Shouldering the burden, Addressing Shoulder mobility.

"Time spent in assessment will save time in treatment." Vladimir Janda

 We are now in part five of the joint mobility series and have arrived at the shoulders. They are complex joints which are responsible for movement of the upper extremities, they consist of approximately twenty muscles, and five articulations. Wow no wonder the shoulder is the other joint called the four knots by Dr. Mark Cheng. We use our shoulders on a daily basis in a wide variety of movements. Often times the importance of the joint will go unnoticed until there is an issue. Unfortunately recent stats show that issues with the shoulders are becoming all the more prevalent; Between 1998 and 2004, over 5 million physician visits were attributed to rotator cuff problems1, an increase of nearly forty percent in the given period. A recent study by the he American Academy of Orthopedic Surgeons, 5-40 percent of people without shoulder pain may have a torn rotator cuff.2 These tears will progress in 40% of these patients, and there will be an enlargement of the tear within a five-year period.3 Twenty-percent of these patients will experience no pain, while 80% percent will.3 Keeping the shoulders strong, maintaining good function and range of motion is imperative for everyone even if you are currently pain free. As you may know the main issue for sustained recovery is compliance. So after reading the blog and doing some research devise a corrective exercise plan for your training program that is user friendly and can be continually altered as you assess and correct.  My dream with this series is to have people moving pain free and properly. It is to be hoped that if you had some issues cropping up this has helped you or helped someone you know.  

 You may be asking Hmmm What do the shoulders have under the hood? The shoulder is a ball in socket joint much like the hip, except instead of the femur we have the humerus. The shoulder girdle is made up of three bones the clavicle (collar bone), scapula (shoulder blade) and the humerus. The scapula is complex it is the attachment site for a number of muscles responsible for movement and stabilization of the shoulder. It overlies the second to the seventh ribs and is encased by 17 muscles that provide stabilization against the thoracic wall. It is noted to be tiled forward at a 30 degree angle. The scapula has a shallow fossa on its lateral side into which the head of the humerus fist to form the glenohumeral joint.  The clavicle has an S shape and is the main connection of the upper arm and the rest of the skeleton. It is an attachment point for the pectoralis major, trapezius, sternoclaedomastoid, sternohyoid and the subclavius.  The clavicle meets the scapula at the top of the shoulder where it connects to the acromion process, forming the AC joint. The humerus is the bone in the upper arm that is the ball of the ball and socket joint at the shoulder. The head fits into the glenoid fossa of the scapula. The joints in the shoulder girdle; the glenohumeral joint, the acromioclavicular joint, sternoclavicular joint and the scapulothoracic joint. The glenohumeral joint is the ball and socket joint where the humerus meets the glenoid fossa  moving with the glenoid fossa of the scapula The head of the humerus is large in comparison to the fossa, resulting in approximately one-third  to one half of the head being in contact with the fossa at any one time. It is further supported by the glenoid labrum a ring of fibrous cartilage, this extends the fossa making it wider and deeper. The acromiclavicular joint is formed by the lateral end of the clavicle articulating with the medial aspect of the anterior acromium. The AC joint is important in transmitting forces through the upper extremity and shoulder to the skeleton. The supporting ligaments minimize the joints mobility. They are the acromioclavicular ligament restricts the movement of the clavicle on the acromion and the coracoclavicular ligament prevents vertical movement. The sternoclavicular joint occurs at the sternal end of the clavicle, the cartilage of the first rib, and the upper and lateral parts of the upper sternum. It is the only joint that truly links the upper extremity to the skeleton by way of the clavicles. This joint functions in all movements of the upper limbs and is importing in throwing and thrusting movements. The scapulothoracic joint relies entirely on the surrounding musculature for its control, the serratus anterior which holds the medial angle of the scapula against the chest wall. As well as the trapezius which rotates and elevates the scapula with elevation of the upper arm. Ligaments connect the bones of the shoulder, and tendons join the bones to surrounding muscles the biceps tendon attaches to the shoulder and helps to stabilize the joint. 

