Upper Crossed Syndrome – A foundation for failure

Are you aware of upper crossed syndrome? Does this postural shape look familiar to you? If yes, then you take a look at the corrective exercises I’ve included in the blog.

Posture follows movement like a shadow

Are you being double crossed by your posture? There is a chronic condition called Upper Crossed Syndrome (USC) which is expressed by the rounding of shoulders, forward chin poke of the head.  Mostly seen with elderly, but with an accelerated escalation of sedentary lifestyles and work environments, it has become a common sight for all ages.

Upper Crossed Syndrome Anatomy

The position of your head and shoulder is orchestrated by various opposing forces. These muscle balance forces vary depending on the positions we regularly find ourselves in. With UCS there is usually a weakness of the deep neck flexors and overactive/tightness of the upper traps and levator scapulae. This causes a forward head position with a hinge point at the lower cervical spine.

Lower down with weakness of rhomboids and lower traps, matched with overactive/tight pectoralis major and minor causes a rounding of the shoulders.Posture

The muscle imbalance can affect multiple joint levels of the spine, the glenohumeral joint, the acromioclavicular joint and scapulothoracic joint. These might all lead to dysfunctions and result in injury.

How does this impact me?

Well that depends on how you live your life. This is a chronic condition that affects multiple joints and progressively over years they become stiff or weak. This closes the window on living an active lifestyle and increases risk of injury.

With less mobility and stability, comes greater risk to injury. 

This is typical with most office workers, students or driver’s. Their neuromuscular system has adapted to the UCS shape for years. But the injury risk increases when activity and movement levels are pushed higher than normal, for example overhead lifting, throwing sports or freestyle swimming that requires a wider overhead range of movement and ends up putting undue stress on the upper body.

Have you got the following?

  • Chin Poke: Is your head sticking so far out it’s at risk of falling off! Next time you stop at traffic lights take a look at the other drivers posture, it’s common to see the drivers head stuck at least 12 inches from the head rest.
  • Rounding of the Shoulders: Due to a weakness of scapula retractors, the lower traps and rhomboids, the super tight Pec muscles draw the shoulders forwards. Look at overly developed bodybuilders for a great example of rounded shoulders.
  • Winging scapula: When the scapula lifts away from the wall of the rib cage, it’s usually the result of a muscle imbalance. This might take a friend to spot this one for you.
  • Creasing in the neck: It’s the last places you want to see a crease. At the base of the neck and accompanied by the start of a hump in the thoracic spine.

Change starts now – How do I get there?

Expecting to do an overhead squat or chest to bar pull up straight away might be unrealistic if you’ve spent years holding a UCS posture. But there are ways of getting there…

  • Scaling the new movement that your practicing and working within the ranges that your body allows. Giving the joints time to adapt, without risking injury.
  • Working on individual muscles that developed the weakness and tightness over the years. This requires specific strengthening and stretching exercises.
  • Muscle tightness in your neck and chest may benefit from soft tissue work to release the muscle, like massage or dry needling.
  • Correcting form, sometimes we don’t have the body awareness to identify poor technique. Having the coach or physio look at your movement to correct where it’s needed.
  • Change can only be enforced through repetition and habit. The positions you’re in most of the day dictate your posture. At work, in the car, or at home, try to change your posture regularly.

Below are some basic examples of exercises to get you started with organising the shoulder and head. Try following them regularly to give your body the opportunity to change.

Continue reading “Upper Crossed Syndrome – A foundation for failure”

Study: When is bending too much?

This recent study looked at sustained bending and the time it takes before our postural muscles give in and we begin to rely on our passive structures for support.

Alessa 2017

How long is too long, to be in a forward, bent posture? Many of us spend hours doing house chores; weeding, DIY, working on the car etc. Not to mention the time spent leaning over a computer desk or looking down at your phone.

