Personal Training and Massage

Walk through your local gym you'll see dozens of personal trainers stretching their clients. No doubt this has been going on forever, but is technically outside of the personal trainer's scope of practice.

Scope of Practice- Procedures, actions, and processes that a healthcare practitioner is permitted in undertaking. 

Scope of Practice for Personal Trainers (according to NSCA)

 "Developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” 

Nowhere in there does it mention any sort of muscle manipulating techniques.

Ouch That Hurts

Hey can you move back to that other spot...a little lower....YEAH! OUCH! You got it. 

This was a typical exploratory palpation session with clients whenever they were unable to release muscle on their own and so it made sense for me to get it out for them so we could get back to training. When I started doing bodywork I had already been a trainer for over 5 years and was decently versed on anatomy and biomechanics.

This all is a rationalize for what I was doing, which was outside the guidelines of my liability insurance and scope of practice. The results I got were positive across the board, but I also knew I wasn't allowed to do what I was doing. The more injuries I would encounter, the better I got at feeling healthy tissue and fibrous restrictions in the fascia and muscles. Though in the back of my mind I knew what I was doing was illegal.

I observe dozens of coaches, many of whom I see jam their elbows and fingers in areas where they shouldn't be. And not because now that I'm a manual therapist I'm on my high horse but because they're actually pressing down, rather hard I might add given the discoloration of the skin around said area, into a place where there's way too many nerves or organs.

Pot Meet Kettle

I will never tell any other coach they shouldn't be placing their hands on their clients, because that would make me a giant hypocrite. I do however advise these coaches to exercise ALOT of caution. In an effort to add value to sessions coaches range from the harmless assisted static stretching to downright dangerous let me dig my elbow into your anterior triangle. 

What I've Learned

I Didn't know WHY only how
A Manual therapist, massage therapist or LMT has undergone more extensive training than personal trainers where it pertains to understanding of how and more importantly WHY to work in a given area. They learn more manual muscle testing and specific assessments to address movement compensations. I could copy a technique but didn't fully grasp the methodology behind it.

Most trainers who perform assisted soft tissue via foam roller, ball or roller stick think: harder is better. It's not.

Getting work done on you doesn't in turn show you how to treat your clients
Copying a given technique performed on you might help YOU, but could injure your client. In the same way you wouldn't give a 65 year grandma the same exercise protocol a 25 year old would receive, the same goes for soft tissue manipulation. In the past I've seen coaches receive a quickie treatment only to see them performing the exact thing on their clients that same evening.

I hadn't earned the right to put my hands on clients. Trainers are not therapists.
Many colleagues who are both manual therapist and trainer had to juggle massage therapy school and a full slate of clients at the same time. Depending on where they're located, schooling can range from 500 hours to over 1000 hours. And while this may be a lot or a little depending on how you look at it, it's a large commitment for anyone with full time obligations. 

Trainers are not physical therapists. Most of the corrective exercises seen today don't work because the coach implementing them lack an understanding that the issue needs both manual therapy and corrective exercise.

I of course will not fool myself thinking that I am anywhere near the level of a DPT (Doctor of Physical Therapy) either. I always had a firm grasp on anatomy, or so I thought. I came to see that I lacked a comprehensive understanding of:

• Origin and Insertion sites
• Layers above and below muscles
• Feeling the difference between muscle and organ
• Progressions for treatment
• Contraindications with degenerative and acute diseases or injuries

I understand now I had not earned the right to put my hands on a single client because I had not committed to fully understanding the topics above. I had not put in the time, literally. I thought because I could recite muscles and actions off the top of my head that I could manipulate muscles. I was wrong. On one hand all the clients I've helped has allowed me to get a head start on my education in treating soft tissue restrictions but I also understand I probably shouldn't have ever laid a hand on a single person, no matter the outcome. 

3 Reasons Your Lower Back Hurts That Has Nothing To Do With Your Back

Lower back pain is something most of us will deal with at some point in our lives. You bend over to pick up your kids or tie your shoelaces and BAM! out of nowhere your back goes out. An overwhelming number of low back injuries stem from chronically poor body mechanics and even more likely from poor everday posture.

If you’re reading this on your phone, take a moment to sit up straight and pull the phone up so your neck isn't being cranked downwards.

Here are three things you need to know about back pain:

1. Back Pain Worse After Standing- Extension Based
 Back Pain Worse After Sitting- Flexion Based

For those who suffer from extension based back pain this is likely caused by: Short Hip flexors, poor glute activity and a lack of anterior core stabilization. The combination of weak glute function with shortened hip flexors often leads to lumbar extension substituting for hip extension during activities such as deadlifting, jumping, and running. Put simply if you aren’t putting your glutes into it, you back will be. 

