you cannot make contact with the stick without tilting the head back, you would be considered to have a forward head posture due to thoracic spine and cervical spine mobility issues. If the space between your back and the stick is larger than the thickness of your hand at the knuckles your lumbar curve is greater than normal. If the space between your back and the stick is less than the thickness of your hand at the knuckles, your lumbar curve is too flat. Part 2: A normal result is to achieve 120 degrees of hip flexion without a change in the alignment of the spine. Part 1: Forward Head correction: Thoracic Spine corrections: Increased lumbar curve correction: , 4.5, Decreased lumbar curve correction: 2.1, , 13.4, 16.2 Part 2: ,

47 PRONE KNEE FLEXION Purpose To assess the flexibility of the anterior thigh and hip. Lie prone with leg straight. Bend one knee as far as possible without allowing your spine to extend or rotate or your pelvis to tilt. Result A normal result would be at least 120 of knee flexion without movement of the spine or pelvis. Corrective Exercises ,

48 THOMAS TEST Purpose To assess the extensibility of the hip flexor muscles and hip extension range of motion. Result Corrective Exercises Sit on the edge of a stable surface and lie back bringing both knees to your chest and allow the spine to flatten to the surface. Release one leg with the knee bent and allow the hip to extend. If you are unable to touch the back of the thigh to the surface with the knee bent, a hip flexor muscle is short. Extend the knee. If still unable to touch the thigh to the surface, allow the hip to abduct. A normal result is the ability of the hip to rest on the table with the knee in line with the hip and the knee flexed. No correction is needed. If you extend the knee and the hip extends to the surface, then the rectus femoris is short. If you extend the knee and the thigh does not touch the surface the psoas is short. If you allow the hip to abduct and thigh touches the surface, the tensor fascia latae is short. Rectus femoris: , 8.1 Psoas: 1.2, 1.4, 3.3, 4.3, 4.5, 8.3 Tensor Fascia Latae: 3.4, 6.2,

49 SUPINE HIP ABDUCTION AND ADDUCTION Purpose To assess hip abduction and adduction range of motion. Lie supine with legs straight. Abduct one hip to first determine your abduction range of motion. Then adduct the opposite hip without lifting the leg or rotating the hip. Result Abduction: A normal result is approximately 45 degrees of hip abduction without any movement of the pelvis or hip rotation. Adduction: A normal result will be between 10 and 30 of hip adduction without any movement of the pelvis, leg elevation, or hip rotation. Corrective Exercises Abduction: Adduction: , 7.1,

50 SEATED HIP INTERNAL ROTATION Purpose To assess hip internal rotation with the hip flexed. Sit as tall as possible with your weight positioned evenly on both hips. To internally rotate the hip move the foot outward as far as possible without abducting the hip, side bending the spine, or shifting your weight to the opposite side. Result A normal result is 35 degrees of internal hip rotation. Corrective Exercises 5.4, 6.1,

51 SEATED HIP EXTERNAL ROTATION Purpose To assess hip external rotation with the hip flexed. Sit as tall as possible with your weight positioned evenly on both hips. To externally rotate the hip move the foot inward as far as possible without abducting the hip, side bending the spine, or shifting your weight over the hip. Result A normal result is 45 degrees of internal hip rotation. Corrective Exercises

52 PRONE HIP INTERNAL ROTATION Purpose To assess hip internal rotation with the hip extended. Lie prone with one knee flexed to 90 degrees. To internally rotate the hip, move the foot outward without abducting or flexing the hip or rotating the spine and pelvis. Result A normal result is 35 degrees of internal hip rotation. Corrective Exercises 5.4,

53 PRONE HIP EXTERNAL ROTATION Purpose To assess hip internal rotation with the hip extended. Lie prone with one knee flexed to 90 degrees. To externally rotate the hip, move the foot inward without abducting or flexing the hip or rotating the spine and pelvis. Result A normal result is 45 degrees of internal hip rotation. Corrective Exercises

54 CLOSED CHAIN ANKLE DORSIFLEXION Purpose To assess ankle dorsiflexion with the knee flexed and the foot on the ground. Without wearing shoes, stand facing a wall with the foot pointed at the wall. Keeping the midline of the kneecap in line with the midline of the foot and the heel on the floor, bend the knee and ankle until the knee touches the wall. Repeat the test until you can determine the maximum distance away from the wall that you can position your foot and still make contact with the wall while maintaining alignment of the knee and foot and keeping the heel on the ground. Result A normal result is the ability to touch the wall with your foot approximately 3 inches from the wall. Corrective Exercises

55 SINGLE-LEG SQUAT Purpose To assess gross hip stability including upper gluteus maximus and gluteus medius strength. Stand on one with the other leg bent. With your arms out in front of you, lower yourself downward on the support leg until the knee bends about 60 degrees. Result A normal result shows the midline of the knee in line with the midline of the foot or slightly more lateral. Movement of the knee inside the midline of the foot would indicate a weakness/instability in hip. Corrective Exercises 4.1, 5.5, ,

56 SINGLE-LEG BRIDGE Purpose To assess gluteus maximus strength in hip extension. Lie face up on the floor with your knees bent approximately 90 degrees. Brace the abdominals to maintain neutral spine and lift the hips until a straight line is formed from the knee to the hip the shoulder. Lift one foot off the floor. Result Normal gluteus maximus function is indicated by no change in alignment by going from two foot support to single foot support. Corrective Exercises

57 References 1. Bradley, J. Glenohumeral Range of Motion Deficits and Posterior Shoulder Tightness in Throwers with Pathologic Internal Impingement. Am J Sports Med. 34: Burkhart, SS, et. al. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 19(6): July-August, Cibulka, MT, Threlkeld-Watkins, J. Patellofemoral pain and asymmetrical hip rotation. Physical Therapy. 85: Cressey, E, Robertson, M. Magnificent Mobility Friberg, O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 8(6): Harris-Hayes, M, et. al. Relationship between the hip and low back in athletes who participate in rotational sports. Journal of Sport Rehabilitation. 18: Hartman, B, Robertson, M. Inside-Out: The Ultimate Upper Body Warm-up Hennessy, L. Flexibility and posture assessment in relation to hamstring injury. Br J Sp Med. 27(4): Hollman, JH, et. al. Correlations Between Hip Strength and Static Foot and Knee Posture. Journal of Sport Rehabilitation. 15: Hollman, JH, et. al. Relationships between Knee Valgus, Hip-Muscle Strength, and Hip- Muscle Recruitment During a Single-Limb Step-Down. Journal of Sport Rehabilitation. 18: Hoogenboom, B. The Influence of Improper Posture on Impingement. The Sports Physical Therapy Section Team Concept Conference Janda, V. On the concept of postural muscles and posture in man. The Australian Journal of Physiotherapy. 29(3) In: The Janda Compendium. Volume II. Distributed by OPTP. Minneapolis, MN. 13. Janda, V. Muscle Strength in relation to muscle length, pain, and muscle imbalance. International Perspectives in Physical Therapy 8. Churchill Livingstone, Edinburgh, 57