Back pain

Your muscles play an amazing role of suspending us in these positions, but just like with exercise our muscles will reach a point of fatigue. When the postural muscles aren’t able to provide the support we then rely on “passive” structures like ligaments and fascia, which is not their primary role, eventually leading stress and increased risk of injury.

This study looked at 2 angles of the spine leaning forwards and found that within 40 seconds the participants transitioned from the support of postural muscles to the passive structures. While this was found to be a natural transition the prolonged strain on the passive structures has been shown to increase the risk of lower back pain as suggested in another study.

As mentioned in a previous blog, these positions are not “wrong” but it’s better for the overall health of the spine to regularly change position and break from sustained load on an individual structure to provide balance.

Abstract

Static trunk bending is an occupational risk factor for lower back pain (LBP). When assessing relative short duration trunk bending tasks, existing studies mostly assumed unchanged spine biomechanical responses during task performance. The purpose of the current study was to assess the biomechanical changes of lumbar spine during the performance of relatively short duration, sustained trunk bending tasks. Fifteen participants performed 40-s static trunk bending tasks in two different trunk angles (30° or 60°) with two different hand load levels (0 or 6.8 kg). Results of the current study revealed significantly increased lumbar flexion and lumbar passive moment during the 40 s of trunk bending. Significantly reduced lumbar and abdominal muscle activities were also observed in most conditions. These findings suggest that, during the performance of short duration, static trunk bending tasks, a shift of loading from lumbar active tissues to passive tissues occurs naturally. This mechanism is beneficial in reducing the accumulation of lumbar muscle fatigue; however, lumbar passive tissue creep could be introduced due to prolonged or repetitive exposure.

 

Alessaa F. et al (2017) Changes of lumbar posture and tissue loading during static trunk bending. Human Movement Science

Continue reading “Study: When is bending too much?”

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Understanding your Nervous System

A healthy nervous system allows us to perform at a high level. Using particular methods we can tap into the subconscious side to improve the running of vital bodily functions.

You can’t control the wind, but you can adjust your sails

Our nervous system has a connection to all structures in the body. Without a healthy working nervous system most bodily functions suffer, our performance in life situations and sport are hindered and recovery from injury is impacted.

The Nervous system

Part of our central nervous system, within our subconscious is a mechanism for handling stressful situations. This is called the Autonomic Nervous system. It branches into two parts; the Sympathetic NS (SNS) and Parasympathetic NS (PNS). The SNS stimulates the bodily functions preparing us for the “fight, flight or freeze” in life threatening situations. The PNS is the other branch that prepares us for “rest, digest and heal”. It’s the PNS that should be the primary driver of our physiology.

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Using the mailman and dog as an example. Most canines are territorial and when unknown visitors arrive they become defensive, will bark and jump at the door. It’s ready to fight. When the postman leaves, the dog quickly forgets what happened and is able to fall asleep within minutes. It recognises the threat has gone and can immediately relax.

Consider yourself in the same situation, feeling threatened of an intruder. You might shout at them to leave or prepare to engage with them. When the person retreats could you relax straight away or will you be on edge for hours or even days?

The SNS is important but only has a purpose for the short term, to allow us to deal with threatening situations. Unfortunately with hectic lives, our brain interprets these physical and mental stresses as life threatening, which frequently triggers the SNS on a daily basis. Constantly stimulating SNS can lead to chronic issues…

  • Anxiety
  • Fatigue
  • Irritability
  • Sleep disorder
  • Non-working muscular tension
  • Hyperventilation
  • Adaptation failure
  • Cognitive dysfunction

The brain struggles to identify physical stress’ and imagined stress’. Anxiety of an electricity bill, job cuts at work or relationship issues will fire up the SNS.

Throughout exercise/sport our PNS and SNS working in balance. Depending on particular stressors like speed, distance, duration, the SNS may start to have a greater influence. It’s important to get into our PNS state for improved decision making, better oxygen delivery and for achieving optimal recovery.

Ways of Activating the Parasympathetic Nervous System

The PNS is the system we should be using most frequently . Therefore finding methods of staying in this state even when put under perceived levels of stress are important.

