Movement Econ 315: Addressing throwing shoulder pain by getting after the t-spine

There are lots of similarities in the painful or dysfunctional shoulder. In general, most of these young men and women sit among the top of the heap in their overall size, strength and power capabilities. This is a great advantage to have over your competition but in many case, like the one's we see often, these strengths expose many different weaknesses.

The one we're highlighting here is "ipsilateral thoracic spine rotation lack". We just call it 'thrower's spine'. During normal trunk rotation and shoulder horizontal abduction (think cocking the throwing arm) the t-spine and ribs should rotate and angle themselves back toward the direction of the dominant arm. More often than not in our painful or dysfunctional baseball and softball players this lack of dominant side rotation is very apparent.

If you are working with throwing athletes, be sure to check and address this aspect of their movement econ. This lack of mobility will ask the shoulder to produce the remaining mobility needed to complete the throw.

As has been previously discussed, the movement economics of asking the shoulder to do what the t-spine should be doing is obvious. We're taking an activity which by itself is already violent and difficult and therefore very movement costly and adding more ways to waste movement capital. Unless the movement account is VERY BIG, there won't be too many throws before you are overdrawn.

It is very important to know what other mobility or stability issues exist in your athletes. If 'thrower's spine' isn't the most significant movement econ issue, then this mobilization won't deposit the biggest lump sum to the movement account. If it is, then here is a great first line treatment and home exercise that we use with great effectiveness: the side-lying t-spine rotation (documented as: SL T/S rot):

Have the athlete lie on his/her non-dominant side. If they are a right handed thrower, they should be lying on their left. Next they should maximally flex their hips up toward their chest as in the 'fetal' position. This posture ensures that all of the subsequent rotation happens at the t-spine and not with help from the hips or lumbar spine. Lastly, the athlete will place their hand behind their head or will reach straight ahead with their dominant arm as in pushing away from their chest. The set-up is complete.

The mobilization is simple: The athlete will turn their head toward their dominant side as far as it possible. Once the cervical spine is maximally rotated, begin to track the elbow or arm in as big as arc as possible toward the dominant side. Once the barrier to continued rotation is met, the position is held; a long 5 count is fine. At this time, there shouldn't be pain but restriction to further movement or an urge to lift the knees is normal. Keep the knees together and the bottom knee in contact with the ground/plinth. The mobilization should be done x10 and then t-spine rotation reassessed in standing. If there is a major difference between sides, the mobization should be done more toward the deficient side.

Note: There are some pretty high quality videos of this self mobe available if you simply search 'sidelying thoracic spine mobilization'.

This movement econ strategy should add the funds necessary to getting you or your athletes back on the hill.

Be well.

Guest bloger! Liz Davies: Fight Cancer with Exercise

Physical activity can result in a variety of benefits for people with cancer, just as it would for people who are cancer free. A daily exercise routine gives people a way to stay active, maintain a healthy weight and be more muscular. In addition to these rewards, physical activity increases positivity and self-confidence while lowering exhaustion and the threat of cardiovascular disease and diabetes.

It is important for people undergoing cancer treatments to make sure they remain active; starting just about any type of regular exercise can improve healing. This is true no matter what type of cancer someone is dealing with, whether that is colon cancer or mesothelioma! It is also recommended to consult a professional before beginning a daily exercise routine. There are many licensed health and exercise professionals that can be of great assistance and can tailor individual exercise programs in order to deal with the impact that cancer may have on someone.

Patients who have no prior experience exercising can start with low to moderate intensity mobility exercises. Yoga, tai chi, and pilates are just a few different forms of exercises that are wonderful for improving mobility and balance and can be easily altered for any level of physical ability.

For people who are accustomed to more activity, cardiovascular exercise like swimming, running and walking are great ways to achieve significant benefits from working out. These activities burn calories while increasing lung capacity and decreasing risk of stroke, heart attack and diabetes.

Resistance training, like weight lifting, should not be ignored. This type of exercise helps with improving muscle mass which is very important because treatments like chemotherapy and radiation often cause significant muscle loss. Ideally it is important to include both cardiovascular exercise and strength training into a daily exercise routine.