 Onto the rotator cuff!!!  The rotator cuff is made up of four muscles supraspinatus, infraspinatus, teres minor, and subscapularis. All of these muscles originate on different portions of the scapula and insert on the humeral head where they converge at the glenohumeral joint capsule to form a tendinous cuff around the joint. They assume the role of stabilizing the humeral head within the glenoid cavity, each of the muscles also contribute to humeral motion.  The supraspinatus originate on the upper border of the scapula and inserts on the humeral head. It assists the deltoid in abduction of the humerus the muscle is capable of abducting the humerus without the deltoids assistance. It is responsible for preventing subluxation in overhead motions such as throwing, tennis serves, military presses, lateral raises. Also it is one of the most injured rotator cuff muscle.  The infraspinatus has points of attachment on the posterior scapula and humeral head. The muscle contributes to several humeral motions, including external rotation horizontal abduction and extension. The teres minor originates just below the infraspinatus on the posterior scapular surface and inserts on the humeral head. The muscle contributes to several humeral motions, including external rotation, horizontal abduction, and extension. Along with the infraspinatus, it maintains posterior stability at the glenohumeral joint. The subscapularis is the only one of the rotator cuff muscles originating on the anterior surface of the scapula, and is thus hidden behind the rib cage and several larger muscles. With its insertion on the humeral head, it acts on the humerus through internal rotation, abduction, extension and stabilization. The subcapularis receives quite a bit of work with high volume of internal rotator work in most training programs. So direct subscapularis work is not necessary unless there is a strength deficit.

This article is slightly different as we will be addressing a dysfunction and some pre-hab or preinjury work you can do to avoid injuries. Our dysfunction of the day is shoulder impingement syndrome it is sometimes called swimmers or throwers shoulder. It is caused by the muscles of the rotator cuff becoming impinged as they pass through the subacromial space. The muscles will become inflamed and irritated with repetitive pinching. This can lead to thickening of the tendon which may cause further issues as there is very little free space, so as he muscles become larger, they are impinged further by structures of the shoulder joint and muscles. Impingement Syndrome can be caused by a number of different diagnoses such as bone spurs, rotator cuff injury, labral injury, shoulder instability, biceps tendinopathy, and scapula movement dysfunctions. The treatment plan for impingement syndrome is rest, ice therapy, seek out a sports injury specialist and a gradual return to your sport.   Why would we “work” or “train” the rotator cuff?  To have a strong joint and to have continually increasing strength we need a stable flexible joint. If you have the flexibility or the stabilizers of a baby do you think you will be able to move heavy loads or even handle high volumes of work with a light load?  The other reason is the most programs people do when they start out are chest/front deltoid dominant with biceps and triceps, a lot less back, rear delts and rows. Hey I was guilty of this as well does not make you a bad person. Lets learn from our mistakes and move on.  Oh just to address strength again once you address any gunk in the rotator cuff and strengthen the shoulder your numbers should jump considerably.  Please reference the pictures below as well as the descriptions.

• Isometric shoulder external rotation: Stand in a doorway with your elbow bent 90 degrees and the back of the wrist on your injured side pressed against the door frame. Try to press your hand outward into the door frame. Hold for 5 seconds. Do 2 sets of 15.
• Isometric shoulder internal rotation: Stand in a doorway with your elbow bent 90 degrees and the front of the wrist on your injured side pressed against the door frame. Try to press your palm into the door frame. Hold for 5 seconds. Do 2 sets of 15.
• Wand exercise, Flexion: Stand upright and hold a stick in both hands, palms down. Stretch your arms by lifting them over your head, keeping your arms straight. Hold for 5 seconds and return to the starting position. Repeat 10 times.
• Wand exercise, Extension: Stand upright and hold a stick in both hands behind your back. Move the stick away from your back. Hold this position for 5 seconds. Relax and return to the starting position. Repeat 10 times.
• Wand exercise, External rotation: Lie on your back and hold a stick in both hands, palms up. Your upper arms should be resting on the floor with your elbows at your sides and bent 90 degrees. Use your uninjured arm to push your injured arm out away from your body. Keep the elbow of your injured arm at your side while it is being pushed. Hold the stretch for 5 seconds. Repeat 10 times.
• Wand exercise, Shoulder abduction and adduction: Stand and hold a stick with both hands, palms facing away from your body. Rest the stick against the front of your thighs. Use your uninjured arm to push your injured arm out to the side and up as high as possible. Keep your arms straight. Hold for 5 seconds. Repeat 10 times.