58 London, Madrid, Melbourne, New York, and Tokyo. Pg In: The Janda Compendium. Volume II. Distributed by OPTP. Minneapolis, MN. 14. Kebaetse, M, et. al. Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Arch Phys Med Rehabil. August, 80: Kluemper, M, et. al. Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers. Journal of Sport Rehabilitation. 15: Kritz, MF, et. al. Static Posture Assessment Screen of Athletes: Benefits and Considerations. NSCA Strength and Conditioning Journal. 30(5): Levinger, P, et. al. Frontal plane motion of the rearfoot during a one-leg squat in individuals with patellofemoral pain syndrome. J Am Podiatr Med Assoc. Mar-Apr, 96(2): Loudon, JK. The Relationship Between Static Posture and ACL Injury in Female Athletes. JOSPT. 24(2): August Maffetone, P. Complementary Sports Medicine. Human Kinetics. Champaign, IL Osar, E. Complete Shoulder and Upper Extremity Conditioning Osar, E. Complete Hip and Lower Extremity Conditioning Reiman, MP, et. al. The hip s Influence on low back pain: A distal link to a proximal problem. Journal of Sport Rehabilitation. 18: Rieman, MP, et. al. Hip Function s Influence on Knee Dysfunction: A Proximal Link to a Distal Problem. Journal of Sport Rehabilitation. 18: Sahrmann, S. Diagnosis and Treatment of Movement Impairment Syndromes. Mosby. St. Louis, MO Scannell, JP, McGill, SM. Lumbar Posture Should it, and can it, be modified? A study of passive tissue stiffness and lumbar position during activities of daily living. Physical Therapy. 83(10): Schamberger, Wolf. The Malalignment Syndrome. Elsevier. Philadephia, PA

59 27. Subotnick, SI. Case history of unilateral short leg with athletic overuse injury. J Am Podiatry Assoc. 70(5): Trojian, TH, McKeag, DB. Single leg balance test to identify risk of ankle sprains. Br J Sp Med. 40(7): Tunnell, PW. Protocol for visual assessment. Journal of Bodywork and Movement Therapies. 1(1):

60 Section 3 The Corrections 60

61 1.1 SUPINE STRAIGHT LEG RAISE Purpose To improve unilateral hip flexion mobility. Set-up Lie on your back with your fingers placed in the small of your back. Keep both legs straight, with the toes pointed upwards. Keeping both legs straight, lift your leg up until you feel an increase in the pressure on your fingers. Lower under control to the starting position. Coaching Points Don t worry about your range of motion! Get your mobility from your hips versus your lower back. 61

62 1.2 HIGH KNEE WALK Purpose To improve unilateral hip flexion mobility, while integrating stability from the opposite foot and hip. Set-up Stand up tall; think about a rope pulling your head and body upwards to lengthen you. Take a step forward; while stepping, flex your right hip and knee. Grab your shin and pull your knee to your chest. Relax and repeat on the opposite leg. Coaching Points Focus on keeping your chest up and back flat throughout. Don t allow the chest to cave, or the lower back to round. 62

63 1.3 SINGLE-LEG RDL Purpose To improve unilateral hip flexion, while integrating stability from the opposite foot, hip and the core. Set-up Stand up tall; think about a rope pulling your head and body upwards to lengthen you. Take a step forward with the weight on your heel. With a slight knee bend and good posture, push the hips back and lower the torso to perform a toe touch while the opposite leg swings back. Maintain good posture throughout. You should have your chest out and a slight arch in the lower back. Coaching Points Don t allow the chest to cave, or the lower back to round. Don t rush through reps, and stand up completely in between each repetition. 63

64 1.4 HIGH KNEE WALK TO FORWARD LUNGE Purpose To improve unilateral hip flexion while integrating stability from the opposite foot and hip. Set-up Stand up tall; think about a rope pulling your head and body upwards to lengthen you. Take a step forward; while stepping, flex your right hip and knee. Grab your shin and pull your knee to your chest. From this flexed position, take the elevated leg and lunge forward. Step up and repeat on the opposite leg. Coaching Points Focus on keeping your chest up and back flat throughout. Don t allow the chest to cave, or the lower back to round. 64

65 2.1 KNEELING ROCKBACKS Purpose To improve bilateral hip flexion mobility and teach someone the necessary mobility and stability patterns to squat effectively. Set-up Set-up in an all-fours position with the hands underneath the shoulders, and knees underneath the hips. Your chest should be up, and you should have a slight arch in the lower back. Slowly push the hips backwards towards the heels. Push back to a point just before you lose your arch, and then return to the starting position. Coaching Points Focus on keeping your chest up and back flat throughout. No rounding! 65

66 2.2 SQUAT-TO-STAND Purpose To improve bilateral hip flexion mobility and improve length in the hamstrings and adductors. To teach someone the necessary mobility and stability patterns to squat effectively. Set-up Set-up with your feet in a slightly wider than shoulder-width stance. Bend over to grab the bottom of your feet, and then pull yourself into a deep squat position. As you move into the bottom position, focus on forcing the chest up, pushing the knees out, and keeping the heels down. From the bottom position, raise the hips back up without letting go of your feet. Hold this hamstring stretch for a count of one-one-thousand, and then pull yourself back down into the deep squat position. Coaching Points Do not set-up with the arms outside the knees. Focus on keeping the chest up and knees out throughout. 66

67 2.3 GOBLET SQUATS Purpose To re-groove a proper squat pattern, while simultaneously improving mobility in the hips and thoracic spine. Set-up Grab a light dumbbell or kettlebell and hold it against your chest. Set-up with your feet in a slightly wider than shoulder-width stance, and the toes turned out slightly. Your chest should be elevated, and you should have a slight arch in your lower back. Brace the core, sit back, and push your knees out to the side. In the bottom position, your elbows should graze against your knees. Keep your chest up and out, and return to the starting position. Coaching Points Don t allow any rounding of the lower back. Focus on keeping the chest up and knees out throughout. 67

68 2.4 PRISONER SQUATS Purpose To re-groove a proper squat pattern, while simultaneously improving mobility in the hips ankles and thoracic spine. Set-up Set-up with your feet in a slightly wider than shoulder-width stance, and the toes turned out slightly. Place your fingertips behind your head to help keep your chest elevated and a slight arch in your lower back. Brace the core, sit back, and push your knees out to the side. Go as deep as your mobility allows, or just before your lower back starts to round. With your chest up and knees out, return to the starting position. Coaching Points Don t allow any rounding of the lower back. Focus on keeping the chest up and knees out throughout. 68