1. Breathing Mechanics

The way we breath has a deep connection to the autonomic nervous system. Shallow, apical breathing has a direct link to our SNS. But taking Deep diaphragmatic breaths stimulates the PNS. Using breathing exercises daily can help train you into a more relaxed state.  Methods such as….

Wim Hof Method

Apnea Breathing

Kapalbhati Breathing

2. Meditation Practices

Through channeling your thoughts and breathing, meditation can help induce a state of relaxation. Following this 5-10 minutes daily can help improve many different functions. Easy to use apps for this are…

Head Space

Wildflowers

                      SoundCloud – Mindfulness Works

3. Muscle relaxation

Using methods like meditation or yoga are ways of achieving muscle relaxation. Having massages and soaking in a hot bath also offers a way of relaxing muscles. The release of tight muscles indirectly sends signals to the brain to activate the PNS and switch off the SNS.

Continue reading “Understanding your Nervous System”

Iliotibial Band Syndrome

Whether your running, rowing cycling or lifting. Repeated knee flexion may irritate structures on the outer knee. It is important to get on top of this condition to stop it hindering your training.

Setbacks are the perfect opportunity to grow

Iliotibial band syndrome is most commonly experienced with runners. But also in all sports that require repetitive knee flexion under high load. Early signs and symptoms often go unnoticed (or ignored) until it’s blown up into a fully-fledged injury.

What is the Iliotibial Band?

Iliotibial band

The Iliotibial Band (ITB) is a thick fibrous band of strong connective tissue running down the lateral side of the thigh. Its attachment points at the hip are from the Glutes at the back and Tensor Fascia Latae at the front. The bottom connection feeds into the outer border of the knee and patella. It’s at this attachment point that pain and inflammation develops and would be classed as Iliotibial Band Syndrome (ITBS).

The role of the ITB is to provide the knee with stability and to abduct the hip outwards. When we walk, run or squat it’s working hard to keep the knee in the correct position and force is distributed evenly.

What are the symptoms of ITBS?

Problems arise when the lower limb moves in abnormal directions repeatedly, causing the band to flick over bony structures of the knee, leading to irritation. It may also get tighter than normal through shortening or over activity of the Glutes and Tensor Fascia Latae. This results in the ITB becoming a tighter band pulling more at its attachment and compressing other tissue around it.

ITBS usually is a sharp pain or burning sensation in the lateral knee. Generally, felt during exercise when the knee flexes repeatedly through mid-range. This range of 30-40 degrees is when pressure of the ITB against the bone is at its highest. If this movement is repeated enough, it causes friction and irritates the tissue.

What causes ITBS?

There are a number of factors that can cause a stir up of ITBS. Physically there could be a muscle imbalance, with tightness or weakness around the pelvis, hip or knee, reduced balance, and reduced ground reaction time. Mechanically, often due to the physical limitations that cause incorrect movement patterns, poor weight transferring and distribution of load.

On top of this are issues with training error. How quickly a programme is progressed, especially if it involves load or speed. From running to weight lifting, training loads need to be gradually increased to reduce the risk of injury.

Management of ITBS

Initially you may be restricted from doing the activity that caused your pain while your body recovers. An assessment will help you identify what factors are triggering your ITBS. Treatment will be multifaceted providing advice for tissue loading, gait retraining and specific muscle strengthening and stretches. Additionally, soft tissue manipulation, strapping and dry needling.

With the improved running form, increased strength and flexibility you will gradually be introduced back into the activity. This will make you overall better at your sport and reduce the risk of this problem returning.

Evidence shows that ITBS responds well to conservative management with a success rate as high as 92%.

If you’re struggling with recovering on your own contact me on 09 5290990

Strength Training for Endurance

This is a literature review of the benefits of including resistance training into your running or cycling training programme.