• Resisted shoulder external rotation: Stand sideways next to a door with your injured arm farther from the door. Tie a knot in the end of the tubing and shut the knot in the door at waist level. Hold the other end of the tubing with the hand of your injured arm. Rest the hand of your injured arm across your stomach. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 2 sets of 15.
• Resisted shoulder internal rotation: Stand sideways next to a door with your injured arm closest to the door. Tie a knot in the end of the tubing and shut the knot in the door at waist level. Hold the other end of the tubing with the hand of your injured arm. Bend the elbow of your injured arm 90 degrees. Keeping your elbow in at your side, rotate your forearm across your body and then back to the starting position. Make sure you keep your forearm parallel to the floor. Do 2 sets of 15.
• Scaption: Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, spread them apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold for 2 seconds and lower your arms slowly. Do 2 sets of 15. Progress to holding a soup can or light weight when you are doing the exercise and increase the weight as the exercise gets easier.
• Side-lying external rotation: Lie on your uninjured side with your injured arm at your side and your elbow bent 90 degrees. Keeping your elbow against your side, raise your forearm toward the ceiling and hold for 2 seconds. Slowly lower your arm. Do 2 sets of 15. You can start doing this exercise holding a soup can or light weight and gradually increase the weight as long as there is no pain.
• Horizontal abduction: Lie on your stomach on a table or the edge of a bed with the arm on your injured side hanging down over the edge. Raise your arm out to the side, with your thumb pointed toward the ceiling, until your arm is parallel to the floor. Hold for 2 seconds and then lower it slowly. Start this exercise with no weight. As you get stronger, add a light weight or hold a soup can. Do 2 sets of 15.
• Push-up with a plus: Begin on the floor on your hands and knees. Keep your arms a shoulder width apart and lift your feet off the floor. Arch your back as high as possible and round your shoulders (this is the "plus" part or the exercise). Bend your elbows and lower your body to the floor. Return to the starting position and arch your back again. Do 2 sets of 15.

Next week is the final week of the mobility series we will be speaking to a sports injury specialist with six degrees in nutrition to address post injury supplementation and to highlight some of the newest techniques available.  Entering into a corrective exercise program should be done with supervision, please contact if your interested in a program of this nature or want a movement assessment.  

References

1. American Academy of Orthopaedic Surgeons, Research Statistics on Rotator Cuff Repairs, National Ambulatory Medical Care Survey, 1998-2004. Data obtained from: U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics Retrieved on May 9, 2007, from http://www.aaos.org/Research/stats/patientstats.asp 
2. American Academy of Orthopaedic Surgeons, Rotator Cuff Tear-Surgery versus Rehabilitation, Retrieved on May 9, 2007, from http://orthoinfo.aaos.org/indepth/printer_page.cfm?topcategory=Shoulder&Thread_ID=2 
3. Tempelhof S, Rupp S, Seil R. (1999) Age Related prevalence of rotator cuff tears in asymptomatic shoulders. Journal of Shoulder and Elbow Surgery Jul-Aug;8(4):296-299 

Taking the steps for Ankle Mobility

"Healing is a matter of time, but it is sometimes also a matter of opportunity" Hippocrates

Welcome back, hopefully we are all moving better or at least on the road to moving better. We have introduced information here some you may have been familiar with and some of it may have been new as long your learning and improving your life. This week we are looking at the ankle. A complex joint which is made up of three joints, four bones and two major ligaments. It is one of the more injury prone joints; Sprained ankles have been estimated to constitute up to 30% of injuries seen in sports medicine clinics, 41% of all sports related ankle sprains are basketball related, according to the Academy of Orthopedic Surgeons. Approximately 1 million people sprain their ankles in the U.S. (1 in 320) annually, the treatment of ankle sprains in the U.S. costs more than $2 billion each year. Injuries can also be costly. According to the study, each injury costs close to $12,000 dollars per athlete, in direct and indirect costs to treat. In addition, 30 percent of the athletes who sustain ankle injuries will experience long-term negative effects as an adult. Sports Health News, August 2011. Plantar fasciitis is the most common cause of heal pain that is treated in outpatient clinics, approximately 2 million patients are treated for this condition every year.. This should demonstrate the importance of ankle mobility and stability. 