69 3.1 PULSED HIP FLEXOR MOBILIZATIONS Purpose To improve length of the hip flexors. To teach your body the difference between hip extension and lumbar extension. Set-up Set-up with your left knee down on a towel or Airex pad. Your right leg should be directly in front of the body with your foot flat on the floor. Make sure that both legs are completely straight and parallel to each other. With the chest up and out, gently brace the core and tense your left glutes to drive your hip forward. Push to the point where you get a mild stretch in the front of your left hip. Hold for a two count, and then return to the starting position. Coaching Points Keep the core tight and tense the glutes to get the stretch. Don t extend with your lower back! Don t worry about your range of motion initially. If you do this properly, you won t need to move much to get a killer stretch. 69

70 3.2 WALL HIP FLEXOR MOBILIZATIONS Purpose To improve length of the rectus femoris muscle. To teach your body the difference between hip extension and lumbar extension. Set-up Set-up with your left knee down on a towel or Airex pad. Reach back with your left hand to grab your left ankle. Your right leg should be directly in front of the body with your foot flat on the floor. Both legs should be completely straight and parallel to each other. Make sure to do this close to a wall so you can use it for balance. Coaching Points With the chest up and out, gently brace the core and tense your left glutes to drive your hip forward. Push to the point where you get a mild stretch in the front of your left hip. Hold for a count of one-one-thousand, and then return to the starting position without letting go of your ankle. Keep the core tight and tense the glutes to get the stretch. Don t extend with your lower back! Make sure you don t lean forward. Doing so will reduce the intensity of the stretch. 70

71 3.3 OVERHEAD LUNGE WALK Purpose To improve length of the hip flexors without using the lower back. To integrate hip mobility with thoracic spine mobility. To add in elements of stability and motor control. Set-up Stand up tall with your feet together and your arms outstretched overhead. Gently brace the core this will ensure you re stabilizing your lumbar spine, while extending through your thoracic spine. Take an exaggerated step forward, landing on the heel. Lower under control to a point where the trailing leg knee is just above the ground. Drive through the heel to return to the upright position. Coaching Points Keep the core tight and thoracic spine extended throughout. Land on the heel and drive off the heel. 71

72 3.4 REVERSE LUNGE WITH POSTEROLATERAL REACH Purpose To improve length of the hip flexors without using the lower back. To integrate hip mobility with thoracic spine rotation. Set-up Stand up tall with your chest out and feet together. Gently brace the core this will ensure you re stabilizing your lumbar spine. Coaching Points Take an exaggerated step backward, keeping the majority of your weight on your front heel. Drop down into the lunge position, while simultaneously reaching up and back with the opposite arm over the lead leg. Push through the heel to reverse the momentum and return to the starting position. Keep the chest up and out, and the core tight. Make sure to rotate from your thoracic spine (upper back) versus your lumbar spine (lower back). 72

73 4.1 SIDE-LYING LEG RAISE Purpose To improve hip abduction strength and mobility. To feel the difference between hip mobility and lumbar spine mobility. Set-up Lie on your left side with your body in a straight line and feet stacked on top of each other. Gently brace the core and lift the right leg, leading with the heel. Lift as high as you can using your hip, and then return to the starting position. Coaching Points Don t worry about your range of motion initially! Get your mobility from your hips versus your lower back. Keep your core tight and make sure to lead with your heel. 73

74 4.2 SPLIT-STANCE KNEELING ADDUCTOR MOBS Purpose To improve the length of the adductor magnus. Set-up Set-up on all fours on the floor, and then put one leg directly out to the side with the knee straight. The chin should be tucked and the lower back arched. Rock back, maintaining neutral spine and stopping short of the point where your lower back rounds. As you rock back, shift the weight on your outside foot towards your heel so your toes come up slightly. Coaching Points Maintain neutral spine throughout and do not allow your back to round. 74

75 4.3 WALKING SPIDERMAN Purpose To improve the length of the hip flexors and adductors. Set-up Stand with your feet together and chest up and out. Coaching Points Take a long stride forward into a lunge position. Keeping the chest up and out, lower the same-side elbow to the heel of your forward leg. In the bottom position, squeeze the glute of the trailing leg and drive the hip towards the ground. Stand up and return to the starting position. Maintain neutral spine throughout and do not allow your back to round. Keep the chest up and out. Make sure to take long strides to lengthen the adductors. 75

76 4.4 WALKING SPIDERMAN WITH HIP LIFT Purpose To improve the length of the hip flexors, adductors and hamstrings. Set-up Stand with your feet together and chest up and out. Coaching Points Take a long stride forward into a lunge position. Keeping the chest up and out, lower the same-side elbow to the heel of your forward leg. In the bottom position, squeeze the glute of the trailing leg and drive the hip towards the ground. Push your hips back and up, keeping your hands on the ground. Hold for a count of one-one-thousand, and then return to the starting position. Maintain neutral spine as much as possible and do not allow your back to round. Keep the chest up and out. Make sure to take long strides to lengthen the adductors. 76

77 4.5 WALKING SPIDERMAN WITH ONE-ARM OVERHEAD REACH Purpose To improve the length of the hip flexors, adductors and hamstrings. To incorporate thoracic spine rotation. Set-up Stand with your feet together and chest up and out. Coaching Points Take a long stride forward into a lunge position. Keeping the chest up and out, lower the same-side elbow to the heel of your forward leg. In the bottom position, squeeze the glute of the trailing leg and drive the hip towards the ground. Reach to the sky with the arm opposite your down leg Hold for a count of one-one-thousand, and then return to the starting position. Maintain neutral spine throughout and do not allow your back to round. Keep the chest up and out. Make sure to take long strides to lengthen the adductors. 77

78 5.1 SEATED 90/90 MOBILIZATIONS Purpose To improve hip external rotation mobility. Set-up Sit on a chair or bench, and move to the edge so that only your glutes and upper thighs are supported. Lift your chest and sit up tall, setting a small arch in your lower back. Take your right ankle and place it on your left knee. Use your right hand to slowly press down on your right knee, while using your left hand to pull up on the foot. Hold for a one-two count, and then relax. Coaching Points This is a mobilization, not a stretch. Hold for a one-two count, and then relax. Ease into the movement, and never move into pain. Keep the chest up and a small arch in the lower back throughout. 78

79 5.2 CRADLE WALKS Purpose To improve hip external rotation mobility, while developing stability in the opposite foot and hip. Set-up Stand up tall with your feet together. Take a step forward with your left leg, grabbing your right foot and ankle, pulling your instep upward. Keep the chest up and out throughout, and don t allow the lower back to round. It may help to think about actively pulling the foot up rather than just grasping it. Coaching Points Keep the chest up and a small arch in the lower back throughout. 79

80 5.3 SPLIT-STANCE KNEELING ADDUCTOR MOBS Purpose To improve hip external rotation mobility. Set-up Set-up on all fours on the floor, and then put one leg directly out to the side with the knee straight. The chin should be tucked and the lower back arched. Rock back, maintaining neutral spine and stopping short of the point where your lower back rounds. As you rock back, shift the weight on your outside foot towards your heel so your toes come up slightly. Coaching Points Maintain neutral spine throughout and do not allow your back to round. 80