Motivation can be hard to find when you have an obstacle like cancer standing in the way. This may feel overwhelming but adding some simple activities to a daily routine can be a good way to start. Putting away groceries, taking the stairs instead of the escalator, or buying a pedometer to monitor activity is a good step in the right direction. With such a large variety of activities to choose from finding what works best for you may be the most important part of using exercise to improve your outcomes.

Liz Davies is a recent college graduate and aspiring writer especially interested in health and wellness. She is also a friend of SPARK Physiotherapy! She wants to make a difference in people’s lives because she sees how cancer has devastated so many people. Liz also likes running, playing lacrosse, reading and playing with her dog, April.

Movement Econ 310: Discussion

A reader sent over a question and I thought it would be helpful for everyone else:

Question: Do injuries occur because of "insufficient funds (NSF)", high demand or bad luck or all of the above? Note that Jamaal Charles and Eric Berry (professional football players) blew out their ACL's on successive weeks. Was their deficit, assuming they really had one, due to short training camp and "insufficient funds" or were there high demands on a high balance account for just that 1 instance where the injury occurred?


Answer: Injury is ALWAYS an issue of NSF. Always!

Part of the time you might think of luck or 'being at the wrong place at the wrong time' as having a role that no matter the size of your movement bank account, you couldn't prevent the NSF. However, if you think of all injury within the concept of Movement Econ then what you have to assume is that some movements/activities/etc simply cost more than any person can invest.

Let's step outside of the athletic arena for a second to explain. Off the top of my head a hundred activities pop to mind that no one could fully prepare for (read: save up, invest, etc).

For example: a fall from an unrecoverable height.

This might happen as a result of a tree climbing accident, a fall from a tall ladder or your roof. Whichever you choose as the specific example, we can easily put ourselves in that situation and just as easily understand that a fall from a height like this (30-40 feet) WILL result in a catastrophic failure of one, if not many, structures upon hitting the ground. It wasn't that you couldn't save up adequate movement funds but it was that this activity was simply too costly. IF it were ever possible to add funds to your account so much so that this would not cause an NSF situation you would NOT be injured.

Take it back to the question of the athletic ACL injury resulting from a blow to the side with the knee either fully extended or at end range flexion: the outside force is simply too costly to overcome and then results in an overdrawn account (read: failure of the structure).

In the case of the very highly trained few, like the pro football players mentioned in the question, it can be easily understood that a program specific to ACL injury prevention would add the funds necessary to at least reduce the risk of NSF if that situation presented itself. It's certainly better than a program that does nothing to add funds needed to prevent ACL injury. A writer from the Wall Street Journal just wrote an article on this subject relating to female athletes; a very susceptible population for ACL injury.

On injuries resulting from this season's NFL lock out, there is evidence to support it. A recently published article pointed out the increased incidence of Achilles injury related specifically to the short preseason and contracted training camps. ACL injury numbers are soon to follow.

From an anecdotal standpoint, the easiest way to analyze this might just be to take injury incidence over the first 8 weeks of the season and compare to previous seasons. The way this year worked out, it almost completely controls for other factors because we haven't seen a play stoppage since the late 1990's.

Looking forward to your comments.

Be well.

Movement Econ 310: Adding funds to your movement account

Now that we've covered the basics and the athletic/performance aspects of Movement Economics we want to give everyone insight on how to improve your own Movement Econ.

The simple answer: ANYTHING that you do to improve your physical abilities or improve upon a skill will improve your Movement Economics. Any activity designed to make you stronger, more powerful, more flexible, more alert or aware of your surroundings or that improves your confidence will build within each of us more movement capital to negotiate the small bumps in the road that we face from time to time. This "wiggle room", aka: compensation ability, flexibility, whatever you want to call it is MOVEMENT ECON!

Here are some examples:

#1: An obvious account booster: Going to the gym or performing some form of moderate to high intensity exercise. In all honesty the idea that each of us has to belong to a warehouse with every machine imaginable on site is a very old notion if you ask a REAL exercise professional; (hopping off my soapbox now)
Done properly, with the appropriate amount of intensity, volume, rest and recovery will certainly add movement capital to your account.

