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Happy Friday everyone, it’s time to spring into action! But if you haven’t moved much lately, don’t fret: we have some excellent rotational warm-ups, a five-step couch-to-adventure plan, and a brand-new strategy to kick that stubborn (fascially-driven) low back pain. Check it out!

Cool Exercises I Like. Robust Resisted Rotational Gym Warm-Up! Avid readers of Victory Friday know I’m a big fan of:

• functional, athletic movement, emphasizing whole-body and spinal elongation and rotation1, and:
• combined mobility and strength: moving through full range with resistance2.

Tayla Cannon (@taylacannonphysio) shares this excellent multi-body warm-up sequence that emphasizes both full segmental range of motion and neuromuscular activation and control.

Her five pre-workout exercises:

1. Hip CAR (controlled articular rotations). This works three-dimensional hip and pelvic mobility (on a stable spine).

2. Sidelying thoracic rotation press. This weighted rotation is pretty brilliant: pushing a dumbbell against gravity to work on active rotation; while the same dumbbell eccentrically stretches into increased counter-rotation… but all executed in non-weightbearing.

3. Jefferson curl. I’m a big fan of these (highlighted here before3): again, using weight for a controlled stretch into spinal and posterior fascial flexion, then actively extending out of it.

4. Banded kneeling lateral lean. Performed in a neutral lunge position, a band stretches the spine into a full sidebend, and provides resistance counter-bending back to neutral.

5. Banded quadruped hover. Finally, this bent-knee plank hold adds band resistance to elements of the thoracolumbar spine to facilitate trunk stabilizers in front and back sides!

Tayla might warm up with it, but this series, alone, would be a great stand-alone active strength-and-mobility session!

Joe’s Articles. Five Couch-to-Adventure Run Workouts. Summer is fast approaching, and so might be that goal race or adventure on your calendar.

If you feel behind — if training is off to a slow start, or if an early-year injury has held you back — deciding how to prepare may feel overwhelming.

I’ve coached enough clients — and, at times, myself — out of the rut and into strong, healthy summer fitness using these five progressive training workouts.

They start easy, but quickly build toward two key foundations of healthy, peak performance running:

• Biomechanical efficiency

• Metabolic efficiency

From iRunFar.com,

Five Spring-Training Workouts for the Summer Majors

TL;DR: the five-workout progression:

1. Nasal-breathing easy runs. Nasal breathing provides two crucial benefits: it regulates the effort enough to be true (“Zone 2”) aerobic training, and it facilitates greater diaphragm utilization: activating and strengthening a breathing muscle for long and fast running, and a key core stability muscle, to boot!

2. Treadmill uphill hiking. This, too, provides multiple benefits including: easy-run caliber aerobic work without impact, working key postural (hip hinge) and propulsive (glute, calf) elements without impact, and training for vertical climbing…without the punishment of the return downhill!

3. Short uphill sprints. These are the safest way to introduce high-intensity: hard anaerobic work without the orthopedic strain of flat (or downhill) running. Uphill sprinting is also a great way to challenge and reinforce running efficiency: including forward hip hinge posture, downward/rearward hip extension, upward/forward hip flexion and a fast, strong arm swing.

4. Up-Down-Flat training. With the foundations of metabolic and mechanical efficiency in place, the most “efficient” way to work on trail racing specificity is an “Up-Down-Flat” workout:
   
   • a prolonged uphill (hike or run)
   • a prolonged downhill (focusing on descent efficiency and speed), then:
   • a flat-and-fast segment: a mile or two at “race pace”
   
   This latter element practices finding one’s efficient stride, and forcing a faster race pace, after the ups-and-downs of a mountainous trail race.

5. Short (1-2 minute) track repeats. Finally, short track repeats are a great way to work top-end speed and reinforce — if not “re-discover” — optimal running form. Ultramarathon-specific long runs and vertical sessions can make us stiff and inefficient; a weekly flat-fast session will challenge our ability to re-establish an efficient system.

Got it? Good, now get to work!

Victory Friday. Fascial Front & (Low) Back Freedom. I’m on a hot streak in treating low back pain right now: several new clients with stubborn, sensitive, and severe low back pain are getting better, faster, and with more sustained and robust relief.