What is the ankle? The ankle consists of 4 distinct bones the tibia, fibula, talus and calcaneus. The interplay between these bones allows for movement of the joint. The ankle is made up of three different joints talocural joint, inferior tibiofubular joint, subtalar joint.  The talocular joint is a hinge joint formed by the distal ends of the tibia and fibula enclosing the upper surface of the talus this allows for dorsiflexion and plantarflexion.  On to the inferior tibiofubular joint this  is a  point of strength between the lower surfaces of the tibia and fibula, the is supported by the inferior tibiofibular ligament. The subtalar joint comprises the articulating surfaces of the talus and calcaneus, it provides shock absorption and movements of eversion and inversion of the foot (outward and inward movement of the ankle). The ankle ligaments are extremely important for the stability of the ankle, comprised of mainly the collateral ligaments, both medial and lateral. The lateral collateral ligament prevents excessive inversion it is made up of three bands, the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The other major ligament is medial collateral ligament its also known as the deltoid ligament its considerably longer than the lateral ligament  and spreads out in a fan shape to cover the distal end of the tibia and the inner surfaces of the talus, navicular and calcaneus.  The plantar fascia is thin connective tissue that runs from the calcaneus to the metatarsal bones (the bones in between each toe and the bones of the mid foot).

The dysfunctions we are going to speak about this week are ankle sprains and plantar fasciitis.  First up ankle sprains there are two types sprains inversion sprain which is the most common accounting for 90% of ankle sprains. The inversion sprain occurs when the foot is inverted falling inward, this causes the lateral to be stretched to far. The other type of sprain is the eversion sprain, this occurs when the foot twists outward causing the deltoid ligament to be stretched too far. Now with ankle sprains you have three grades, Grade 1 is just stretching of the ligament with some pain. Most people can walk without crutches, but cannot jog or jump. A Grade 2 sprain is a partial tearing of the ligament, with noticeable swelling and bruising. People have pain with walking but can still take a few steps. This leaves us with the Grade 3 sprain which are complete tears of the ligaments, noted to be very painful with difficulty walking. Some of the notable symptoms are instability in the joint along with bruising swelling and pain.  Plantar fasciitis is the inflammation of the plantar fascia in the feet, this occurs with tight calf muscles, increases in weight or activity, repetitive activities like running. The symptoms are pain on the bottom of the foot near the heel, pain with the first steps getting out of bed or after sitting for an extended period of time and greater pain after exercise. 

Our solutions for this week, ankle sprains are usually treated with RICE Rest Ice Compression and Elevation, this along with NSAIDS is the initial treatment plan. If you have the ankle immobilized you want to limit immobilization, begin some range of motion exercises achilles stretches and alphabet writing. Then some strengthening toe raises, heel and toe walking, from there proprioceptive training which is where your body relearns to send proper feedback to the brain. This where you will get the most bang for your buck, a 1988 study by University Hospital in Linkoping Sweden showed that six weeks of balance training improved balance and stability with soccer players with ankle instability. This was followed up with a 1997 study by the Norwegian University of Sport and Physical Education which found a two fold reduction in the incidence of acute ankle sprains in volleyball players after introduction of an injury prevention program using proprioception. Now with Plantar fasciitis you will need to stretch your calves, look to see if you need to clear up either the hips or hamstrings as well. Upon waking in the morning lightly rolling either a golf or lacrosse ball may help to break up the adhesions, after you run your take a frozen bottle of water and roll that under your foot. The other things you can do are towel crunches, picking up marbles with your toes and putting them into cups as well as stretching your foot into dorsiflexion with a towel. Some people report having benefits with night splints. Remember assess before after and during otherwise how will we know we are making progress. 

The next blog will be about shoulder mobility!!

Take a knee so we can address those mobility issues

"I know of no more encouraging fact that the unquestionable ability of man to elevate his life by
  a conscious endeavor" Henry David Thoreau

Welcome back, hopefully you have been gaining some insight into the importance of joint mobility. In last week's blog we spoke about the spine along with three common dysfunctions and some solutions. This is part 3 of the joint mobility series we are going to look at the knee. The knee is one of the most commonly injured joints right behind the ankle.  So let's look at some statistics: 15% of all sports injuries involve the knee, 50% of knee injuries result in a visit to the doctors office, 75% of surgeries done on professional football players involve ligament and cartilage tears. It is a common injury with basketball players as well accounting for approximately 42% of their injuries. In addition, the Mayo clinic reported in their 2012 METEOR1 study that people who opted for a meniscectomy had a much higher risk of developing arthritis/osteoarthritis. Suffice to say joint health is very important particularly the knee.  In case you are not familiar with some terms that are in this article, please refer to the glossary at the end . 

