The blog just got a major facelift thanks to my friends at Local Wisdom, and I have to admit that it's a significant upgrade! The brilliant minds at LW have been my go-to computer experts since I started, and without them, I would barely know how to turn my laptop on.
Teh coMput3rz maiks my heAd hurTz
I think the blog looks great, and I hope that you do too. Let me know your opinion in the comments!
Last weekend I took the drive up the NJ Turnpike all of the way to the Mass Turnpike and attended Mike Boyle's 3rd Annual Winter Seminar (yes, it was Valentine's Day: my Jenny is a very understanding woman!). I had a great time, and the presentations were varied and full of great information. I met a lot of talented coaches and trainers this weekend, and a few listeners of The FitCast too (thanks for coming by and saying hi, guys!).
I have this question that I have been pondering. It's about shoulder internal rotation and range of motion. First of all, we've got two ways of assessing it, right? Abducted shoulder internal rotation and back scratch test.
With the back scratch test I've not yet seen a clear classification of what arm position corresponds to what range of motion. General classification is : if your arm goes horizontal - that's a good start; if you can't get horizontal - bad; if you can go above horizontal - you have good flexibility. Always look for the inferior border of the scapulae and scapular winging - the easiest way to cheat the test. Other ways are shoulder abduction and thoracic lateral bend.
That one's fine with me, if you say that it's a good test.
The one that's bothering me is the abducted arm internal rotation test. Here's the thing - I can rarely get anyone to go into internal rotation without scapular elevation and/or anterior tilting.
What Eric Cressey is showing in his pictures usually corresponds with my observation - on most of the pictures he post, he allows people to hike the shoulder up and get more ROM. Now don't get me wrong - he's a really smart guy, but is that ok with you?
Best of wishes. TS
A: In general, we've got definite ROMs that we would use for shoulder internal/external rotation that we consider to be "accurate" (90 & 70 degrees, respectively, by goniometric measure according to the American Academy of Orthopeadic Surgeons). Personally, I prefer the supine position (the subject remains on his/her back with the arm brought out 90 degrees), but any position is fine relative to patient needs (from a clinical standpoint, there may be a reason that the patient can't get into the position that you need them to, so you have to use different strategies). That can include the arm held at the side or with the shoulder abducted to 90 degrees, etc. The scratch test is fine too, but it's more of a gross movement test vs. a single, isolated movement test and you won't get a "pure" number corresponding to just one movement. In the gym, this is fine. In the clinic, this may or may not be ok...it just depends on the case.
If we're interested in the technical word of law, then no: you shouldn't allow any additional movements such as scapular tilting (or any other compensation) when taking the ROM of the shoulder. However, it probably isn't that important in a non-pathological shoulder, which is what you're likely to see in a gym client.
In terms of "real world" function, observing compensations by allowing gross movement can be extremely valuable, so I understand why Eric would say that. I generally do the same thing for a non-pathological client, too. I would just add that if there's a difference, you probably need to break down the movement into it's constituents (IR, extension, elbow flexion, etc) and see what's really going on.
Which leads to the last point: how do you measure things in the "real world" outside of goniometers and the AAOS? Compare both sides: it's more important that a client is symmetrical then if they have the appropriate ROM in most (if not all) cases. Problems will occur if there is a difference between limbs, and that's what you should be looking for.
Yes, if a client presents with bilaterally short hip flexors, for instance, you would probably look to address that through various stretching and mobility work, but if you have the case of one hip flexor being significantly stiffer or shorter than the other, that's where you will see non-symmetric, unilateral alterations to the kinetic chain, which can cause major problems over time. That's like driving with one flat tire: eventually, your car's alignment will also need fixing, too.
My friend and fellow trainer Galya "tagged" me in her blog three weeks ago. The rules of this game are pretty simple:
Link back to the person who tagged you
Share 7 random or weird facts about yourself
Tag 7 people at the end of your post, and include links to their blogs
Let each person know they've been tagged by leaving a comment on their blog
Galya and me at last year's Indianapolis Performance Enhancement Seminar. Mike Robertson took the picture. Apparently, he has never heard of "Head Space."