What’s different?

For each back patient I still do my customary systems-based treatment, including:

• addressing whole-spinal efficiency: not just lumbar, but thoracic — vertebral and ribcage — and cervical.

• optimizing hip and pelvic efficiency: restoring hip and pelvic alignment, motion and strength. This often includes a significant but often overlooked element: pelvic rotations and torsions4.

But where I’ve had the most rapid and sustained success has been the consistent application of two additional, fascial mobilization strategies:

1. Visceral mobilization: moving the tissues — organs, connective tissue and surrounding fascia — that are located beside, or rest within, the lumbopelvic area.
   
   This is by no means a new strategy: I have been treating visceral restrictions in all lumbar spine cases for over six years.
   
   But my treatments are more thorough and multi-dimensional, including key structures like the aorta and iliac arteries5.

2. Posterior pelvic superficial fascia mobilization: freeing the fascial layers directly over the low lumbar, sacrum and lateral pelvis, in particular, over the sacroiliac joints.

Freeing superficial fascia is nowhere near a “new idea” for me — I’ve used it extensively for both thoracic6 and lumbar pain relief7 — performing focused assessment and treatment of the fascia directly over the sacrum is novel.

It could be a simple omission; but often these omissions are driven by awkwardness: working this tissue requires, quite frankly, a hand on one’s bare sacrum that may feel intrusive for both patient and practitioner.

But once I began to assess this area — which is the very inferior-most aspect of the thoracolumbar fascia8 — I found all sorts of restrictions, often directly related to a motion loss at the sacrum.

In the same way that sacrum motion is often altered or restricted by “sticky guts” on the front side of the bone, so, too can the best sacroiliac joint mobilizations and self-stretching techniques be thwarted by sticky superficial fascia!

So, after first clearing the periphery — the upper spinal (and fascial) elements, and hip and pelvic mobility — performing these “front and back fascia” treatments to the lower lumbar-sacrum area has provided some huge wins!

Takeaways. Free the Front and Back Fascia! The best focal treatments — mobilizations, strength exercises and motor control strategies — can easily be thwarted by sticky fascia on either the front side or back side of the back and pelvis.

Put even a small amount of time and effort to assess and free these layers and see what Victories might be in store for you and your clients!

Issue 136 is a wrap!

Help people move, function and feel better: please share this publication!

Share Renegade Orthopedics

Thanks for reading, and have a great weekend,

Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:

Subscribe now

It’s a spring Friday: are you getting out and enjoying yourself? Now’s a good time to open up (abduct) those hips — if you want to get rid of that foot, ankle and leg pain —check your (and your clients’) running strides, move more, and move better…but don’t forget to rest (at least 72 hours!) after those big efforts!

What I’m Into: Manual Microbursts: (More) Shoulder & Lumbar Landscapes.

Shoulder Pain is Always a Landscape Problem. I seldom see immediate post-op clients any more (acute post-operative care is the purview of insurance-based medical care, as it should be).

But I occasionally see post-operative shoulders, in protective sling-braces, and each time, without fail, I can clearly observe:

• a rounded, restricted upper thoracic spine

• a stiff, compressed cervical spine

and a five-second hands-on test would reveal:

• a scapula that is locked-down (stuck forward and/or in elevation)

All shoulder pain treatment must include — and should begin with — comprehensive “landscape treatment”.1

Only then can the direct shoulder ball-and-socket strain be relieved and prevented, and efficient, pain-free motion restored and maintained.

All Low Back Pain Benefits from Decompression. Lumbar pain is complex because of all the factors — and all the body systems — that can sensitize it.

Most low back pain is caused — or made worse by — two factors:

1. Excessive motion:

• hip mobility loss transfers excessive motion into the pelvis and sacrum, causing excess motion at the low lumbar segments

• thoracic spine and ribcage mobility loss causes excessive motion (all motions, but especially rotation) in the upper to mid-lumbar segments

2. Compression

• hip mobility loss drives the pelvis and sacrum up into the lumbar

• thoracic spine and ribcage stiffness results in excessive kyphosis (flexion), which is often counterbalanced by excessive lumbar lordosis: compressive extension strain.