BIG problem though: Most don't realize that they are too weak until it is far too late. Remember that winter when you were shoveling snow and then you suddenly felt that intense burn in your back and down your leg? That was the catastrophic failure of some part of your lumbar spine (discs, joints, or otherwise) that occurred because you lacked the strength to perform that movement for as long as you were doing it. Simple, right? I'm sure each of us, even those of us who exercise very regularly, can point to an event like this where they had to find out that we overdrew our movement account.

#2:  Get skills!
This will make perfect sense to our athletes, but those of us who only occasionally find ourselves in real competition may need some remedial education on this one. There are tons of professionals out there who's job it is to teach us the nuance and detail within different sports. If you want to pitch at the highest level, there's a coach for that. If you want to run faster than you've ever run, there's a coach for that. There's a coach and/or a group  for just about EVERYTHING you can think of. How you go about selecting a coach is up to you. Of course, we have our preferences but it's very much a personal decision.

Let's think for a second what these coaches do. Do they MAKE you stronger, more flexible or more powerful? Well, no. Not really. They might tell you that there are some exercises you should do when you're doing your own training but most skills coaches stick to what they know.

Do they help with your body awareness or your overall outlook about your performance?  This is mostly a yes but it's through drilling specific and coordinated movement and not directed at ONLY improving these traits.

So what do these pros do? They ALL take the athlete that shows up and make them better at their skill. They do it by observing a specialized movement, assessing areas of ineffective movement and making corrections. THAT'S MOVEMENT ECON! It's how to get the most from our ability while wasting as little movement capital as possible.

With the number of high school, college and professional ballplayers we see it's always easiest to use them as the example: If a baseball pitcher's lead leg is hitting the ground in an externally rotated position then the torque that they are counting on to generate through their trunk and ultimately to their hand speed is decreased! They are wasting movement capital. If that same pitcher then opens up his front side (read: the glove side arm) his throwing arm and shoulder will be dragged prematurely through the acceleration phase of the pitch. He is wasting even more movement capital. Remember a bit earlier in this series the pitcher who brought $30 to the activity that costs $100? Well that is what we're seeing with the example above and it's precisely what the coach is looking to improve.

Like we said, you don't have to be a high level athlete for this to have meaning for you. All forms of exercise will make you better at moving throughout your environment. Some more than others but the constant is that the activity is done with proper intensity and technique. All movement costs money. It's just a matter of how much it costs and whether you have the reserves to make it work or fail in doing so.

To close Movement Econ 310, this way of thinking about movement describes that with the proper stimulation, given at the right time, with the right intensity we can work to fully express our physical potential.

Have a good training session today? Really hit those plyos hard? That’s money in the bank.

New PR in the snatch today? Great! Racking up the savings!!

Uh oh. Did you forget to do your home exercise program and now that shoulder and thoracic spine is exactly as stiff as it was the last time you left treatment? Well, that’s gonna cost you down the road.

We have all the ability to sock movement capital away for when we need it. If we come to a point when we are out of those important funds, our system will make an adaptation or fail in the task we are asking of it.

Movement Econ 415 will wrap this series of blogs. In that entry we'll discuss a specific case study in great detail: probably one of the most grueling and difficult events on the planet known as the Tough Mudder. It will be a unique way to explain how important training variety and intensity are in making each of us the best mover we can be.

Until then, be well.

Movement Economics 201: The specifics of athletic performance econ

We’ve touched on the economics of movement from a developmental stand point. 

In this level of Movement Econ, we’ll break down a specific movement. Since the majority of the clients we work with are high level baseball pitchers, we’re going to examine the act of pitching a baseball.

The details are easy to follow: A baseball weighs 5oz. After 13 years of age, the distance from the pitching rubber to the leading edge of home plate is 60’6”. The catcher crouches about 12” behind home plate which is 17” wide by 17” deep. The total distance of each pitch before it reaches its target is approximately 63’.
To get the 5oz ball 63’ with the best movement econ each of the phases of pitching should be taken into account.

