Adaptive Athletes Don’t Have to be Limited in their Mobility Work

I want to introduce you Jedidiah Snelson.  I’ve only known him for a short period of time, but he’s already been an encouragement to me.  Two years ago, his love for motocross changed his life.  A nasty crash left him with an array of injuries at both his upper and lower extremities, but most detrimental was an incomplete spinal cord injury at T12 (lowest segment of the mid-back).  As a result, he’s been adjusting to continuing life in a wheelchair for the last two years.  Let me tell you though, it hasn’t slowed him down.
He’s actively involved at Snake River CrossFit in Nampa, Idaho on a regular basis.  Whether it’s working on his strength or mobility he’s credited the CrossFit community in playing a part of maintaining a high level of function after his injury.  “Aside from giving me an outlet to satisfy my thirst to compete, CrossFit is the most functional training out there that has improved my ability for increased independence.  Simply put, functioning in a wheel chair can be awkward.  The adaptation of CrossFit is strengthening under awkward movements which directly reflects being able to function at a higher level with increased strength,” Snelson said.  His dedication recently landed him a spot at the CrossFit World Championships for adaptive athletes in which he placed second overall.  Here’s a video from the championships below.

https://www.instagram.com/p/BHz6UQOjy2m/?taken-by=jedidiahsnelson

As a result of having to use his upper extremities as the primary source of his transportation, his shoulders take on a significant amount of stress getting from point A to point B.  Add CrossFit workouts to this and Snelson mentioned that his pecs, upper traps, lats, serratus, and his deltoid muscles are areas that take the most punishment.  He understands the importance of mobility and maintaining adequate range of motion at his shoulders.  “Spending most of my day in a sitting position it’s hard not to slouch and hunch forward, this causes my muscles to tighten and with the constant use of my upper body it can put a strain on things.  By mobilizing and keeping things loose, my body is much more efficient and less uncomfortable,” Snelson said.

Recovering hard is just as important as training hard and Jedidiah dedicates quality time to recovery to get the most out of his training sessions.  “I spend quite a bit of time mobilizing, 10-15 minutes after each workout stretching and mobilizing key areas that were worked that day.  I also get a 75 minute massage weekly and spend two days a week doing a full mobility session for an hour to an hour and a half,” he said.  

The challenge Jedidiah and other adaptive athletes have is getting down on the floor or up against a wall to effectively foam roll or use a lacrosse ball to decrease soft tissue tension.  Over the last year and a half in working with Movement Guides, Inc., we’ve designed the T-Dot Mobility System with this in mind. I have a desire to provide adaptive athletes with more independence and they shouldn’t have to be limited in the type of mobility work they can do.  Even more independence is provided with the newly released Mobile T-Dot Mobility System allowing the athlete to take the device with them wherever they go.  It also gives them clearance from a squat rack to provide enough room to position their chair and incorporate movement to assist in reducing soft tissue tension.

Jedidiah loosening up his upper traps with the Mobile T-Dot Mobility System
Decreasing tension at the pecs can assist in improving posture and movement
​Jedidiah’s feedback on our newest product was great.  He’s not slowing down due to his injury and his mobility work shouldn’t have to either.  I look forward to providing the T-Dot Mobility System to many other adaptive athletes to assist them in being at their best each day. 
“The T-Dot is a great tool that allows for optimization of my mobility program.  It allows me to do more detailed work with greater independence.  The size of the system allows me to carry it with ease from home to gym and from competition to competition.  It also allows me to do a greater amount of mobility and tight muscle release from my wheel chair and on my own.  Consistency to mobility is the key, and with the universal use of the T-Dot, it allows me to be more consistent with my mobility.”                       
 -Jedidiah Snelson
Check out the video below as Jedidiah goes through some example mobility exercises on the newly released Mobile T-Dot Mobility System.

https://vimeo.com/175835924

For more information on the T-Dot Mobility System, please visit www.movementguides.com.
For more on Jedidiah, follow him on Instagram or Twitter

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Tennis Anyone?  Why the T-DOT is Essential for the Game!

I wanted to quickly review an article that was published in the April edition of the International Journal of Sports Physical Therapy (IJSPT) led by Stephanie Moore-Reed.  This study looked at how a tennis match can acutely impact shoulder rotational motion in women on the professional tour.  There’s a few other studies that have shown the loss of motion that occurs in baseball following a single game that I’ve mentioned in other blogs, but this is one of the first looking at female tennis players.
 
Methods: Passive shoulder internal rotation and total range of motion (internal rotation + external rotation) were measured before match play, immediately after match play, and 24 hours post match play.
 
Results: Nearly 50% of these athletes (79 subjects) presented with a clinically significant loss of internal rotation immediately following match play as well as 24 hours post match play. Nearly 40% presented with a clinically significant loss of total range of motion immediately following match play. 
 