Rønnestad 2014

For recreational runners and cyclists, strength training is not always considered important when developing increased pace, endurance and mechanics. But this paper from 3 years supports the involvement of explosive strength training as part of a training program for endurance runners/cyclists. With benefits of improved endurance to muscle fibres when in an anaerobic state, increased tendon stiffness and greater explosive power.

The study went on to find numerous benefits with the addition of strength training. And provided these recommendations.

  1. To improve the chance of increased endurance performance following a strength training program, the resisted exercises should engage similar muscle groups and imitate sport specific movements. This will result in firing up the same neural pathways connected with the motion of running or cycling.
  2. Force output may increase the ground strike in runners or force velocity in cycling if an explosive focus is put on the concentric phase of the muscle. For example pushing fast out of the back squat.
  3. At least 2 sessions per week of strength training to develop maximal strength over a 12 week program. Beginning with lighter loads in the first 3 weeks to learn correct form before increasing load. Working within 8-12 reps and 2-3 sets.

Some beneficial lifts for runners and cyclists would include back squats, dead lifts, hip thrusters and bent over rows.

Abstract

Here we report on the effect of combining endurance training with heavy or explosive strength training on endurance performance in endurance-trained runners and cyclists. Running economy is improved by performing combined endurance training with either heavy or explosive strength training. However, heavy strength training is recommended for improving cycling economy. Equivocal findings exist regarding the effects on power output or velocity at the lactate threshold. Concurrent endurance and heavy strength training can increase running speed and power output at VO2max (Vmax and Wmax , respectively) or time to exhaustion at Vmax and Wmax . Combining endurance training with either explosive or heavy strength training can improve running performance, while there is most compelling evidence of an additive effect on cycling performance when heavy strength training is used. It is suggested that the improved endurance performance may relate to delayed activation of less efficient type II fibers, improved neuromuscular efficiency, conversion of fast-twitch type IIX fibers into more fatigue-resistant type IIA fibers, or improved musculo-tendinous stiffness.

Rønnestad et al (2014). Optimizing strength training for running and cycling endurance performance: A review. Scandinavian journal of medicine & science in sports

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Lunge Hip Mobility

The 2nd part of hip mobility focuses on your lunge shape. Having full access to hip extension will improve your running, throwing and kicking abilities.

This is the second part of the hip series. These hip shapes are positions that we should all be striving for to have confidence and feel safe to function if exposed to complex positions. 

Following on from the blog hip opener for the hinge shape is our next hip position we should try to achieve. The lunge shape is full extension and internal rotation of the hip with the knee positioned behind the hip and foot pointing forwards. This shape is most seen in lifters doing split jerks, kicking a football, ball throwing. But most commonly seeing this lack of range with runners, not utilising the full hip extension in the push off at the end of stance phase.

Over the years adaptive changes happen either through injury or more with positions we adhere to. The most common being sitting, which results in anterior structures of the hip becoming limited. Lacking the end range of this movement could mean we’re selling our self short of momentum, power or endurance.

Running-lunge

Using the picture of long distance runner Mo Farah, he demonstrates a great lunge shape at the hip. While maintaining a neutral spine he manages to reach full hip extension and toes are pointed forwards, maintaining the internal rotation of the hip. Lacking hip extension can compromise running form of the upper limb and spine. But as you can see he reaches a good press shape of the opposite shoulder in the arm swing making his running style extremely efficient and balanced.

Below are a series of stretches and mobility exercises to help improve your lunge shape.

Couch stretch

If hip flexors are tight this is one of the best stretches for improving length back. A long sustained hold of this stretch with full diaphragmatic breathing over 2 minutes is extremely effective.

Illiopsoas Trigger Point Release

This muscle sits within the abdominal cavity and if tight it will feel sore with pressure through the abdominal wall towards the muscle. At first the pain can be quite high but relaxing into the pressure overtime the pain subsides and will feel looser once released. Aim for 1-2 minutes hold.