81 5.4 SPLIT-STANCE HIP SWIVELS Purpose To improve hip external rotation mobility. Set-up Set-up on all fours on the floor, and then put one leg directly out to the side with the knee straight. The chin should be tucked and the lower back arched. Drive hip internal and external rotation by rolling back and forth between your heel and toes on the outside foot. Hold at the end range of each direction for a count of one-one-thousand. We typically perform this exercise for time versus reps. Coaching Points Maintain neutral spine throughout with the chin tucked and lower back arched. Rotate from the hips and not the lumbar spine. Use the toe motion to drive hip motion. 81

82 5.5 HIP AIRPLANES Purpose To improve hip internal and external rotation mobility. To develop stability in the down-leg hip and foot. Set-up Split your legs from front to back and place all your weight on the front leg. Incline the upper body forward and extend the back leg so you develop a straight line between your upper body and back leg. Abduct your arms to 90 degrees for balance. Lift the back foot to balance on the front leg. Rotate the pelvis towards the front leg, and then away from the front leg. The upper body and back leg should be in a straight line throughout. Coaching Points Maintain the incline of the upper body throughout the exercise. Rotate from the hips and not the lumbar spine. 82

83 6.1 KNEELING GLUTE MOBS Purpose To improve hip adduction mobility. Set-up Set-up in an all-fours position with the hands underneath the shoulders and the knees underneath the hips. Take your right ankle and place it on the back of your left knee. Set a slight arch in your lower back. With your back set, think about pushing back into your right hip. Hold for a 1-2 count, and then return to the starting position. Coaching Points Maintain neutral spine throughout. Keep the hips pointed towards the front, rather than allowing them to rotate or side-bend. 83

84 6.2 CROSS-BEHIND OVERHEAD REVERSE LUNGES Purpose To improve hip adduction mobility, with an added element of stability from the supporting hip and foot. Set-up Stand up tall with your feet shoulder-width apart and arms outstretched to the sides. As you stride backward and behind you with one leg, reach overhead. The shin on your stance leg should be completely vertical throughout. Drive off the front heel and return to the starting position. Coaching Points Keep the torso upright, and do not allow the shoulders and upper back to round. Make sure not to stride too far laterally; if you do, you ll tip over. 84

85 7.1 LYING KNEE-TO-KNEE PULL-INS Purpose To improve hip internal rotation mobility which are caused by muscular restrictions. Set-up Lie on your back with your knees bent and feet flat on the floor. Exaggerate the width between your feet. From the starting position, think about trying to touch your knees together while keeping your feet on the floor. Hold for a two count, and then return to the starting position. Coaching Points Don t worry if your feet are totally flat on the ground; as long as you re getting a stretch in the hip region, it s not a big deal. 85

86 7.15 PRONE WINDSHIELD WIPERS Purpose To improve hip internal rotation mobility which are caused by hip capsule restrictions. Set-up Lie on your stomach with your arms out to the sides. Your knees should be together and feet up in the air. Keeping the knees together, let the feet fall out to the sides. Hold for a two count, and then return to the starting position. Coaching Points Focus on keeping the knees together throughout the course of this exercise. 86

87 7.2 SPLIT-STANCE HIP SWIVELS Purpose To improve hip internal rotation mobility. Set-up Set-up on all fours on the floor, and then put one leg directly out to the side with the knee straight. The chin should be tucked and the lower back arched. Drive hip internal and external rotation by rolling back and forth between your heel and toes on the outside foot. Hold at the end range of each direction for a count of one-one-thousand. We typically perform this exercise for time versus reps. Coaching Points Maintain neutral spine throughout with the chin tucked and lower back arched. Rotate from the hips and not the lumbar spine. Use the toe motion to drive hip motion. 87

88 7.3 HIP AIRPLANES Purpose To improve hip internal and external rotation mobility. To develop stability in the down-leg hip and foot. Set-up Split your legs from front to back and place all your weight on the front leg. Incline the upper body forward and extend the back leg so you develop a straight line between your upper body and back leg. Abduct your arms to 90 degrees for balance. Lift the back foot to balance on the front leg. Rotate the pelvis towards the front leg, and then away from the front leg. The upper body and back leg should be in a straight line throughout. Coaching Points Maintain the incline of the upper body throughout the exercise. Rotate from the hips and not the lumbar spine. 88

89 8.1 SUPINE BRIDGE Purpose To improve hip extension, and learn the difference between hip motion and lumbar spine motion. To activate the gluteals. Set-up Lie on your back with your arms at your sides, knees bent and feet flat on the floor. Tense your abs and squeeze your glutes to initiate the movement. Go only as high as your glutes will take you; don t arch your back! Lower under control to a point just above the ground, and repeat. Coaching Points Drive through the heels and use the glutes to promote the movement, versus the lower back and hamstrings. Don t go further than your glutes can take you, and definitely don t hyperextend the low back. Do it right! 89

90 8.2 ONE-LEG SUPINE BRIDGE Purpose To improve hip extension, and learn the difference between hip motion and lumbar spine motion. To activate the gluteals in a unilateral fashion. Set-up Lie on your back with your arms at your sides, knees bent and feet flat on the floor. Pull one leg up to your chest. Tense your abs and squeeze your glutes to initiate the movement. Go only as high as your glutes will take you; don t arch your back! Lower under control to a point just above the ground, and repeat. Coaching Points Drive through the heels and use the glutes to promote the movement, versus the lower back and hamstrings. Don t go further than your glutes can take you, and definitely don t hyperextend the low back. Do it right! Avoid rounding the back when grabbing the shin. Your head should not come up off the floor. 90

91 8.3 WALL MARCH ISOMETRIC HOLD Purpose To improve hip extension, and learn the difference between hip motion and lumbar spine motion. To activate the gluteals in a unilateral fashion. To train opposing hip function one hip flexes, one hip extends. Set-up Stand facing a wall; you should be a few feet away with your hands and fingertips resting gently up against it. There should be a natural amount of forward lean in this position. Gently brace your core and actively drive the heel of your stance leg in the ground. Simultaneously raise your opposite knee as high as it will go. In this position, you should be actively contracting the glute of your stance leg, your chest should be out, and your opposite knee should be as high as it will go. Coaching Points Stay tight/tall throughout. Squeeze the glute of the stance leg. No hamstrings allowed! 91

92 8.4 BOWLER SQUATS Purpose To train the gluteals to produce and resist motion in all three planes of movement. Set-up Stand on your left foot with a slight bend in your knee and your right foot held slightly off the ground. Your chest should be out and your back flat. From the starting position, sit back into your left hip while reaching across your body with your right hand. Sit back until you get a nice stretch in the glutes, or until you feel as though you re going to lose your balance. Return to the starting position. Coaching Points Keep the chest up and back flat throughout. Shorten the range of motion initially if need be. It will increase as your hip mobility and strength improves over time. 92

