Here’s the latest Monterey Herald Article with a simple breathing exercise at the end. Proper breathing dynamics is so important. It balances the body, helps with alignment and proper muscle activation, and decreases stress levels. I focus more on proper breathing in preparation for exercises, and find it fundamental for pelvic issues, musculoskeletal issues, and chronic pain. I also love the stress relief and mindfulness it can offer with just a few minutes a day. I am liking the Headspace app for guided meditation for anyone interested.
Recently I have been treating a lot of high school patients with hip and knee pain during sports activities, and in more than one case the underlying cause is probably a long history of “W sitting” which is demonstrated in the above photo. I would always correct my children when they got in this position because I know that it can have some serious long-term risks for their developing bodies like the following:
- It can increase the risks of their hip and leg muscles from getting overly tight or overly stretched depending on what muscles you are talking about. Impairments in muscle length can have broader implications on hip and knee stability, mobility and motor control.
- Increased risk of hip dislocation as the hip is at end-range hip rotation
- Decreases use of trunk and core muscles for stabilization because now the wide base of support is doing it. In addition, this position does not allow rotation of the truck which makes movement and play more difficult.
- It can cause permanent damage to the hip by changing the angle the hip sits in the hip joint. Because of this change, children often exhibit a toe-in pattern with their knees also facing in and potential over-pronation. It can also cause lower-leg tibial torsion meaning the lower leg rotates outward to compensate for the femur (thigh bone) rotating inward. All if this makes for misalignment and difficulties with gait and running.
What to do?
If you do have a toddler or older child that still does this, cue them to get out of the position any time you see it, and ask any care givers or teachers to be aware of it.
Encourage other sitting position like the following:
- long sitting with legs out in front of them
- Tailor sitting or criss-cross leg sitting
- Side sitting
If you continue to notice toe-in pattern as the child ages ask your pediatrician about physical therapy. A therapist can assess your child’s hip alignment, and help create a plan of strengthening and mobility work to encourage a better gait pattern for your child.
Blake Russell, PT
There are so many great hip openers out there, but I wanted to share one of my favorites. It is my go- to exercise when I feel like my alignment is a little off, or my back or hips are feeling achy or just not as mobile as I know they should. It’s as close to WD40 you can get for your hips. The purpose of this exercise to get a gentle hip capsule stretch while you are pushing towards your feet, then a gentle gluteal and pirformis stretch as you pull your knee to opposite shoulder. To do this, take up the tissue slack and then breath out as you press down towards your feet. The movement is small- like maybe 1/2 inch. The breathing is really important, so make sure you first do this in a quiet place so you can concentrate. Remember, you are always breathing out on the mobilization or stretch part.
Aside from working the hip capsule, this is a very gently and effective psoas Muscle stretch. The Psoas muscle is one of the body’s main hip flexor muscles, or trunk flexor if your feet are stable. Since it inserts on the T12-L5 vertebrae, if can cause back pain if tight or in spasm. A tight psoas muscle also effects posture and alignment, so it’s one to stay on top of if you do a lot of hip flexing (runners, I’m talking to you.) Manual work is great for this muscle, but if that’s not an option, this will help.
The knee drop (second part of the video) is great for stretching your smaller external hip rotators that can effect your hip and sacral alignment. Again, let your leg fall in GENTLY to the center with gravity stretching it. Breath in as you come back up, and then repeat on the other side. Go back and forth 6x each leg.
As always, there should be no pain with any of this, so stop if you feel any. Though they feel great, 1-2 x times a day is plenty. Again, I will stress, be GENTLE. Don’t over do it or you will have a sore back and hips.
Happy running…or what ever form of exercise you choose!
Blake Russell, PT
Single-leg dynamic stability is important, as is core stability. This exercise challenges both and is great for almost any sport. Add it to your routine as a warm-up or routine. I am using a 10 pound medicine ball, but it’s best to start light and stay light as the focus of this drill is quality of movement; not strength. Balance is something I work on quite a bit to keep my feet intrinsic muscles and hips strong for the pounding of running. Keep your routine fun and add these rainbow passes to your gym routine. Enjoy!
There are so many things out there for recovery, it’s easy to get over-whelmed. I admit the roller is not my go-to tool mainly because any time I sit on the floor, my 4 year old decides to sit on me. But, doing some sort of stretching or body work after you have run or worked out is a good thing for muscle fiber health. Rolling has not been proven to give any lasting effects more than a few hours afterwards, but combined with some active movements or trigger point pressure, it’s been shown to be beneficial. It’s probably even best to cut your run a few minutes short if you are pressed for time and allow a few minutes of stretched to elongate the muscles that are prone to tightness so you will feel better on your next run or workout.
Your quadriceps (front thigh), hamstrings (back of thigh) certainly take a beating with any workout. Foam rolling is a great way to address these using your body weight. You can literally roll on it to work these muscles, stopping at any tender spots or trigger points and holding at least 30 seconds. The breathing is important, so take at least 2 deep breaths in and out slowly to send a signal to your brain to relax.
Also, roll with some active movements. For instance, in the below photo I am rolling my adductor (inner thigh) muscles. The longest one (Adductor Magnus) crosses the knee, so adding some knee bending and straightening while holding in the same spot is good for increasing tissue and fascial glide.
If you don’t work your mobility on a daily basis you will slowly loose it. So what, you say? Well, tight hip flexors mean your stride is shorter and can alter your alignment leading to back pain, tight pectoralis muscles (chest muscles) mean your posture changes and your shoulder joint is not as efficient, tight calves effect your ankle mobility and ability to squat to name a few. So, take the time to do a few minutes a day of something. Your body will thank you by feeling better on your next workout. I generally do a few minutes after a run, then about 10-15 minutes before bed. What is your favorite recovery tool?
Our bodies are born mobile, and it’s not until we stop using certain positions that we loose our ability to get in them. Often its sedentary life style, desk jobs, and sitting in cars that slowly robs us of our mobility. Even sports, strength training and our workouts can leave us limited if we don’t constantly work areas that are prone to tightness.
The squat test is a great movement to tell you how well somebody’s body is moving, particularly if you have your arms overhead as you are doing it. A simple quick squat test can tell you some much about the movement quality of someone’s spine, shoulders, hips, and ankle joints and even assess their body control.
Why is important to stay mobile? Because the body is smart, and losing mobility in one area will cause it to find it in another often resulting in an injury. Also, less mobile areas mean other areas work harder and your body is not as efficient. For example, not being able to get low enough to lift something heavy with your legs, means you might round your back and be prone to an injury. Or another example, have a shortened Latissimus muslce (back muscle) or poor thoracic mobility can effect your shoulder in over-head range of motion leading to pain and inefficient over-head activities. Even being able to get into a good squat is vital for explosive jumping in sports.
The good new is it might take a little time, but you can get your mobility back. Through some functional movement assessment, joint mobilizations, tissue release and corrective exercises, you can increase your mobility and retrain your brain to use your body the way you did as a kid.
Here is an example of good squatting mechanics with hips below knees, knees over toes, torso upright with arms overhead. Can you get in this position?