We’re going to give pitching a baseball a number: it costs $100 to pitch at a high level.

As soon as we begin the motion of pitching any area that is not prepared for the movement or is in a less than optimal position to pitch will “waste” movement capital. The areas of our body that are not prepared for this movement will have to be compensated for and in the case of high level athletics the more compensation that happens the less actual output you will have.

Here’s the best explanation for this:

The Wasteful Pitchers:
These athletes demonstrate weakness in vital areas like their hips, deep core and spine muscles and scapular (shoulder blade) control muscles. They might also have tightness in critical muscles such as their hip flexors, hip extensors and deep shoulder ligaments and muscles. Lastly they are uncoordinated, not coached, and/or not properly warmed up or recovered from previous/current injury.

If you think about this in dollars and cents, they are bringing their $30 to a high level movement that requires $100. If you run out of funds when trying to perform at a high level, you will have pain and you run the very high risk of being injured.

The Elite Pitchers:
These athletes are strong and flexible where it matters most. They have excellent motor coordination, are well-coached and very importantly come to play properly warmed up and recovered from any previous injuries or pain they might have had.

All of the $100 brought to the game are spent to propel this athlete to the finish

Why? They are not wasting their hard earned money!!

Movement Econ 301 will break down how to add those funds to your account so you will ready to compete at the next level.

Be well.

Movement Econ: 101

Movement Economics is a way that we try to explain how we can take an athlete who is relatively pain free and improve their performance by addressing deficits they didn’t know existed.

Let’s start from the very beginning. From the day we are born, we have on us all the muscles, most of the bones and a vast majority of the neural components that we will use for the remainder of our life. Our physical potential is represented by this set point. From our very first breath our “movement bank account” is open and ready to be filled with “movement capital” so that our bodies can perform all of the movement that will come over our entire lives. Not only this but every possible variation of our total performance capability is being molded from this point in time (some might argue even earlier than your birthday!).

During the course our existence, the choices made regarding physical activity intensity, frequency and duration will impact the size of our movement bank account. Generally speaking, our accounts are pretty barren when we’re born but they’re open and ready to receive funds.

All movements cost money; everything from walking up the stairs to throwing a 92mph slider. The currency of the body is multifactorial. The basics include things like muscular strength and endurance, cardiovascular endurance, flexibility, bone density, neuromuscular control, agility, body awareness, etc. Another neat thing is that none of these factors is mutually exclusive. They are all interrelated but can be stimulated in their own special way. To make it even more interesting, each of these components has components of their own which can play a significant role in the expressed potential.

In the blog entries that follow we’ll get a little deepr into this concept and discuss some more examples and about how ‘Movement Economics’ play a role in our day-to-day as well as in the more finely tuned movement machines like the athletes we treat on a day-to-day basis.

Stay tuned and be well.

2011 Fall into Fitness Boot Camp: Begins September 12th!

When: Begins SEPTEMBER 12th through OCTOBER 19th
Mondays and Wednesdays: Sessions to begin promptly at 7AM and end on time at 8AM.

Where: The ‘Quad’ in front of the Carlyle Club
411 John Carlyle St
Alexandria, VA 22314

Season Pass Rate: $99 for 6 weeks: that's 12 total sessions for less than $9 per!
AND each Season Pass holder will recieve a FREE physical therapy screening from the doctors at SPARK

Drop in rate: $10 per class

60-minute, high energy and FUN exercise session

Led by SPARK Physical Therapist and Performance Enhancement Specialist:
Dr. Ashley Speights, PT, DPT, PES

Each participant must bring:
-yoga or stretching mat
-towel
-water
-a positive attitude and your best effort!

Exercise session to include: warm-up, flexibility training, full-body strengthening and toning exercises, targeted core strengthening exercises, cardiovascular conditioning and cool down.

$99 per participant for entire 6-week program

Registration closes soon so contact us today: amspeights@SPARKphysio.com

Competitor shelf-life?