A sure fire postural sign a person is a candidate for extension based back pain is viewed from the side via anterior pelvic tilt, or the back of your pelvis is higher than the front.

I meant to take a buttfie

Flexion based back pain often afflicts those who sit for long periods of time like office workers or truck drivers. The main muscle that creates problems for these individuals is the Psoas. This is the only hip flexor that remains active once you draw your leg up above 90 degrees. Those seeking hip flexion like during a squat will get lower back rounding instead. Their problems are aggravated by a host of other factors such as: Poor glute function, cervical spine positioning, lack of thoracic spine extension and poor anterior core stability.

Someone with this type of back pain is in a catch-22. They need to stop sitting so much but they likely sit a lot due to work. For this individual I would recommend setting a timer to periodically stand up and stretch to break up the monotony. Along with taking time each day to use a foam roller or lacrosse ball to break up any soft tissue adhesions formed in the hip flexor muscles.

2.     Not All Back Pain is Due to “Tight” Hips

From an anatomical standpoint the hip flexors are a combination of muscles: illiopsoas, sartorius, and rectus femoris.

Lets focus on the Psoas.

The psoas attaches through the side of the lumbar spine and connects to the discs in the area of T12-L5. Because of this vertebral origin point, the psoas is also involved in 360 degrees of spine stabilization.

For those who believe they have chronically tight hip flexors, stretching them isn’t going to magically solve the problem because the underlying cause may not be tight hips but an unstable spine and poor core strength. If a muscle is short and tight, stretching it won’t release any neural tone which only leads to it tightening back up afterwards.

Their issues may be solved simply through core and glute activation.

A properly performed plank will solve all that ales you. Not only because by staying in a neutral position will you decrease recruitment of the illiopsoas but also by squeezing the glutes hard you’ll force the muscle to relax due to reciprocal inhibition.

Talking about hips and glutes leads me to the final point

3.     Poor Internal-External Hip Rotation

A quick screen for both:

Need Internal Rotation 35 degrees

External Rotation 45 degrees

Less than stellar results?

Corrections:

Need Internal Rotation- Side Plank

External Rotation- Prone Plank

The muscles that resist internal rotation are all located on the outside of the hip. By stimulating these muscles it forces them to all stabilize the spine and possibly allow your hips and core to work correctly.

On the other side of the equation are the muscles that resist external rotation found on the inside and anterior aspect of the hip. All these muscles co-mingle when it comes to core stability. Like in the aforementioned tip, when a properly performed prone plank is performed, the hip flexors are held in a tight stretched position to help the hips and spine stabilize.

Correcting these restrictions can bring relief to those suffering from chronic lower back pain. These screen are the beginning to figuring out if you need more mobilization or simply needed more stability. 

How to be a Healthy Runner

The key component to more efficient running and avoiding most injuries is improving on landing softly. Not exactly groundbreaking advice but how does one go about learning to absorb contact more effectively?

Photo by Mārtiņš Zemlickis on Unsplash

First thing to address is technique. Landing hard on your heel is often due to over-striding instead of landing with the foot underneath your hip. Butt-kicks mimic where your foot shot be landing, when you're warming up perform a few meters of butt-kicks before resuming your regular stride.

Second would be posture. You want to maintain a slight forward lean which will in turn aide in your ability to use gravity to land more mid-foot. I always think hips high and run tall. I would be remiss if I didn't mention not everyone likes to run with a forefoot landing, preferring a heel landing, which still doesn't change the focus of today's topic of "landing softly". Many elite long distance runners are heel to toe type runners, so you have to find what sort of stride works bests for you. 

Often heard advice on running faster is increasing cadence, or stride frequency, but if you're plodding along loudly like a hungry dog the only thing that's going to increase are hip, knee and ankle issues. 

The final thing I would address is strength training protocol. Are you performing any type of jump training? It's important to focus on absorbing contact just as much as it is in learning how to produce more of it.

Here is a Depth Jump progression that can help you start running 

Depth Drop

• Teaches you how to land properly and absorb the impact.
• The mechanics are similar to squatting, I would not have a client perform any type of plyometric work until they can properly demonstrate a basic understanding of the squat. 

Depth Jump

• Like the depth drop, upon landing immediately dip back down and explode up. 
• Focus on landing softly.

Single Leg Depth Jump

• Stepping off a 12 inch box, landing softly with both feet. 
• Using only one leg, dip down and jump straight up. Land softly and repeat. This time by jumping off the other foot upon landing. 

Depth Broad Jump

• Step off a 12 inch box, landing softly and immediately performing a broad jump.
• Focus on using the hips, full extending, and once again land softly.