Sustained low back pain relief must involve both Systems2 treatment as well as a decompressive strategy: releasing stiff, restrictive tissue (Dimensional3) elements above, below, in back and in front4 of the low back!

Cool Exercises I Like. Justin’s Best Groin Stretch. Hip (and pelvic!) opening is a crucial — and often overlooked — element in a lot of pain: and not just hip and thigh pain, but knee, lower leg, foot and ankle (see this week’s Victory, below)!

If the hip and pelvis are stuck in a “closed” (adducted) position, this can make the groin muscles tight and angry, but also cause all sorts of other problems downstream.

To sustainably re-open the hip, try this elevated hip abduction opener, courtesy of Justin Lin, PT at Rehab & Revive:

This is one of the key reinforcing exercises I prescribe my clients with sneaky hip and pelvic mobility loss.

Check out this week’s Victory, below, to find out why this is so important!

Joe’s Articles. Respect the 72! The Post-Exertion Vulnerability Window. During an injury repair process, the body initially breaks down tissue further, in order to rebuild even stronger:

Imagine a house that largely survives a tornado, with only a few damaged siding panels. To restore full structural integrity, a team of carpenters arrives and systematically inspects every wall. For approximately three days, they remove nails and screws, check each board, replace where necessary, and reinforce with additional fasteners.

During this repair period, the house is far more vulnerable. Should another storm strike while the carpenters are still working, the structure is much more likely to sustain additional — and potentially greater — damage.

The same principle applies to our connective tissue in the days following an ultra[marathon].

What most of us don’t realize, and what new real-world research is demonstrating: this process — tear-down - inspect - rebuild — occurs after every high-intensity, athletic activity. Regardless of pain or frank tissue damage.

Most of this process peaks at 72 hours post-activity. That means, on average, our tissue is at its weakest and is most vulnerable, three days after the event. Often after a lot of the soreness and fatigue has faded.

Thus the key to a high-integrity recovery and maximal injury prevention: limiting tissue load for at least three days.

From iRunFar.com:

Rest for 72 Hours: The Science Behind Post-Ultra Tissue Recovery

Victory Friday. Frontal Plane Pelvis & Footstrike: Pelvic Mobility Crushes Lower Leg & Foot Pain. Many issues ago I shared a fun and impactful Victory: an oft-injured high school runner whose chronic lower leg pain was resolved with pelvic alignment and mobility work5.

That was a potent lesson learned, which sensitized me to look at pelvis alignment and motion with any runner with repetitive foot, ankle, and lower leg pain — as well as lateral knee and hip pain.

This week I had multiple clients with stubborn, lingering pain that was resolved by examining and correcting pelvic alignment and mobility deficits: in the frontal and transverse plane.

For both runner clients, they initially presented with:

• chronic knee and ankle/foot pain

• significant pelvic torsions with ribcage mobility loss and asymmetry

Our initial treatments were focused on:

• restoring full and symmetrical thoracic spine & rib mobility: often with simple foam roll mobilization to the ribcage and diaphragm.

• hip and pelvic mobilization: to de-rotate the pelvis and improve flexion and extension mobility.

After doing so, pain rapidly improves:

• efficient hip and pelvic alignment and motion improve gait landing and push-off efficiency, greatly reducing strain to the legs.

• knee torsion dramatically improves (especially when paired with ankle dorsiflexion mobilization.)

But in both these folks, they were 80% better — back to running, cycling, hiking, weight training — yet still had some lingering pain:

• a stubborn fraction of their knee pain and sensitivity, and/or:

• stiffness and soreness in the lower leg, foot and/or ankle

Look Again & Look Closer. For each, to get rid of this remaining pain it took a closer look at two subtle-but-powerful factors:

1. Running stride width

2. Frontal & transverse plane pelvic mobility

For my high school runner, the side view — the “aesthetic view” — of his running stride looked amazing! Tall, hip hinged, with excellent vertical hip strategy and foot-under-body landing.