There are many ways to quantify health these days. There are even more neat ways to quantify high level performance. Some professionals have created very specialized metrics or algorithms that will give you a number that taken by itself provides you a baseline from which to measure physical improvement or deterioration. All of these tools are valuable but are truly best used when other such measures are also considered.

In our work we continue to come across a disturbing trend that gives the impression of a timed physical depreciation. If you watch any amount of sports news you've certainly heard of the "aging running back" who's career is over at 30 years of age. Maybe it was the last summer Olympics where you saw the gymnast who would retire after the games at the ripe ol' age of 22. Your own baseball career might have been cut short by an injury or you might have had a long and prosperous one competing well into your 40's! These ages, while varied between activities, are very commonly used benchmarks when gauging the "usefulness" of a competitor, to use a very General Manager/Owner-esque term.

Now, think of a world where a running back could remain effective at 35 or 40 years of age. Or that gymnast or swimmer competing on the world stage well into their 30's. Is this fantasy? Not possible, right? Well, here are a couple thoughts that will stimulate more conversation.

1. Who's on your team?
I'm not a fan of many racing sports. Those who know me understand my love for motorcycles, but this analogy is best explained from the pits of a NASCAR race.
These cars possess the latest technology, the fastest, lightest and "safest" (that depends on which race fan you ask) of everything. Yet, without the pit crew working diligently before raceday and then constantly checking in on that functioning unit, the car would NEVER finish a race. NOT ONE. The car would certainly face a catastrophic failure along some portion of that day without the care of the pit crew. The issue here is simple: the closer the car operates to maximum levels, the more likely the instance where a failure will occur.

This concept is well understood in athletics and so I will not belabor the point but to mention this: Even if you're not a track and field fan, we've all seen the 100M sprint hundreds of times. Every one of us can recall the runner who suddenly begins the fastest limp you've ever seen and that look on their face when they realize they've had a catastrophic failure.

Much attention is paid to professional athletes and to some higher level amateur athletes.  However, for a few reasons, which we won't get into here, many of them are slow to put together their pit crew. The 'why' is varied and complex. The solution is information. When we speak to our performance-minded clients, we need to be able to relay the above message. Once our athletes, young and old, first or 15th round picks, understand that they can increase their performance, limit injuries and extend their shelf-life the buy-in is tremendous. In this way we elevate the game of the athlete as well as the game of real performance physical therapy. We are only now taking advantage of the wealth of information we can provide that others cannot.


Not only this, but who better to be the pit crew Chief than a PT? The true musculoskeletal experts. Orthopedic surgeons are certainly an important crew member. Their ability to put back into order that which has failed is widely respected. Athletic trainers possess many skills that are essential for high level performance. However, the PT with an intimate knowledge of biomechanics and a keen eye for movement patterning is the main client-professional interface. Performance PTs live in the crossover between dysfunction and performance.

2. What does it take?
Balance. Symmetry. Control. Strength. Power. Flexibility.
I'm not speaking about concepts that are foreign to any of our readers. What I am aiming to do is to reiterate the idea that ALL of these concepts need to be constantly evaluated and optimized for maximal performance with minimal risk for failure. We often tell clients that we'd rather see them in once per month and competing than see them at all on our treatment tables. The 'new' PT believes this to be true. Do you believe it? Unfortunately, many clinics aren't set up this way. A global change must happen. It might be initially bad for business but in the long run the gains are worth it.

Level of competition aside, the idea that there is a finite amount of time that you can spend at a high level is a prevalent one. In recent stimulating conversations with my colleagues, we are uncovering some recurring themes that we hope to one day re-frame. For now we will do our best to find dysfunction BEFORE it has an effect on complex and powerful movements. We will treat people and not just body parts. We, the new performance PTs, will blaze the trail. We work each day to elevate the game and ask the help of our colleagues to do the same.

Get through all the noise and discover the truth.

We are inundated with health and fitness info every day. Each time you open a magazine or turn on the TV, someone is trying to sell you on THE ANSWER to all your health and fitness needs.