Ice Skater & Bounding

• Ice skater focuses on lateral absorption and power development. 
• Motion needs to occur from the hips, land softly. As competency increases, so can speed of the movement. 

• Bounding is a forward motion, great for working on timing, footwork, and linear power development. 

Give these a try and see how it might improve your ability to run faster, run longer and stay injury free. 

Thoracic Spine, Breathing and You

The thoracic spine/ribcage is the boss when it comes to deciding where the scapula sits. Trainers and coaches find that if an athlete is having trouble with overhead movements, thoracic extension and the muscles involved must be mobilized.

Some lifters don’t respond well to traditional t-spine exercises like thoracic extensions or back-to-wall slides, no matter how many times they're performed.  For these individuals those particular drills and mobilizations don't help because they're already stuck in extension. The goal is to try and move them into a more neutral position where the diaphgram and pelvic floor face each other. This allows for the upper back to move into extension thus allowing better movement and less strain on secondary breathing muscles. 

Improving your squat requires reps, so too does your breathing. By fully drawing in air and exhaling, you'll improve your rib and thoracic mobility. By correcting this it will free up a majority of shoulder impingements at the top of pressing movements. I have had countless clients attempt to breathe deeply only to be able to take in air for 2-3 seconds at most.

I would add that these clients often exhibit dysfunctional breathing muscular restrictions like overactive scalene, sternocleidomastoid, levator scapulae, pec minor and traps. 

Before beginning, if you're a female in the Los Angeles area looking to make long lasting changes and lose that stubborn weight, click on the link above in my profile for details👆🏼😬 *️⃣*️⃣*️⃣*️⃣*️⃣*️⃣*️⃣ 90-90 hip lift with balloon. If you change your breathing mechanics, you can drastically improve your thoracic mobility. Using a balloon is an amazing tool to teach you how to better engage the muscles needed to stabilize the trunk and creating intra-abdominal pressure voluntarily. How to: Lie on your back with your feet flat against a wall. Knees and hips at 90 degrees. Stick your tongue to the roof of your mouth in order to maintain pressure. The hip lift encourages posterior tilt by trying to engage your hamstrings not the abdominal muscles. 1) Begin with an exhale to set rib position. The goal is use a minimal amount of oblique contraction to the ribs down during inhalation 2) Exhale fully through mouth without clamping down on your rectus abdominis (6 pack muscle). 3) Pause 2-3 seconds before inhaling again. Inhales and exhales should be relatively effortless. Limit straining, keep a relaxed neck. 4)Expand chest 360 degrees. Chest should expand, not rise towards the shoulders.

A video posted by Gary Heshiki Fitness (@garyheshikifitness) on Feb 1, 2016 at 9:03pm PST

I learned this trick from the Postural Restoration Institute (PRI). 

The balloon is an amazing tool to teach you how to better engage the musculature needed to stabilize the trunk, create and release pressure voluntarily.  Really honing this skill has immense carryover to all lifts and movements.  

Try to not pinch off the balloon with your teeth. Stick your tongue to the roof of your mouth in order to maintain pressure.  The arm lift helps to facilitate opening up the chest and the hip lift which encourages posterior tilt where you are trying to engage your hamstrings.

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Key Points

• Begin with an exhale to set rib position.
• The goal is use a minimal amount of oblique contraction to the ribs down during inhalation
• Exhale fully through mouth without clamping down on your rectus abdominis (6 pack muscle).
• Pause 2-3 seconds before inhaling again.
• Inhales and exhales should be relatively effortless.  Limit straining, keep a relaxed neck.  Expand chest 360 degrees.
• Chest should expand not rise towards the shoulders. 

Exercise Breakdown: Plank to Side Plank Rotations

I got this variation from the LA Lakers S&C coach Tim DiFrancesco

I believe most people would benefit from performing more side plank variations as it will increase lateral stabilization and often times fix most internal hip rotation restrictions. 

A side plank targets muscles like the Quadratus Lumborum, Lats, Obliques, and the Rectus Adomonis. The best part of this movement is that as you rotate in and out of the plank variations you'll have to get tight throughout the body and resist both extension and lateral rotation forces on the body. 

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How To:

• Begin in a prone plank position with your arms at 90 degrees, one in front of the other. 
• Brace into a plank position, deep exhale as to set the ribcage in the proper position and to achieve a strong core brace.
• Rotate onto one side while simultaneously rotating the feet to help facilitate a proper side plank position. Careful to not lose proper "shoulder stacking", meaning you should not feel ALOT of pressure in the front of your shoulder while doing this. 
• Rotate back to the prone plank and then repeat on the other side. 
• Perform 8-12 passes total near the end of a workout.