So what exactly is the knee? The knee is where the femur and the tibia meet; it's a hinge joint with some medial rotation. While it is often injured, it is noted to be a very stable joint. The knee's stability comes from the geometry of the bones, muscles and ligaments. The muscles attached to the knee are the quadriceps which consists of the vastus medialis, vastus lateralis, vastus intermedius and rectus femoris. They attach at the top of the patella or knee cap and begin at the front of the spine. The quadriceps are responsible for knee extension. Just like last week muscles are working at cross purposes but in unison. The hamstrings are responsible for knee flexion as well as providing medial support to the knee. The ligaments would be on "TMZ for the joints" they are celebrities, which are the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament.  The ligaments work to stabilize the knee externally and internally with the help of the menisci. The menisci are thin c-shaped pieces of cartilage on which the knee glides. There are medial and lateral menisci. The medial meniscus is attached to the MCL. The joint is protected by the patella or kneecap.

The dysfunctions we are looking at today is patellafemoral syndrome or runner's knee and Iliotibial band syndrome. Runners knee stems from overuse or repetitive motion. It can come from running, jumping, volleyball, cycling, basketball and crew. A number of factors contribute to runners knee: Misalignment of the kneecap, complete or partial dislocation, tightness, imbalance or weakness of thigh muscles, and flat feet. Chondromalacia Patella is the softening or wearing away of the cartilage behind the kneecap; it may manifest itself in pain in the back or hip. In cases where the cause is misalignment, vigorous exercise can cause excessive stress and wear on the cartilage of the kneecap. This in turn will cause pain in the underlying bone and irritation of the joint lining.  The pain is usually under or around the bottom of the kneecap, it can be exacerbated by walking up or down stairs, kneeling, squatting and/or sitting with bent knees for to long. Iliotibial band syndrome or IT band syndrome is common in up to 12% of runners, usually described as a burning sensation in the outside of the leg. A recent study has cleared up the actual function of the IT Band. Previously it was thought the IT band would snap back and forth over the lateral femoral condyle, causing inflammation. In the Fairclough2 study it was proven that back and forth movement was an illusion, what you are seeing is alternating tension in the TFL and the glute max. The shifting of tension from anterior to the posterior fibers of the IT band creates the illusion that the band is displacing forward and backward. The IT band acts as a compressor to the femur lending strength and preventing it from bending in single leg stances. The authors of the study note that the IT band is never inflamed itself rather its the distal part of the vastus lateralis muscle. You may ask why these conditions are in this article together because they can go hand in hand all to often. They can give you an idea of what you may be looking at dysfunction wise and what needs to be addressed. 

Onto the solutions!

When it comes to runners knee rest ice compression elevation to start. Then you move onto strengthening weak muscles and stretch tight muscles. Some of the usual suspects will be involved look for hip tightness, calf tightness weak hamstrings and/or glutes. If your concerned with IT band syndrome it is suggested that you strengthen the hip abductors and external rotators. Another concern could be a tight TFL, tight hip flexors and even glute max tightness all three increase strain on the band. So staying loose will help you tremendously. Before working out or running, warm up and then do some soft tissue release, then move onto stretches. As you move out of a corrective exercise phase increase your training intensity and/or workload slowly. Also if you are running go to the local running store and get outfitted for correct shoes. It would be worth your while to get a movement assessment to determine what corrective exercise plan would get you into optimal condition. I hope you have enjoyed this week's installment. Please share this blog. Next week we move onto the ankles. 

Please see below for links :

http://www.drrobertsilverman.com

http://www.mobilitywod.com

http://www.youtube.com/user/TheBrentBrookbush

1.Meniscal Tear With Osteoarthritis (MeTeOR) Study. Accessed April 13, 2012.

_{http://www.mayoclinic.org/medicalprofs/meteor-study.html}

2.Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.J Anat, 2006;208:309-316.

Glossary 
Distal means further away from the body 
Proximal means closer to the body 
Medial means towards the center line of the body 
Lateral means away from the center line of  the body
Anterior means the front of the body 
Posterior means the back of the body 

Week 2 Mobility Series Back on Track

"Physical fitness is not only one of the most important keys to a healthy body, it is the basis of dynamic and creative intellectual activity." John F Kennedy

Disclaimer: I am not a Doctor although you may find me in a lab coat.  If you are having a back issue or an issue with any joint. I urge you strongly to seek out medical assistance prior to attempting to resolve the issues yourself.  

