In the past few weeks I have seen numerous athletes with jaw pain or TMJd (temporomandibular joint dysfunction- Google it for more general knowledge). In all cases, they had chronic forward head positioning particularly exacerbated with heavy exertion. We see this often with athletes, the head juts forward (aka chicken neck) when concentration is diverted towards completing the movement (particularly with overhead movements and lifts such as the overhead squat, snatch, pull-ups, throwing). This forward head protrusion is also clearly a postural fault seen in daily life, particularly those deskbound at work. There is some research to support head-neck posturing and jaw dysfunction. And most importantly, forward head/ugly posture decreases your attractiveness (but you probably already knew that, Quasimodo).
Anatomically, a forward head changes the line of pull of several muscles (the infrahyoids) running from the mandible (lower jaw bone) to the sternum and even the scapula. This new alignment causes an altered pull on the jaw jamming up the delicate, sensitive disk within the TMJ. So if we're adding poor control of the head (forward head posture is an open, unstable position) to an altered and weak jaw alignment, the result is an ugly - literally - and painful TMJ. The real problem is that coaches and athletes are NOT paying nearly enough attention to head position and it's impact on the jaw. Especially when athletes are biting down hard, adding huge compressive loads to a poor jaw position in an effort to close the circuit and gain stability.
Here's the fix:
As with prior posts on prioritizing spinal position, proper head and jaw position is crucial to avoid injury and stabilize movements.
Thoughts? What are some cues you use to fix the dreaded chicken neck position?
This week's post is a public service announcement to get everyone to cease and desist leaning on one leg (i.e. hanging on one hip) when standing. Many of us do it without even thinking, shifting our body weight over onto one leg and just hanging out there. But in the effort to use less effort, we are reinforcing awful movement patterns and putting the entire kinetic chain in a damaging position. If you or your athletes have medial knee pain, hip or back dysfunction a good place to start may be how they're standing. We also definitely see this in our athletic new mother's too, who hold the baby on their hip while leaning on one leg (hello pelvic floor dysfunction).
Here's the deal:
Our musculoskeletal system is set-up to distribute the weight of our body plus gravity in an optimal way. However, when leaning onto one leg that weight is redistributed such that the pelvis drops toward that leg (see image below). The result is ugly:
But the real problem is that we are reinforcing this faulty pattern daily and even hourly often out of habit. This contralateral pelvic drop is a pathognomic we look for often as physios, yet our athletes are reinforcing it even between reps while training! How much will you benefit from motor control or strength training - often directly targeted at this hip/pelvic control issue - if you lean on one hip while drinking water between sets? Yet this happens all the time. In order for our training and performance gains to stick there has to be carryover to everyday movements. You move how you move. Chances are if you are standing with this pattern you will walk and run with this same pattern.
Here's the fix (it's an easy one): stop leaning on one leg! You should have active glutes while standing (you need to be squeezing them and your abs while upright). No more passive leaning, hanging on your hip joint. If necessary, stand with a wider base of support, march in place, or put one foot on stool for a bit to unload your spine during prolonged standing. Penalize yourself or your athletes with 10 burpees for every minute of leaning on one leg.
Here ends this Public Service Announcement.
This week's post is about the importance of the pursuit of perfect movement mechanics in the face of challenge. Being at the end of your rope means that you have used up any buffering of poor mechanics and the margin for error is slim. I love Urban Dictionary's definition of being at the end of the rope as "to be out of options or alternative courses of action; to be stuck in a bad situation" because it really gets to the essence of the importance of quality of movement.
It doesn't take an in-depth knowledge of biomechanics or pathoanatomy to know this is a bad position, right? What makes athletics so awesome is the opportunity to push the boundaries of movement mechanics and challenge the body throughout the entire spectrum of movement. But we have to do it the right way.
So how do we keep ourselves and athletes within the adaptational range and away from moving at the end of our rope?
1) We need to train in these weak positions and the only way to discover our weak positions is to add variables and movements that challenge the athlete to maintain excellent position and mechanics (within reason of course - having a shot putter run multiple 5Ks probably isn't necessary to drive appropriate adaptation). Doing step-ups for the basketball player pictured above really isn't getting to the bottom of the athlete's movement mechanics - we can do better.
Even mobility work will not transfer to functional movements unless that movement and position is reinforced - and motor control is prioritized. The beauty of a variable movement training program is that it challenges the athlete to see and feel what those tenuous positions are like and adjust accordingly. Drive the change thru competitive stress, position/range, speed, load, duration, metabolic demand to name a few.
2) Take off the low-hanging fruit by improving some of these everyday errors: Part 1. Part 2.
3) Most importantly, strength and conditioning coaches are the catalyst here. We need to make the athlete aware of the movement faults, trust your eyes, and don't be afraid to unload the movement to understand why the athlete is at the end of the rope.
Bottomline: At some point, the details start to matter. Don't let injury be that point. Optimal movement mechanics and motor control should ALWAYS be prioritized so that the athlete can handle and adapt to movement challenges and stay away from the end of the rope.
This week's post is a short explanation on why we need to prioritize motor control, particularly of the spine, in our tight and restricted athletes. The tendency is often to look right at the joint or muscles that appear tight. Can't bend over? Must be the hamstrings. Can't follow through with the golf club or baseball bat? Must be tight hips. Well maybe, but it's also likely that underlying poor motor control of the spine is negatively affecting mobility and ultimately performance of the extremities and spine.
There is some compelling research by Moreside and McGill (click here for the article) in which they improved hip range of motion by stretching (the hip itself as well as the myofascial components). Makes sense, right? But here's the interesting part: another group performed only core endurance and control exercises and didn't stretch the hip at all - and hip rotation improved. A third group stretched and stabilized - no surprise they improved hip range the most. Why does this matter, besides being pretty cool? Well those with low back pain have been found to have MORE lumbar and pelvis motion during hip rotation which increases dangerous shearing forces across the spine (by the way, the spine was built to handle lots of compression but not so much with the shearing stuff). Hip-spine dissociation then becomes critical in which the stiffened spine allows improved realization of hip motion and power - improving performance.
While this hasn't been explicitly studied in other body regions, I believe there is a significant neuromotor, self-protective event occurring - the nervous system limits joint motion in response to poor dynamic control of the spine. The result is what appears to be tight hips, tight hamstrings, tight shoulders but really may be a vicious cycle in which poor spine control causes poor extremity control and a reactive tightening or fixating of the tissues downstream ultimately causing altered movement of the spine - won't be long before your back hurts. Not to mention excellent hip mobility is necessary for nearly all athletic movements.
Prioritizing motor control and spinal stiffness helps close the circuit yielding better power and mobility through the extremities. Increasing torque and mobility through the extremities keeps the circuit closed - reinforcing proper spinal stiffness. It's an effective system that is so often lost in our athletes who aren't performing to their potential.
What does this all mean? Put simply, organize your spine and prioritize control AND set-up. Getting into a flexed, bent-over spine position prior to swinging a golf club is difficult to overcome once you then load that system. Providing a stable platform to work from (again, proximal stability yields distal mobility) by getting the athlete into a good and repeatable position, along with some selective motor control exercises aimed at separating spinal movement from hip movement, will go a long ways to improve performance. Decreasing load and prioritizing quality is essential especially when learning or tweaking your skill or movement. We've discussed prioritizing spinal control with shoulder performance previously.
Bottomline: Improving spinal control (no, not sit-ups/crunches but functional positions with progressive core demands) and being hyper-aware of spinal positioning before and during movement can help improve extremity control and performance and will certainly augment your ongoing mobility work. Here's a prior piece we did on improving hip rotation mobility in swinging athletes.