These products range from magic pills that will eliminate body fat or rid your body of the oft-dreaded “toxins”. Other times it’s a new piece of equipment or training system. The “best” total body workout imaginable in the shortest amount of time.

“All you have is three minutes a day? No problem! OUR system will give you that beach body you’ve always wished for in TWO MINUTES A DAY! GUARANTEED or your money back!”

The amount of time and money poured into the making of these products and commercials is staggering. Commercial health and wellness is a multi-billion dollar industry and it gets bigger as the majority of us struggle with new and effective ways to improve our health.

Unfortunately, the burden of delivering the “bad” (read: factual) news to the public usually rests on those of us in the industry who are GENUINELY concerned about our clients’ health.

Here is a short list of the fitness myths to keep in mind when you’re being yelled at by the 12-3am infomercial about the next biggest thing:

1. There is no magic pill. If there were it’d have been in the hands of actual health professionals long ago. Companies can make ridiculous claims because what they are selling you is not regulated by the FDA. Thus, these manufacturers can say anything as long as they “believe” it will do what they claim. A simple thing to remember is to read the fine white print at the bottom of the screen when they make their money back guarantee.

2. There is no ONE best method or piece of equipment. If there were, then why is that guy Jake selling something different than he was a year ago??? Those of us who have made health and fitness a career attempt to be proficient using thousands of pieces of equipment and better yet, no equipment at all. A carpenter can do a better job with a hammer that he’s mastered than with a hundred different hammers that he is familiar with.

3. Don’t believe the hype: Be skeptical, ne, avoid any purchase that promises results “AS FAST AS POSSIBLE” or in “JUST __ MINUTES PER DAY”. Please understand that these folks are not in the business of health, they are in the business of sales. Promising results as fast as can be imagined sells better than telling the truth about putting work in over an extended period of weeks, months and years.

4. You can’t lose just “belly fat”: It’s just impossible. Our bodies don’t work that way. Take our word for it.

The solution is simple but many of us struggle with the implementation:

1. Eat well! Your meals should be made up of low fat, low sugar items that are rich in lean protein and complex carbohydrates.

2. Eat often!!! This one is tough because it requires the most discipline of all the rules. If we’re serious about getting better, we should eat a small meal every 3-5 hours throughout the day.

3. Exercise. It can be ANYTHING! Walk. Run. Play. Lift. Jump. Dribble. Throw. Literally anything that raises your heart rate for 20-60 minutes per day is enough. When an activity starts to feel easy, bump up the speed, the amount, the frequency or change it up. Variety is important for a number of reasons so switch things up on a monthly or weekly basis.

The short list above is the ONLY time-tested and 100% proven way to achieve maximum physical health. All the other fads and myths will come and go but the true solution will remain.

Be well.

Who's in your corner?

Our clients expect the highest value during their time with us. Most of the people we work with are among the top athletes and physical performers in the our area. From evaluation to discharge our focus is on accelerating healing and improving function to progress toward maximum performance levels. This can only be accomplished if client, physical therapist and physician are on the same team!

There are professionals who refuse to work in this way. People who are no longer learning and claim to have all the expertise necessary to fix all problems all the time. This is not exclusive to physical therapy, sports medicine or coaching. 

The best physician in the world cannot fully heal a patient if the patient is does not comply with certain recommendations.

The most gifted athlete in the world will surely fail if the rely only on their abilities without learning from the lessons of a skilled coach.

The most skilled physical therapist will certainly see their interventions wasted if their client's physician is contradicting or undermining their care.

You see, it is only when all of the pieces of this puzzle fit together that each can acheive their highest potential. Ask yourself and others:

• Does your physician speak with your physical therapist?
• Is your physical therapist in contact with parents or coaches?
• Has your any one part of your performance team given input to another?
• Is there communication between athletes, parents, and trainers?

If you are among those who want to experience your greatest potential, you must first be able to truly answer 'yes' to all of the above.

Not all of us will have the opportunity to play professional sports. However, all of us DO have the potential. It is those of us who recognize that if they attempt to go it alone, the journey will be treacherous. We must see that there are people and professionals that can help to maximize all areas of sports performance.