I appreciated the sub-group analysis the authors provided in this paper, because it also showed that some athletes maintained motion, others gained motion, but the majority tended to lose it.  Other studies I’ve seen published on acute motion loss haven’t provided the extra analysis and it goes to show that shoulders can respond differently overhead activity.   It is important to identify those who are losing their motion acutely, because it may put them at increased risk of injury.
 
In conclusion the authors state…
 
“Given the changes in glenohumeral motion following acute exposure to tennis, evaluation of players for significant motion alterations following overhead activity and intervention strategies to minimize such alterations in these players are recommended for high level tennis players.”
 
This is another reason Movement Guides, Inc. has created and are continuing to develop the T-Dot Mobility System.  If soft tissue restrictions are primarily responsible for these acute changes, having a tool help re-establish homeostasis immediately following competition would seem to be advantageous.  You can learn more at www.movementguides.com.  
 
Reference:
Moore-Reed SD, Kibler WB, Myers N, Smith BJ. Acute Changes in Passive Glenohumeral Rotation Following Tennis Play Exposure in Elite Female Players. Int J Sports Phys Ther. 2016; 11: 230-236. 
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Stephen LaPlante of the Andrews Institute on the T-Dot Mobility System

Movement Guides Brett Burton had a chance to touch base with Stephen LaPlante, physical therapist at the Andrews Institute in Gulf Breeze, Florida for a short question and answer session.  Stephen and the physical therapy staff have been using the the T-Dot Mobility System at their clinic on a regular basis for the past few months.  Read more below to find out what he has to say…
BB: In your opinion, how important is restoring muscle length and decreasing tone in your practice and why is this something that needs to be addressed?

SL: Restoring muscle length and decreasing muscle tone might be one of the things that we neglect the most in our rehab treatments.  Muscles that are prone to becoming short or “tonic” like the pectorals restrict the posterior shoulder and scapular muscles from being able to function properly.  This can lead to pain, weakness, and dysfunctional movement patterns which will inevitably cause injury.

BB: What are your thoughts on the pec minor and upper trap restrictions influencing shoulder rotational range of motion in overhead athletes?

SL: I think it a lot of this relates back to Janda’s Upper Crossed Syndrome.  A good number of our overhead athletes have poor posture in general, which creates glenohumeral joint dysfunction.  This is often seen as restricted rotational movements of the shoulder, particularly internal rotation.  Once these restrictions are resolved we tend to see a marked increase in glenohumeral mobility.  Tightness of the pectorals and upper trap also lead to dysfunctional movement of the scapula and doesn’t allow for the scapular stabilizers to function properly, leading to greater risk of injury in these overhead athletes.

BB: How has the T-Dot Mobility System changed the way you approach soft tissue work in your practice?

SL: As much as I would love to be able to manually address all of the soft tissue dysfunctions I see, it’s not very realistic in a high volume clinic.  The T-dot gives me the ability to still get in the soft tissue mobilizations that my patients require and the results are similar to my own manual techniques.  It’s actually the first thing my patients use before they get started with their treatment.   Once they figure out what areas to target, it’s very easy for them to use the T-Dot and when they realize how helpful it is, they actually request to use it.

BB: How is the T-Dot Mobility different from other methods of independent soft tissue release and how do you feel it is more advantageous?

SL: The difference for me is how much more versatile it is compared to other forms of soft tissue mobilization.   What I like about the T-Dot is that we can use movement in conjunction with the soft tissue mobilization, but my patients aren’t as restricted by a floor or wall such as when they use a trigger ball or foam roller.  I’m also using it post-operatively with patients that have tightness from guarding.  I like that they are in control and they can feel more relaxed going into manual therapy and exercise for their treatment session.

Learn more about the T-Dot Mobility System at www.movementguides.com

Brett Burton is a Physical Therapist – St. Luke’s Sports Medicine at St. Luke’s Health System and a
Product Development Associate at Movement Guides, Inc.

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The Influence of Rotator Cuff Stiffness on Shoulder Range of Motion

An excellent article investigating the cause of shoulder range of motion deficits in asymptomic baseball players was recently published in the American Journal of Sports Medicine (AJSM).(1)  The group at Proaxis Physical Therapy out of Greenville, South Carolina wanted to better understand how much influence the capsule, rotator cuff, and bony alignment of the shoulder had on range of motion deficits.
 
They designed a study that involved one group of athletes stretching (using the sleeper and cross body stretch) for four minutes, while the other group performed the same amount of stretching, but also received four minutes of instrument-assisted soft tissue mobilization (ISTM) to the infraspinatus.
 