93 9.1 HIP ABDUCTOR WALL SLIDE Purpose To activate and strengthen the glute max and posterior glute medius. Set-up Take your shoes off and lie up against a wall on your side. Your entire body should be up against the wall; feet, glutes, upper back and head. Slightly externally rotate the toes of the left foot. Gently brace the core and pull the heel back into the wall while lifting it upwards. Lift in a controlled fashion to a point where you run out of hip motion, and then return to the starting position. Coaching Points Keep the toes externally rotated, and pull back into the heel throughout the exercise. Focus on keeping the core tight, and moving from the hip versus the lower back. 93

94 9.2 X-BAND WALKS Purpose To activate and strengthen the glute max and posterior glute medius. To strengthen the core, scapular stabilizers and shoulder external rotators. Set-up Take a resistance band and step on it so that both feet are resting on the band. Cross it over itself so the band forms an X, and hold it with your hands facing each other and your arms tucked into your sides. Brace your midsection, get tall, and walk slowly from side-to-side. Think about leading from your heels versus your toes. This will make sure you re using all the muscles to abduct your hip, not just your TFL. Coaching Points Focus on leading with the heel, not the toes. Stay tall and tight throughout. Do not allow the torso to side-bend. 94

95 9.3 SIDE BRIDGE WALL SLIDES Purpose To activate and strengthen the glute max and posterior glute medius. To build functional movement patterns by integrating the opposite side quadratus lumborum. Set-up Take your shoes off and lie up against a wall on your side. Your entire body should be up against the wall; feet, glutes, upper back and head. Slightly externally rotate the toes of the left foot. Coaching Points Gently brace the core and drive up into a side bridge position. Your feet, hips and torso should be in a straight line. Next, pull the heel back into the wall while lifting it upwards. Lift in a controlled fashion to a point where you run out of hip motion, and then return to the starting position. Make sure to keep a neutral spinal alignment, and keep the hips up throughout. Keep the toes externally rotated, and pull back into the heel throughout the exercise. Focus on keeping the core tight, and moving from the hip versus the lower back. 95

96 9.4 BOWLER SQUATS Purpose To train the gluteals to produce and resist motion in all three planes of movement. Set-up Stand on your left foot with a slight bend in your knee and your right foot held slightly off the ground. Your chest should be out and your back flat. From the starting position, sit back into your left hip while reaching across your body with your right hand. Sit back until you get a nice stretch in the glutes, or until you feel as though you re going to lose your balance. Return to the starting position. Coaching Points Keep the chest up and back flat throughout. Shorten the range of motion initially if need be. It will increase as your hip mobility and strength improves over time. 96

97 10.1 SIDE-LYING CLAMS Purpose To train the gluteals to produce and resist external rotation. Set-up Lie on your side with your hips and knees bent, and feet together. Brace your core, and slowly rotate your left leg away from the floor. Keep both feet together throughout the movement, and rotate your hip as far as you can without moving the lower back. Return to the starting position. Coaching Points Keep the core tight and rotate from the hips versus the lower back. Hip range of motion may be limited at first. It may help to think about swiveling through your heel. This should facilitate better gluteal function. 97

98 10.2 BAND RESISTED CLAMS Purpose To train the gluteals to produce and resist external rotation. Set-up Place a light band around your feet, and slide it up so that it rests just above your knees. Lie on your side with your hips and knees bent, and feet together. Brace your core, and slowly rotate your left leg away from the floor. Keep both feet together throughout the movement, and rotate your hip as far as you can without moving the lower back. Return to the starting position. Coaching Points Keep the core tight and rotate from the hips versus the lower back. Hip range of motion may be limited at first, especially when adding resistance. It may help to think about swiveling through your heel. This should facilitate better gluteal function. 98

99 10.3 BOWLER SQUATS Purpose To train the gluteals to produce and resist motion in all three planes of movement. Set-up Stand on your left foot with a slight bend in your knee and your right foot held slightly off the ground. Your chest should be out and your back flat. From the starting position, sit back into your left hip while reaching across your body with your right hand. Sit back until you get a nice stretch in the glutes, or until you feel as though you re going to lose your balance. Return to the starting position. Coaching Points Keep the chest up and back flat throughout. Shorten the range of motion initially if need be. It will increase as your hip mobility and strength improves over time. 99

100 11.1 LYING PSOAS MARCH Purpose To activate and strengthen the psoas. To teach the difference between hip flexion and lumbar flexion. Set-up Lie on your back with your legs straight and your arms bent so that your fingertips are in the small of your back. Set a neutral spine; if you need to, place a small towel roll in between your lumbar spine and the ground. Initiate the movement by pulling from the front of your hip. Pull as high as you can without losing the curve in your lower back, and then return to the starting position. Coaching Points Keep the natural curve in your lower back throughout the course of the movement. Make sure to pull your knee in a straight line don t allow it to deviate sideto-side. 100

101 11.2 SEATED PSOAS HOLDS Purpose To activate and strengthen the psoas, while integrating core stability. To teach the difference between hip flexion and lumbar flexion. Set-up Sit on a very low box with your knees above your hips. Place the fingertips behind the head, lift the chest, and gently brace the core. Slowly raise one knee an inch or so off the ground. Focus on staying tall through the torso and driving from the front of your hips. Hold for 3-5 seconds, and then return to the starting position. Coaching Points Keep the natural curve in your lower back throughout the course of the movement. Make sure to pull your knee in a straight line don t allow it to deviate sideto-side. 101

102 11.3 WALL MARCH ISOMETRIC HOLD Purpose To improve hip flexion, and learn the difference between hip motion and lumbar spine motion. To activate the gluteals in a unilateral fashion. To train opposing hip function one hip flexes, one hip extends. Set-up Stand facing a wall; you should be a few feet away with your hands and fingertips resting gently up against it. There should be a natural amount of forward lean in this position. Gently brace your core and actively drive the heel of your stance leg in the ground. Simultaneously raise your opposite knee as high as it will go. In this position, you should be actively contracting the glute of your stance leg, your chest should be out, and your opposite knee should be as high as it will go. Coaching Points Stay tight/tall throughout. Squeeze the glute of the stance leg. No hamstrings allowed! 102

103 11.4 STANDING PSOAS HOLDS Purpose To activate and strengthen the psoas, while integrating core, foot and hip stability. To teach the difference between hip flexion and lumbar flexion. Set-up Stand up tall with your fingertips behind your head. Coaching Points Gently brace the core, lift the ribcage and pull the left knee as high as possible. Keep your chest out, core tight, left knee above 90 degrees, and your right hip extended with the glutes tense. Hold for 3-5 seconds, lower and repeat. Maintain good posture throughout chest up and neutral spine throughout. Make sure to flex the hip versus the lumbar spine, and actively extend through the down leg. 103

