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If there’s one thing that I see and treat pretty much every single day of the week, it’s terrible posture. What is difficult for me to deal with is the elderly population with terrible thoracic kyphosis and decreased hip extension. Some of the most common issues I see in these populations:
It makes sense that having a tremendous forward head posture from a resulting thoracic kyphosis will lead to neck pain. We also know that treating the thoracic spine can be beneficial for this population.
Having a huge thoracic kyphosis is going to lend to scapular anterior tilt and internal rotation, both of which are implicated in shoulder pain.
Having a combination of thoracic kyphosis and osteoporosis also increases our risk of having compression fractures, something that causes additional pain and even worse posture. Sounds like a pretty viscous cycle aye? Aging sucks.
Side Note: Interestingly, increased lumbar extension correlates with shoulder pain (tsunoda 13 j orthop sci) (Straker Manual therapy 09).
Looking down the chain we tend to lose hip extension as we age. Coming with this are slower walking speeds and subsequent increased risk of having falls (Falls are incredibly dangerous for the elderly population). Although patients with spinal stenosis tend to have a flatter lumbar spine, they also tend to feel better in this position (even better when flexed). If they’re lacking hip extension then they’ll compensate with lumbar extension with gait and when standing (One of the reasons standing and walking are painful for these patients).
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I picked this one up from 2 time olympian and 8 time national champion olympic weight lifter Chad Vaughn at the Power Monkey Camp this past fall.
As described earlier, adequate tibial internal rotation is important for achieving a deep squat. If you’re lacking tibial internal rotation you might find your feet spinning out at the bottom of a squat or just having trouble getting your knees out over the toes in general.
I like to put this in either my warm-up, cool down or between sets of a strength exercise. Give it a shot and let me know what you think. Works for Chad Vaughn, works for me.
Can’t argue much with olympians,
Dan Pope DPT, CSCS
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We all know the importance of hip and ankle mobility for deep squatting. What most people don’t know about is the importance of adequate tibial internal rotation.
Ya, I was confused at first too. You see, we all love the cue knees out during the squat. Depending on who you like to get your facts from we want to be getting our knees to track out somewhere between the 2nd and fifth toes (aka Mr. Pinky toe).
When we sink into a deep squat we need to have adequate mobility of the hips in order to drive the knees out to track properly over the toes. When we descend into the deep squat we also need to have adequate tibial internal rotation to get the knees out over the toes without also spinning the feet out. This would be an important screen for your athletes who can’t seem to get their knees out over their toes, and have excessive toe out (Keep in mind you have to rule out the hips too).
Ala SFMA we can assess this:
If you’re missing some internal rotation you’d benefit from trying to correct this. For the clinicians out there, physical therapist and friend Dr E. has some excellent manual techniques for improving tibial internal rotation and subsequently, your deep squat. Get some knowledge below:
Here’s another do it yourself drill from Adam Kelly Using Dr. E’s Edge Bands. I use this drill quite a bit myself:
Get to work,
Dan Pope DPT, CSCS
P.S. If you enjoyed this article then sign up for the newsletter to receive the FREE guide – 10 Idiot Proof Principles to Performance and Injury Prevention as well as to keep up to date with new information as it comes …read more