The results of the study showed that those who underwent both stretching and ISTM of their dominant shoulder showed 12.1 degrees improvement with internal rotation and 13.5 degrees improvement of horizontal adduction which was 5 and 7 degrees more than the stretching groups respectively.  These findings also support a study Laudner and colleagues published in 2014 showing significant improvements of internal rotation and horizontal adduction following only 40 seconds of ISTM to the posterior axillary border.(2)
 
In the conclusion of the recent AJSM publication, the authors state that by decreasing stiffness of the rotator cuff acute range of motion gains were noted.  “The study results show that changes in rotator cuff stiffness, not glenohumeral joint mobility or humeral torsion, are most likely associated with the range of motion deficits observed in adolescent baseball players.”
 
So, why are these findings important and how can they be applied to caring for overhead athletes?  These studies show that restricted soft tissue surrounding the shoulder girdle, specially the rotator cuff, can contribute to internal rotation deficit in the dominant arm of throwing athletes.  Like I mentioned in my last post, this can lead to increased risk of shoulder injury.   So, reducing rotator cuff stiffness with manual therapy directed at the soft tissue can improve range of motion, which may be beneficial in decreasing injury risk.
 
The literature is showing the added benefit of soft tissue work, but in the athletic training room it’s difficult and challenging to provide this to each athlete before they practice and compete.  As a physical therapist and athletic trainer myself, I’ve experienced fatigued hands and struggling to keep up with the demands.  The T-Dot Mobility System was developed to assist in providing the athlete the needed soft tissue work and increase their independence in managing the health of their arm.  This wasn’t intended to replace trained hands, but can supplement programming to assist in providing exceptional care.  In summary, getting to the soft tissue of the shoulder is important it shouldn’t go overlooked when treating overhead athletes.
 
For more information about the T-Dot Mobility System, go to www.movementguides.com and check out their Facebook, Twitter, and Instagram pages.
 
References:
 

  1. Bailey LB, Shanley E, Hawkins R, et al. Mechanism of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med. Published online September 24, 2015.
  2. Laudner K, Compton BD, McLoda TA, Walter CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. Int J Sports Phys Ther. 2014; 9: 1-7. 
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The T-Dot Mobility System: A Different Approach to Improving Shoulder Internal Rotation

​Loss of shoulder internal rotation in overhead sports is something that just happens.  It can be seen in several sports with baseball usually being at the forefront, but it can also pop up in weight rooms and other arenas where stress is placed on the shoulder overhead.   Many have suggested this can be caused by bony alignment, posture changes, posterior capsule tightness, and musculotendinous tightness.(1)

Over the years, several ways have been proposed to improve internal rotation or prevent the loss of internal rotation from occurring, as research has proposed that substantial loss of glenohumeral internal rotation has been tied to increased risk of shoulder injury.(2,3)

The sleeper stretch and the cross body stretch have been, and continue to be used as treatment options to improve internal rotation.   Modifications of both of these stretches have been made to help increase their effectiveness, but how much of a difference do they make?  If we start with the sleeper stretch, one study showed an acute improvement of 3.1 degrees in college baseball players.(4)  Another showed a 12.4 degree improvement in shoulder internal rotation after performing the stretch daily for four weeks, but didn’t use symptomatic subjects or overhead athletes.(5) 

As of late, several clinicians have preferred the cross body stretch over the sleeper stretch.  It tends not to put an athlete into the “impingement” position, which decreases the subacromial space and can cause pain in the shoulder.  Also, with the assistance of a clinician or positioning themselves against the wall, there is improved stabilization of the scapula to direct the stretch at the posterior shoulder.  Acute improvement of 11 degrees was shown following the cross body stretch in 16 year-old volleyball players with a clinician stabilizing the scapula.(6)  When comparing it to the sleeper stretch and performing daily over four weeks subjects did show a 20 degree improvement.(5)

Using the cross body stretch as the standard for improving shoulder internal rotation, I wanted to compare it to one of our pec minor protocols on the T-Dot Mobility System.  I used a single subject’s left shoulder.  He is a 39 year-old male with a history of a rotator cuff tear.  He is a Crossfit coach and is performing overhead activities on a regular basis.  For the first round of testing, I measured his internal rotation prior to performing the cross body stretch.  Then, he used the T-Dot to stabilize the scapula when performing the stretch and it was performed 3 times holding for 30 seconds with a 10 second rest in-between sets.