104 12.1 ROCKING ANKLE MOBS Purpose To improve length of the gastrocnemius and/or soleus. Set-up Start in a pike position with the hips higher than the rest of the body. Place the left foot behind the right ankle. With the right leg straight, press the heel of the right foot down until you get a mild stretch. Hold for a one-two count, and then return to the starting position. If you want to put more emphasis on the soleus versus the gastrocnemius, try bending the stretch leg versus keeping it straight. Coaching Points As mobility and soft-tissue extensibility improves, work your hands further apart to increase the stretch. 104

105 12.2 WALL ANKLE MOBS Purpose To improve ankle mobility into dorsiflexion. Set-up Stand facing a wall, with the toes of one foot directly up against the wall. Stand up tall, and place your hands on the wall for support. Coaching Points Place the weight on your front heel, and gently glide the knee forward, touching the wall. Pulse in and out of this position several times. If you can easily touch the wall, scoot your foot backwards in half inch increments until your mobility is tested. When you can no longer keep the weight on your heel, or you feel the weight shifting towards the inside of your foot, stop the drill and repeat on the opposite side. This is a mobility drill, NOT a stretch. You may not feel much of anything. Keep the weight on the heel, and towards the outside of the foot throughout. 105

106 12.3 KNEE-BREAK ANKLE MOBS Purpose To improve ankle mobility into dorsiflexion. Set-up Place a pair of small plates on the floor. Stand up tall, placing your toes on the plates. With your weight on your heels, gently glide your knees forward. As you glide, resist the temptation to move at the hips, or shift the weight toward your toes. Coaching Points If you have a significant asymmetry between sides, return to the previous exercise until you achieve symmetry. Stay tall, and keep the weight on the heels throughout. 106

107 13.1 THORACIC EXTENSION ON ROLLER Purpose To improve extension in the thoracic spine. Set-up Position yourself on the floor with the knees flexed to 90 degrees and your body perpendicular to the roller behind you. Lie back so that the roller crosses your upper back, just below the shoulder blades. Clasp your hands gently behind your head, pull your elbows together, and tuck your chin. From the starting position, extend your upper back, hinging over the foam roller. Keep the stomach tight throughout, and make sure to extend at the upper back versus your lower back. Coaching Points Keep the butt on the ground throughout. Extend at the upper versus the lower back. Keep the chin tucked throughout. 107

108 13.2 BENT-OVER THORACIC SPINE ROTATION Purpose To improve rotation in the thoracic spine. Set-up Stand up tall, and then sit back with the hips as if you were going to perform a deadlift. Your arms should be hanging down towards the ground. Raise one arm out to the side with the thumb up, following it with rotation of your head. Keep the core gently braced throughout; this will ensure thoracic spine rotation versus lumbar rotation. Coaching Points Keep the upper arm at a 90-degree angle to the body. Keep the spine in neutral throughout. Don t allow the chest or shoulders to sag. 108

109 13.3 QUADRUPED EXTENSION-ROTATION Purpose To improve extension and rotation in the thoracic spine. Set-up Start in quadruped with the hands underneath the shoulders and knees underneath the hips. Next, place one hand behind your head. Coaching Points Gently move the elbow of the top elbow down and back towards the opposite knee. Reverse the motion, coming past the starting point to promote extension and rotation. Driving the eyes upwards will help as well. Keep the elbow up throughout. Don t move too far downward at any point in the movement. Make sure to stabilize the lumbar spine and move from the thoracic spine throughout. 109

110 POINT EXTENSION-ROTATION Purpose To improve extension and rotation in the thoracic spine. To improve core/lumbar stability while rotating from the thoracic spine. Set-up Coaching Points Start in quadruped with the hands underneath the shoulders and knees underneath the hips. Next, take place one hand behind your head. Press up into a modified push-up position with the feet wider than usual. Gently move the elbow of the top elbow down and back towards the opposite knee. Reverse the motion, coming past the starting point to promote extension and rotation. Driving the eyes upwards will help as well. You ll have to use muscular control to prevent lumbar hyperextension. Keep that core tight! Keep the elbow up throughout. Don t move too far downward at any point in the movement. Make sure to stabilize the lumbar spine and move from the thoracic spine throughout. 110

111 13.4 YOGA PUSH-UPS Purpose To improve extension in the thoracic spine. To promote scapular and core stability, while mobilizing the hamstrings and calves. Set-up Start in a basic push-up position. Coaching Points Perform a basic push-up with the chest, and not the chin, leading the movement. Keep the elbows tucked at a 45 degree angle to the body throughout. As your reach the top of the movement, shift your hips up in the air while driving your heels towards the ground. Keep the elbows tucked throughout. Don t allow the lower back to sag. Don t look up with your eyes. Keep you chin tucked throughout. 111

112 13.5 SQUAT-TO-STAND WITH EXTENSION-ROTATION Purpose To improve extension and rotation in the thoracic spine. To integrate thoracic spine mobility with hip mobility Set-up Set-up with your feet in a slightly wider than shoulder-width stance. Coaching Points Bend over to grab the bottom of your feet, and then pull yourself into a deep squat position. As you move into the bottom position, focus on forcing the chest up, pushing the knees out, and keeping the heels down. Keep your right hand under your foot but raise your left hand up overhead, following it with your eyes. Hold for a count of one-one-thousand. Bring the left hand back under the left foot, and then repeat on the right side. From the bottom position, raise the hips back up without letting go of your feet. Hold this hamstring stretch for a count of one-one-thousand, and then pull yourself back down into the deep squat position. Do not set-up with the arms outside the knees. Focus on keeping the chest up and knees out throughout. Don t rush through the movement! Hold the bottom of the squat, the left hand up position, the right hand up position, and the hamstrings stretch for a count of one-one-thousand each. 112

113 14.1 FOREARM WALL SLIDES Purpose To improve serratus anterior activation and drive upward scapular rotation. Set-up Face the wall with your arms in front of our body and elbows flexed to 90 degrees. The forearms should be parallel to the wall. Protract the shoulder blades so the forearms are flat up against the wall. Posteriorly tilt the shoulder blades and gradually slide the forearms up the wall. When you hit end-range, gradually lower your arm and repeat for the desired number of reps. Coaching Points Keep your head and neck in neutral throughout. 113

114 14.2 FEET-ELEVATED SCAP PUSH-UPS Purpose To improve serratus anterior activation and strength. Set-up Set-up in a push-up position with the feet elevated on top of a box or bench. The chin should be tucked throughout. Coaching Points Without allowing the elbows to bend, let the shoulder blades come together. From this position, push-up to protract the shoulder blades and return to the starting position. This should elevate your torso a few more inches over the starting position. Don t allow the hips to sag. Keep the core tight throughout. Don t allow the elbows to bend. Move from your shoulder blades. Don t let the head protrude forward. 114