How do you move when you get out of bed in the morning? Are you walking normally, or are you limping joints cracking and popping like the rice crispy’s you? Unfortunately, more of us experience the latter myself included however, this can be corrected. A recent study showed that mobility not only affects your quality of life, but now we have proof it affects your longevity. The study involved more than 2000 men and women between the ages 51-80, asked to sit then rise without assistance off the floor. They were followed until they died, which on average was 6.3 years the people who scored lower used their hands died sooner than those who score higher did not use their hands. The study speaks to the need for flexibility, muscular strength, power to body ratio and balance. The costs of back injuries in the United States floats from $24 billion to $64 billion a year with over three quarters of a million working days lost and an estimated 40,000 nurses reporting illnesses from back pain each year.  Hopefully this shows that mobility is important on many levels, for quality of life, longevity and economically.

The back is made up of bone the vertebrae, the spinal cord and nerves as well as muscles and ligaments. The spine is noted to be in three different sections the cervical under the head, thoracic meeting the cervical and lumbar or low back. We have 24 vertebrae they go from the sacrum to the base of the skull. The spinal joint is made up of two bones and the disc between them. Each vertebrae is separated from the next one by a disc it acts as a shock absorber which provides the surface for each vertebrae to move upon one another making it a movable joint. If the joints go beyond the normal range of motion that can lead to pain or spinal joint dysfunction.   Ligaments connect the bones together and keep them proper alignment, muscles move the joint. So ideal spinal functioning is dependent upon the muscles and ligaments working in harmony.  We will be speaking about some of the muscles in the back the  deltoids, latissumus, trapezius, levator scapulae, erector spinae, gluteals, multifidi, and teres.  I almost forgot we have approximately 100 million nerves in the spine along with the muscles, ligaments and bone.

Last week we shot from the hip, this week its getting the back on track. Some of the same environmental factors apply to this weeks blog such as sitting for to long, poor posture, muscular imbalances and old injuries.  One common condition that affects the hip and the lumbar spine is the anterior pelvic tilt. This occurs when the hip flexors are shortened/overactive causing the gluteals and hamstrings to be long/underactive. As discussed previously this can contribute to dyfunctions like plantar fasciitis, runners knee, chronic low back and knee pain. The same affect takes place in the upper body called upper crossing syndrome this occurs when the pectoralis, levator scapulae, upper trapezius are short/overactive and the lower trapezius, deep cervical flexors and serratus anterior are long/underactive.  This affects the shoulders causing them to be rounded, possibly contributing to rotator cuff tears, and causing postural defects .These similar conditions were called lower and upper crossing syndromes by Dr. Victor Janda. One of the other issues we are looking at is thoracic immobility which can be caused by age, poor posture sitting causing hyper-kyphosis or a change in the curvature in the spine. The spine is set up so that the lumbar spine is stable, the thoracic spine is supposed to be mobile. It was made to move rotationally as well as in flexion and extension. Lack of  mobility will effect shoulder mobility  and performance, ability to perform overhead movements, as well as overall spinal health. It is noticeable if you cannot get into a correct squat position without a rounded upper back.

This all begs the question, How do I fix it? My suggestion is  to have a personal trainer, physical therapist or chiropractor screen you with a movement screen prior to addressing any issues . So that they can assess you and write you up a corrective exercise program. It does not have to be one or the other you can use a mix, so that you can cover all your bases.  Once you have your program set it will be necessary for you to reassess to track progress and modify as you move forward.  The tools of the trade are going to be foam rollers,  and tennis or lacrosse ball possibly a lacrosse ball for soft tissue release. Yoga bands, tubes and jump bands for stretching. Please review the links below for some solutions and fixes. 

Solutions :
Anterior Pelvic Tilt Lower Cross Syndrome

 Stretch the hip flexors,  Lunge stretch,  Lower back stretches

Strengthening the glutes and hamstring supine pelvic tilt, glute bridges

Changing your position intermittently through out the day

Thoracic Immobility

Use of a peanut on the thoracic spine  thoracic crunches

Posture correction and Spinal manipulation under the care of a Chiropractor 

Upper Cross Syndrome

Stretch the Pectoralis, Levator Scapulae Stretch, Upper Trap Stretch 

Strengthen with Chin Tucks, Ball Prone Cobra, Seated row with Theraband 

Press ups   

http://www.youtube.com/user/TheBrentBrookbush

http://www.youtube.com/user/sanfranciscocrossfit

Fitness Equipment

In the next blog we will be taking a look at knee mobility. Also given the demand I will interview a nutritionist about injury rehabilitation diet and supplementation. Please join my mailing list for a Newletter, E-book coming out summer 2013, and upcoming Seminars.