​The acute impact of the cross body stretch wasn’t as influential as I’d expected.  A 2 degree change was noted as the difference when comparing pre and post-intervention, which was significantly less than Salamh, et al. noted in their study.  They were looking at 16 year-old females, which tend to be more hypermobile than most, asymptomatic, and the stretch was also clinician aided – so those were primary differences observed.
Twelve days later, pre-intervention measurements were taken and then he completed our pec minor protocol which took 1 minute 45 seconds to complete.  He performed 15 reps of shoulder flexion while leaning into the T-Dot with pressure on the pec minor.  That was followed up with 15 reps of horizontal abduction and 15 reps of shoulder external rotation at 90 degrees of abduction.  A short example of this protocol is shown in the first half of the video below. 

https://vimeo.com/133110238

The acute impact of the T-Dot Protocol was much more drastic than what I saw with the cross body stretch.  The subject showed 13 degrees improvement in internal rotation while spending approximately the same amount of time working on improving motion as he did with the cross body stretch. 

So the next question most people ask after seeing these changes is “What’s causing this?” or “Why does my shoulder feel so much looser?”  The T-Dot is different with its approach because we are focusing on reducing muscular tension on the shoulder through pressure and movement at the muscles that attach to the scapula.  The cross body and sleeper stretch are more directed at the posterior capsule, which can be restricted in overhead athletes, but our hypothesis is we are modifying musculotendinous tightness and scapulothoracic position that can also be involved in internal rotation loss.

By looking at the pectoralis minor anatomically, it originates at ribs 3-5 and inserts at the coracoid process on the scapula.  I think what we are seeing is that by decreasing tension on the coracoid process/scapula, the position of the scapula is changed, which alters the position of the glenoid fossa, and therefore changes how the head of the humerus sits in the glenoid.  Ultimately this would impact internal rotation motion at the glenohumeral joint. 

The challenge at this point in time is there is minimal to no formal research that has been conducted looking at addressing the anterior shoulder and how this impacts shoulder rotational range of motion.  I am thankful for the team we have on board who has been willing to investigate this concept more and work toward publishing formal research on the T-Dot Mobility System.

I look forward to sharing more in the months to come discussing concepts that make the T-Dot Mobility System work.  We didn’t reinvent the wheel, but have taken established principles and built them into a system that allows the user to independently improve their movement and function.

To learn more about the T-Dot Mobility System, check out www.movementguides.com 

References
1.    Wilk KE, Hooks TR, Macrina LC. The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete. J Orthop Sports Phys Ther. 2013; 43: 891-894.
2.    Wilk KE, Macrina LC, Fleisig GS, et al. Cor¬relation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011; 39: 329-335.
3.    Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion defi¬cits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006; 34: 385-391.
4.    Laudner KG, Sipes RC, Wilson JT. The acute effects of sleep stretches on shoulder range of motion. J Athl Train. 2008; 43: 359-363.
5.    McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007; 37: 108-114.
6.    Salamh PA, Kolber MJ, Hanney WJ. Effect of Scapular Stabilization During Horizontal Adduction Stretching on Passive Internal Rotation and Posterior Shoulder Tightness in Young Women Volleyball Athletes: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2015; 96: 349-356

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The T-Dot Mobility System:  Long-Term Effects  

We just released the T-Dot Mobility System three weeks ago. Since that time, I’ve had some great discussions and fielded questions from people in many different disciplines. Each one of these conversations has been beneficial, because I’m still learning about the system myself and about the many different ways it can be implemented. The more I discover, the more I realize I don’t know.

I am going to try to provide some more information for a common question that gets asked:
You guys are seeing some major changes within a single session of using the T-Dot, but what are you seeing long-term?
I haven’t had an answer to this until until recently, because the system hasn’t existed long enough to trial over weeks and months.  I’ve been following a single subject over the past 9-10 weeks and wanted to share our in-house findings on how it has impacted his internal rotation.

The subject has been using the T-Dot Mobility System since the end of May.  He goes through the pec minor and upper trap protocols 1-2 times per week.  The combination of these protocols take around 4 minutes to complete, so he’s not spending a ton of time on the system.  He does have a history of an AC joint sprain (shoulder separation) on the right shoulder and a rotator cuff tear on the left shoulder.  What did we find? (All photos were taken prior to any type of exercise or warming-up)
When comparing right and left sides, the subject had significant asymmetry in internal rotation range of motion. So, by looking at the right side or “stiff side” the subject had about 10 more degrees of passive internal rotation available before starting any type of intervention.
On the left he started off being less restricted, but picked up around 17 more degrees of passive internal rotation across the 9-10 week span.To go back to the question, it seems as changes are lasting longer than immediately after using the system.  The changes shown are also demonstrated with very little time each week devoted to address soft tissue restrictions at the upper trap and pec minor. I realize I’m are only looking at one subject, had different people taking measurements, had slightly different camera angles and/or arm positions, but I feel like there is enough to show a change over time in this single case.

I’ve been learning as I go, and my goal is to get better with consistency of camera placement, arm angle, etc. to provide the most accurate results.  More blogs are in the cue, so I’m looking forward to sharing more.  Check back in as the next one will be comparing acute effects of the T-Dot compared to the cross-body stretch. 
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