115 14.3 PUSH-UP PLUS Purpose To improve serratus anterior activation and strength. Set-up Set-up in a push-up position with the feet on the floor. The chin should be tucked throughout. Perform a normal push-up, leading with the chest versus the chin. As you come up to the top, overemphasize the protraction of the scapulae. This should elevate your torso a few more inches over the starting position. Coaching Points Don t allow the hips to sag. Keep the core tight throughout. Don t let the head protrude forward. 115

116 14.4 HAND SWITCHES Purpose To improve serratus anterior activation and strength. Set-up Set-up in a push-up position with the feet on the floor. You ll want a low aerobic box or step of about 6-8 in height placed to your right. Coaching Points With only a slight bend in your elbow, reach up and place your right hand on the step. Follow it up immediately with your left hand. Walk down to the right side of the step. Follow it immediately with your left hand. Once both hands are on the right side of step, go back in the opposite direction. Don t allow the hips to sag. Keep the core tight throughout. Don t let the head protrude forward. Maintain only a slight bend in the elbows throughout. 116

117 14.5 ONE-LEG SCAP PUSH-UPS Purpose To improve serratus anterior activation and strength. To improve core stability, specifically preventing lumbar extension and rotation. Set-up Set-up in a push-up position with the feet on the floor. Next, take one foot 1-2 off the ground. The chin should be tucked throughout. Coaching Points Without allowing the elbows to bend, let the shoulder blades come together. From this position, push-up to protract the shoulder blades and return to the starting position. This should elevate your torso a few more inches over the starting position. Halfway through your reps, switch which leg is supporting you. Don t allow the hips to sag. Keep the core tight throughout. Don t allow the elbows to bend. Move from your shoulder blades. Don t let the head protrude forward. 117

118 15.1 SIDE-LYING CROSS-BODY STRETCH Purpose To improve length of the posterior rotator cuff muscles. To improve shoulder internal rotation mobility. Set-up Set-up by lying on your side on a stable surface, tucking your shoulder blade down so that the chest puffs out. If possible, make sure your head is supported by a foam roller (or a similar object). With the elbow flexed to 90 degrees and the arm elevated to 90 degrees and resting on the floor, pull the elbow and upper arm across the body slightly. Make sure the scapula is stabilized throughout. Coaching Points Don t allow your shoulder to round during this movement. Keep the chest out. 118

119 15.2 SLEEPER STRETCH Purpose To improve length of the posterior rotator cuff muscles. To improve shoulder internal rotation mobility. Set-up Set-up by lying on your side on a stable surface, tucking your shoulder blade down so that the chest puffs out. If possible, make sure your head is supported by a foam roller (or a similar object). Coaching Points With the elbow flexed to 90 degrees and the arm elevated to 90 degrees and resting on the floor, gently press down on the wrist of the bottom arm. Make sure the scapula is stabilized throughout. Try performing this stretch at 75, 90 and 105 degrees of elevation to see which works best for you. Don t allow your shoulder to round during this movement. Keep the chest out. Keep your shoulder blade tucked at all times. This isn t an aggressive stretch. Be very gentle and it will improve with time. 119

120 15.3 PRONE INTERNAL ROTATION Purpose To improve activation and strength of the subscapularis. To improve shoulder internal rotation mobility. Set-up Set-up by lying face down on a stretching table or bed, with the upper arm supported on a towel roll and forearm hanging off the edge. Both the shoulder and elbow should be at 90 degrees, with the wrist straight. From the starting position, internally rotate the shoulder to move your hand in an arc back toward your hip. If you want to shrug your shoulder or lose positioning of the scapula, return to the starting position Coaching Points Don t allow the elbow to extend, the wrist to flex, or allow the shoulders to shrug. Make sure you re rotating solely from the shoulder. 120

121 15.4 DYNAMIC BLACKBURNS Purpose To improve shoulder internal rotation mobility. To improve scapular upward rotation. Set-up Set-up by lying face down on the ground or a bench. Place your hands behind your back as if you were being handcuffed. Coaching Points To begin, retract the shoulder blades, externally rotate the humerus, and make a wide, sweeping arc until your hands form a Y in front of your body. Return to the starting position, making sure to internally rotate the arms as you pass 90 degrees of abduction on the way down. Keep the chin tucked throughout the movement. Don t force the range of motion. Externally rotate the arms as you move up, and internally rotate them as you move down. 121

122 16.1 NO MONEY DRILL Purpose To improve activation and strength in the external rotators of the shoulder. To improve activation and strength in the lower trapezius. Set-up Set-up with your back against a door frame, corner of a wall, or post. You should have a shoulder blade on each side of the corner. Stand up tall with the head positioned against the corner and chin tucked. The elbows should be flexed to 90 degrees, hands adjacent to each other and the palms up. To begin, retract and depress the shoulder blades while externally rotating the shoulder, moving the hands away from each other. Return to the starting position along this same line and repeat for reps. Coaching Points Keep the chin tucked and head against the wall throughout the movement. Avoid shrugging the shoulders. Don t force the range of motion. 122

123 16.2 SIDE-LYING EXTENSION-ROTATION Purpose To improve internal and external rotation mobility in the shoulders. To improve extension of the thoracic spine. Set-up Assume a right-side lying position with the left hip and knee flexed to 90 degrees and the right leg straight. The left knee should be resting on a medicine ball or foam roller. Rotate your head and trunk slightly to the left. Brace the abdominals, push your right hand up towards the ceiling, and raise your left arm up and out to rotate the thoracic spine. Hold for a count of one-one-thousand, and then return to the starting position. The thumb should rotate back and down as you go through the movement. Coaching Points Brace the abdominals throughout to block lumbar spine rotation. 123

124 16.2 SIDE-LYING INTERNAL-EXTERNAL ROTATION Purpose To improve internal and external rotation mobility in the shoulders. To improve extension of the thoracic spine. Set-up Assume a right-side lying position with the left hip and knee flexed to 90 degrees and the right leg straight. The left knee should be resting on a medicine ball or foam roller. Rotate your head and trunk slightly to the left. Brace the abdominals, push your right hand up towards the ceiling, and raise your left arm up and out to rotate the thoracic spine. Hold for a count of one-one-thousand. For the internal/external rotation, you re going to be going up and down behind the body. In the top the arms will be overhead with more external rotation, and in the body they will be down by the glutes in more internal rotation. Coaching Points Brace the abdominals throughout to block lumbar spine rotation. 124

125 16.3 SPLIT-STANCE BROOMSTICK PEC MOBS Purpose To improve pec extensibility and improve external rotation range of motion. Set-up Set-up in a staggered position with the left foot about two feet in front of the right. Your toes should be facing straight ahead. Stand up tall holding a broomstick so that one end is in your left palm and the other end is in your right hand. Keeping both elbows straight, push gently with your right hand and pull back slightly with your left upper back muscles. Your left arm will be stretched out and back. You should feel a nice stretch in your pecs. Hold for a one-two count, and then return to the starting position. Coaching Points Make sure not to allow the toes to rotate outwards during this exercise. Don t forget to pull the shoulder blade back and down as you are driving the broomstick. 125