Normally I hate "chain letters," but this one kind of looked fun (and it's FAR less time-consuming and annoying than that "25 things about me" thing going around Facebook these days!). Considering the fact that I've also been on one of my blogging hiatus holidays, I also thought that it could be a great way to get back to posting up some new articles. After all, I love to kill two birds with one stone! That's not one of my 7 random facts, but these are:
I had been practicing various martial arts since college, and had certainly been hurt before, so I decided that I had simply suffered a "sprain" and did not seek a medical opinion (I was also afraid that if it was something worse I would need surgery and would have to stop fighting...what can I say, I was young and stupid!). It is still unrepaired to this day. I'm able to perform 99% of the things that I would need to do on any given day including work and working out, but competing in sports (specifically cutting movements) can be difficult and my knee will usually buckle if I'm not wearing a supportive brace. At this point, I doubt that I will end up ever having the surgery to repair it.
2. I hated school growing up.
I was far too social in junior high and high school and would have much preferred to hang out with my friends than study or do homework! I was more-or-less a straight "C" student throughout 7-12th grades. If there were 100 students in my class, I was probably #50 exactly. In fact, it wasn't until my high school graduation that I started to see the error of my ways when my parents told me rather directly that they weren't going to send me away to college. "Why would we spend money on a college education for you?" they asked. "You hate school. You'll just fail out!"
My parents agreed to send me away to school if I proved myself by going to community college and doing well there first. I enrolled in classes at Bergen Community College and began my new journey. I realized that I had made a mistake and that I hadn't lived up to my abilities or taken advantage of my opportunities in high school. After earning a 3.9 GPA that first year, I applied to Rutgers University and was accepted.
I still have some difficulty paying attention in a classroom setting (I work much better hands-on), but compared to my early academic days I'm light-years ahead...and it all started at Bergen Community. To this day, standing their ground and sending me to community college was one of the best things that my parents ever did for me. It was a powerful lesson: I finally understood that I was not only accountable for my actions, but also that when I work hard and dedicate myself to a goal, good things can and will follow. That moment in my life is still one of the lessons that drives me today, even as I am about to complete my doctorate.
Thanks mom & dad.
3. I can't type.
I took a typing course my junior year of high school. Unfortunately, I was seated next to a very attractive girl who was a year younger than I was. By the end of that semester, we were dating...and neither of us knew how to type. Oh well! I make due with a fairly advanced "hunt & key peck" method.
4. I won the dorm awards for "Funniest," "Loudest," and "Best Smile" my first year at Rutgers.
Quite a combination, if I do say so myself.
5. I had my interview for PT school at the City University of New York on November 15th, my mother's birthday. I received notification that I had been accepted into the program on December 1st, my father's birthday. I started classes on January 25th, which is my uncle Bob's birthday, and I will finish the last day of my final clinical rotation, thus finishing grad school, on March 27th, which is also my parents' anniversary. You just can't make stuff like that up!
6. I was terribly shy as a child.
I tend to still be a little shy, although most people don't believe me when I tell them that now. I find myself sometimes (ok, a lot of times) getting that familiar little "jump" in my chest when I first walk into a situation with people that I don't know or don't know well, even now. Without even realizing it, I'll try to hide with a group that I do know in order to avoid "strangers."
I've gotten much better at becoming more outgoing and social, and I've trained myself to seek out new people and get conversation going in unfamiliar situations, but it still shows up from time-to-time (and it probably doesn't help that I hate shmoozing and small-talk, either). It doesn't happen too much, but it's more often than I'd like it to. Admittedly, I probably look like I'm ignoring people and that I'm a rude jerk, but I swear that I'm not...I'm just a little shy sometimes.
So consider this a public apology to anyone that I may have inadvertently avoided at a party or gathering over the years: I didn't mean to!
7. I'm horrible at time management...which is why this post took two weeks to finish!