Hip flexor stretch (with band)

Another hip flexor stretch with a joint mobilisation using a band. Position the knee behind the hip. Allow the band to pull the hip forwards, contract the glutes to get the best anterior hip stretch.

Quads and inner thigh release with LaX ball

A lacrosse ball is a great tool for isolating sections of tight muscle. Rolling on the ball like you would a foam roller will be more effective, if tolerated. Then opening up inner thigh/hip adductors using the kettle bell handle. The knee flexion/extension stretches the muscle through range while being tacked down.

Suspended split stretch

This is for the more adventurous. It will help your lunge go deeper while increase stretch through the hamstrings. Throughout this movement, it is important to keep the glutes switched on to avoid hanging of the hip capsules. Spend around a minute each direction.

Continue reading “Lunge Hip Mobility”

Study: Resistance training on neck pain

This study found positive results with strengthening exercises to reduce muscle tension and pain with office workers suffering with neck pain.

Lindegaard 2013

Working in the office you’re bound to suffer with neck pain at some stage. If poorly managed this can progressively become chronic. Not only can this impact your function, but interferes with your levels of concentration and performance at work. This then feeds into your mood and becomes a negative loop which is then difficult to break.

When treating a patient with chronic neck pain there’s a range of manual techniques that have strong evidence to support them. But in addition to hands-on therapy, exercises are provided to assist in the recovery. These could be in the form of stretches, postural setting or strengthening.

This study focused on strengthening exercises using a resistance band  (Theraband). Over a 10 week period they performed lateral raises with the resistance band once per day to the point of fatigue or up to 2 minutes. They found at the end of the 10 weeks through EMG testing the neck muscles were more relaxed and had reduced pain levels.

Original Abstract

Background: This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain.

Methods: 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n = 15) or in control receiving weekly email-based information on general health (n = 15). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday.

Results: Adherence to training and control interventions were 86% and 89%, respectively. Comparedh with control, training increased isometric muscle strength 6% (P < 0.05) and decreased neck/shoulder pain intensity by 40% (P < 0.01). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius.

Conclusion: While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.

Lidegaard M, et al. Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain: randomized controlled trial. Biomed Res Int. 2013.

Hip Opener for Hinge Shapes

The hip hinge is an important movement in daily activities as well as in sports. Many people are unaware this movement exists and struggle with reaching their potential.

Many lifting injuries result from a lack of movement awareness and weakness of the posterior muscles. The hip hinge is a foundational movement for so many actions like deadlifts, squats, sprinting, jumping. Lacking an effective hip hinge is like racing a formula 1 car on flat tyres.

Developing a good hip hinge will improve the strength of the posterior chain. This includes muscles like the glutes, hamstrings and back extensors. The hinge movement is primarily coming from the hip. The goal is to maintain a neutral spine throughout the movement, the hips start to bend with your butt moving backwards and minimal flexion in the knee. This will increase the tension on the hamstrings and glutes.

The majority of people find this pattern of movement unnatural, as it’s rarely practiced and in most cases, are quad dominant. This quad dominant pattern causes weight to be distributed anteriorly, which is fine with some activities, but most actions we need to be more engaged with our posterior chain.

hip hinge movements.jpg

 

Below are a series of stretches and strengthening exercises to help Improve your hip hinging abilities.

Weighted Hip Hinge

This exercises is a great way to warm up and encourage the hip back movement while fighting the resistance to maintain a neutral spine.

Banded Hip Distractions

These two movements are also great for warming up. Both encourage release of the hamstrings but also the band provides a traction force on the hip socket. This should allow the joint to move free’er and help you access more range in the joint.

Dynamic Hamstring stretch

This is a deeper stretch of the hamstrings. Having more flexibility here will help you hinge better at the hip which will off load the knees.

Jefferson Curl

This movement is a great way of developing movement segmentally and will help build strength when maintaining a stable spine. It’s important to note if you have a spinal injury to avoid this movement until you have gone through the appropriate phases of rehab.

Continue reading “Hip Opener for Hinge Shapes”