126 16.4 SIDE-LYING EXTENSION-ROTATION WITH PERTURBATIONS Purpose To improve internal and external rotation mobility in the shoulders. To improve extension of the thoracic spine. To improve reflexive firing and stabilization of the rotator cuff muscles. Set-up Assume a right-side lying position with the left hip and knee flexed to 90 degrees and the right leg straight. The left knee should be resting on a medicine ball or foam roller. Rotate your head and trunk slightly to the left. Brace the abdominals, push your right hand up towards the ceiling, and raise your left arm up and out to rotate the thoracic spine. At the end range, have a partner gently push your wrist in various directions and hold for a five count. Focus on locking your shoulder in place throughout the exercise. Coaching Points Brace the abdominals throughout to block lumbar spine rotation. The partner providing the perturbations shouldn t get too aggressive. Don t push too hard, slap or go too fast. 126

127 16.5 SUPINE NO MONEY DRILL WITH BAND Purpose To improve activation and strength in the external rotators of the shoulder. To improve activation and strength in the lower trapezius. Set-up Set-up on the floor with a foam roller positioned along your thoracic spine and supporting your head. You may need several rollers to accomplish this. Pull the shoulder blades back and down around the roller to pop the chest out. With the chin tucked and elbows locked at 90 degrees, externally rotate the humerus against the mini-band. This can be done as a warm-up, or with 10 second holds at the end of a workout. Coaching Points Keep the chin tucked and head against the roller throughout the movement. Avoid shrugging the shoulders, and don t allow the chest to cave over. 127

128 17.1 SCAPULAR WALL SLIDES Purpose To improve activation and strength in the lower trapezius. Set-up Set-up with the back of your head, upper back and buttocks up against a wall. Your feet can be set comfortably out in front of you. Raise your hands up overhead with your hands as far back as they can comfortably go. From the starting position, slowly slide your arms down the wall by pulling your shoulder blades down and puffing your chest out. Work to keep the arms as externally rotated as possible. Hold the bottom position for a count of one-one-thousand, and then return to the starting position. Coaching Points Keep the chin tucked and head against the wall throughout the movement. Work through a full range of motion. 128

129 17.2 BEHIND THE NECK PULL-APARTS Purpose To improve activation and strength in the lower trapezius. Set-up Stand up tall and raise your hands up overhead with your hands as far back as they can comfortably go. You will be holding a mini-band with both hands. From the starting position, depress the shoulder blades and puff your chest out as you lower the arms to the bottom position. The band will pass behind your head as you go. Hold at the bottom position for a count of one-one-thousand. Coaching Points Keep the chin tucked and head in-line with the torso throughout. Work through a full range of motion. 129

130 17.3 REACH, ROLL AND LIFT Purpose To improve activation and strength in the lower trapezius. Set-up Kneel on the floor with the chest over the thighs in a neutral spine position. The palms should be flat on the floor in front of you. Slide one hand as far forward as possible. At the end range, and without bending the elbow, externally rotate the arm and lift the hand off the ground. Hold for a count of one-one-thousand, and then return to the starting position. Coaching Points Don t bend the elbow on the lift. Instead, thinking of driving from the scapulae. Don t allow the chest to rise. 130

131 17.4 DOORWAY SLIDES Purpose To improve activation and strength in the lower trapezius. To improve shoulder external rotation mobility. Set-up Set up in the middle of a doorway with both arms raised to 90 degrees and your hands on the door frame. Gently lean forward to get a stretch in your pecs. Keeping the chin tucked and cervical spine in neutral, depress the scapulae by sliding the hands down the frame and puffing the chest out. Hold for a count of one-one-thousand in the bottom position, and raise the arms back overhead. Keep the chest up and out throughout. Coaching Points Don t allow your body to slip into a head forward posture. Don t be too aggressive with the initial stretch. 131

132 18.1 FOREARM WALL SLIDES Purpose To improve serratus anterior activation and drive upward scapular rotation. Set-up Face the wall with your arms in front of our body and elbows flexed to 90 degrees. The forearms should be parallel to the wall. Protract the shoulder blades so the forearms are flat up against the wall. Posteriorly tilt the shoulder blades and gradually slide the forearms up the wall. When you hit end-range, gradually lower your arm and repeat for the desired number of reps. Coaching Points Keep your head and neck in neutral throughout. 132

133 18.2 PRONE TRAP RAISE (Y) Purpose To improve upward scapular rotation. Set-up Standing tall with the chin tucked, sit back with an arched back as if you were setting up to deadlift. Your arms should be hanging straight down towards the ground. Coaching Points Drive through your shoulder blades to raise your arms to the 10 and 2 o clock positions. The thumbs should be up. Hold for a count of one-one-thousand before lowering to the starting position. Gently brace your core throughout the movement. Do not allow the upper or lower back to round. Don t allow the head to move, and keep the neck in neutral. Drive from the scapulae don t just shrug! 133

134 19.1 SUPINE CHIN TUCK Purpose To improve activation and strength in the deep neck flexors. Set-up Lie on your back on the floor or a table. Tuck the chin to make a double chin. You should feel muscle activation in the front of your neck, as well as a subtle stretch in the back. Hold for a count of one-one-thousand, and then repeat. Coaching Points Do not allow the head to lift off the ground. Keep it in contact throughout. 134

135 19.2 STANDING CHIN TUCK Purpose To improve activation and strength in the deep neck flexors. Set-up Stand up tall. Tuck the chin to make a double chin. You should feel muscle activation in the front of your neck, as well as a subtle stretch in the back. Hold for a count of one-one-thousand, and then repeat. Coaching Points If you re performing this up against a wall, do not allow the head to move away from the wall. 135

136 19.3 SUPINE NOD AND LIFT Purpose To improve activation and strength in the deep neck flexors. Set-up Lie on your back with your neck in neutral alignment. Perform a nodding motion with the head to activate the deep neck flexors. Next, lift the head slightly off the ground without flattening the natural curve of your neck. Coaching Points Do not perform an extreme chin tuck. Avoid lifting the head too high. 136

137 19.4 QUADRUPED CHIN TUCK Purpose To improve activation and strength in the deep neck flexors. Set-up Set-up in a quadruped position with your knees underneath your hips and hands underneath your shoulders. Protrude your entire head out, attempting to keep the head parallel to the floor. Slowly scoop with the head so that the chin comes all the way down to your sternum. Keeping the chin tucked all the way in, slide back to the top position to reposition the head in neutral. Hold for a 5 count. Coaching Points Do not rush through the movement. Do not hyperextend in the top position. 137