Motion Stability's Blog


When Doing Squats, How Do I Avoid A Stiff Back? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

If your squatting is causing your low back to feel stiff it indicates that either your form, the amount of load or repetition, or the sequence of muscle contractions are incorrect and not safe for your back. With your form – there are many proper ways to squat, but people we see that have back pain or stiffness after lifting typically let the back arch or round too much. It may be the angle your squatting at, but it may also mean that your spine is more structurally unstable than you may think it is. Have a qualified practitioner observe your form to look for any inefficiencies.

In regards to load or repetition – even if your form is perfect eventually your back can wear out due to excessive weight or overdoing the number of times that you squat. I would recommend finding out the repetition, sets, or weight that you feel like you back just begins to stiffen. Next time you do squats, do less than that so your back does not stiffen. As you improve your form and the proper muscle sequence you should notice that you can increase your weight and repetitions gradually without worsening your back stiffness.

Most importantly – back stiffness can occur with squats due to improper muscle sequence. With a squat, the trunk and back muscles should all activate to provide stability to your spine. The muscles that should provide the most power and movement in the squat are your gluteal / buttock muscles. The primary joint that moves in the squat should be the hip – which is controlled by the glute muscles. But what we see are patients that use their knees or back more – causing the quadriceps or back muscles to be used more. This develops an improper sequence of muscle firing patterns and ultimately places more stress on your back as your form and coordination of movement is inefficient. You should contact a skilled health practitioner such as a Physical Therapist to assess the strength and control of your hip, back, and leg muscles if your back stiffens while squatting.

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What Exercises for My Core Can Help Prevent Lower Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.

Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine – eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back – regardless of how strong your core is.

As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist – such as a Physical Therapist – to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.



Could Uneven Shoulders Indicate Any Issue? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

Uneven shoulders can be observed in a couple of planes. One of the most common observations is when one shoulder looks higher than the other. This could indicate either a structural, muscular or neural imbalance.

Structurally, the patient may have a leg length discrepancy or a scoliosis that causes the shoulders to be raised on one side.

Muscularly, the shoulder blade or scapula has multiple muscles that stabilize it in position. Muscular imbalances can easily occur that cause certain muscles of the scapula to pull it in a certain direction. For example, in many single arm-dominated sports such as baseball or tennis, the dominate arm tends to over-develop the latissmus dorsi which is your ‘wing’ muscle. With more muscular development it actually pulls the shoulder blade down. In standing postures, most of these athletes will look like their shoulder is lower on the same side. This can create problem for the lowered shoulder, especially when the arm is required to repetitively raise over their head. With the shoulder lowered it takes greater work of the opposing muscles to raise the arm overhead. Over time, it can cause poor shoulder mechanics and lead to injury of the shoulder.

When someone has chronic nerve symptoms in their neck and arm due to a radiculopathy or pinched nerve in their neck, many times you may see that the shoulder on the same side looks elevated. This is due to the adaptation of the muscles to shorten or spasm to elevate the shoulder girdle and allows more room for the nerve to conduct. Patient’s with this pattern often feel tight in their neck and upper shoulder. When they try to stretching the muscles it makes their nerve symptoms worse. This happens because the muscle is not tight but in protective spasm keeping the nerve from being injured further. In this case it is important to treat the nerve first before trying to lower the shoulder girdle.



What Can I Do to Prevent an ACL Injury? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

An ACL injury is usually due to the knee going into excessive valgus (knee turning inwards) and/or some type of rotary /pivot force. Many people focus on training the musculature around the knee such as the quad and hamstrings. This does help, but one must also consider the stability of the joints above and below – which would be the hips and ankle/foot complex.The knee can be viewed as a junction between two different stilts. If the hip is not stable or has excessive mobility, or the foot / ankle is not supportive such as excessive flat feet or stiff ankles from an old ankle sprain – it can place excessive valgus force at the knee – possibly leading to increased stress to the ACL.
Training thus should consist of hip and thigh training that does not promote internal rotation/valgus to the knee – such as gluteus medius / lateral hip stabilization, as well as improving ankle mobility/foot stability exercises. Once proper movement patterns are established, progression to higher level plyometrics, as well as sports specific training should be introduced.



What Can I Do For Plantar Fasciitis? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

Pain in the arch or heel of your foot is commonly diagnosed as ‘plantar fasciitis’. However, there are several reasons that can cause pain at the bottom of the foot.

Plantar fasciitis: Usually due to an over-stretched arch. Treatment by taping, manual therapy, orthotics, and use of night splints can provide short-term relief. Long term prognosis is based not only treating the plantar fasciitis itself, but also restoring proper mechanics of the entire leg.

Nerve Pain: The tibial nerve, which is a branch of the sciatic nerve can cause symptoms in the bottom of the foot. The key to treatment in nerve injuries is to determine why and where the injury occurred and treat the nerve accordingly.

Muscle Trigger Points: According to Travell and Simmons, muscle trigger points in the calf and foot muscles can cause referred pain to the foot. Soft tissue techniques and intramuscular manual therapy can be used.



Play Golf? Avoid Lower Back Pain With These Stretches. by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

There are numerous studies that have come out recently that show the loss of lead leg internal rotation of the hip in the golf swing has a high prevelance of low back pain in golfers. This is due to the lead leg in the golf swing acting as your swivel / finishing point in the swing. With limitations in the hip, the back has to work harder to finsh the swing. 

You should work on the foam roll to loosen the lead leg hip musculature, knee to chest and pirformis stretches can also help.

Standard back stretches can help alleviate your back after golf, but consider the causitive reasons why your back is hurting in the first place. I work at a Nike Golf Performance Center called Terminus Club (www.terminusclub.com) we utilize 3D Motion Capture Reality systems to analyze your swing, as well as utilize a Physical Therapist to determine the physical limitations of the body. From there we tailor your swing based upon who you are as an individual and not just the way a PGA Tour swings.



Will I Need Physical Therapy After Hip Replacement Surgery? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

It is recommended that you work with a skilled Physical Therapist after hip replacement surgery. The Physical Therapist will coordinate with the operating surgeon to improve your hip range of motion, strength, and progress your weightbearing and walking on your hip appropriately. They will also demonstrate to you safe and proper movement with your hip with functional activities such as sitting to standing, getting in / out of cars, and progress you back to your other functional and recreational goals.