But with closer examination:

• the frontal plane showed a narrow, crossover landing pattern

and on the treatment table:

• his pelvis was stuck in adduction and external rotation

Recalling that lesson, I re-examined the running strides of both clients this week. Unsurprisingly:

• each demonstrated a unilateral crossover landing pattern: the painful foot and ankle — for each, the right leg — was landing too narrowly, across midline.

• each had a paired pelvic dysfunction: the right pelvis was stuck in adduction (lacking abduction) with a paired (equal-opposite) issue on the left: stuck in abduction (lacking full adduction).

The solution wasn’t:

• foot and ankle work, or

• telling them to “run wider!”

(And while external and internal rotation deficits weren’t huge issues with either, I did find minor deficits that I treated: if only to help facilitate full freedom of frontal plane opening/closing)

Immediately post-treatment, both demonstrated efficient, symmetrical — and effortless — improvement in stride width, with concurrent improvement in foot strike comfort.

Takeaways. A couple keys:

1. Examine Stride Width! Inefficiency — namely asymmetry — of frontal plane stride width is the biggest tell of a relevant pelvic alignment dysfunction. A pelvis stuck in adduction will drive that leg and foot to land excessively medially, “crossing-over” midline. And the converse is often true: the opposite pelvis is often stuck in abduction, and will result in a landing that may be too wide (even if slight).

2. Assess & Optimize (Frontal and Transverse Plane) Pelvic Mobility! Test for end-range motion of the hip and pelvis, particularly:
   
   • pelvic abduction and adduction
   • pelvic external and internal rotation

Pelvic alignment and mobility matters! And everything from moderate (but especially severe and/or repetitive) falls on the hip and butt, to subtle-but-prolonged fascial tensions in the belly and spine can mis-align and restrict motion of this leg-foundation bony system!

Clinicians should test it, and individuals should be educated on how to self-assess and restore symmetrical and full motion!

A little awareness and effort can go a long way to snuff out even the most stubborn leg aches and pains!

Issue 135 is a wrap!

Help people move, function and feel better: please share this publication!

Share Renegade Orthopedics

Thanks for reading, and have a great weekend,

Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:

Subscribe now

While most physical therapists fantasize about training the next generation of elite athletes, I somehow became the patron saint of the 70-and-up crowd.

And, I don’t mind it: they’re a lot of fun!

My clients don’t just want to “get by”; they want to keep hiking, running, and embarrassing their grandchildren on the pickleball court. In this issue we turn creaky joints and stubborn aortas into a surprisingly effective fountain of youth!

What I’m Into: Retiree Rejuvenation. Many people are surprised to find out that most of my clients are not young athletes. Rather, my caseload is filled with my favorite people, who are:

• 40+ years old

• moderate-to-high-complexity: including significant trauma history (both acute/major events like falls, auto accidents, concussions; and micro-repetitive traumas experienced in contact sports)

• highly-active: they walk, hike and even run a lot; they often lift weights, have a yoga practice, and are otherwise active around the house, with extended (younger) family, and in the community.

• highly motivated: they are intent (if not hell-bent) to maintain their high level of function, investing time, energy and financial resources to stay healthy and fit.

As such, even my older clients — 70+ and 80+ year olds — come to me in good overall physical condition: if not excellent for their age cohort.

But recently, outside the office observing more of the general population, I began to think:

One who has lost significant (if not profound) mobility, strength and stamina, yet they are still highly motivated.

The person I imagine:

• has stooped (forward-flexed) posture
• has significant functional mobility & balance loss: hip extension, ankle dorsiflexion, spinal movement (in all planes), having difficulty with transitions (sit-stand) and impaired balance
• has significant strength loss, including muscle atrophy

What would I do to safely and effectively get them stronger, more mobile and more active?

And how would I safely and sustainably do so, minimizing risk of injury or other harm?

Here’s what I’d do:

1. Safe Mobility & Core Stability: Aquatic Therapy. Water exercise is a crucial tool in dealing with a sensitive client. What it offers:

• safety: It allows for aggressive mobility with hardly any (impact) fall risk.

mobility: water does two things. First it unweights the body, creating a traction effect in key weight bearing joints (legs and spine). Second, water reduces tone. Both combine to powerfully improve mobility: possibly faster than any other technique.

stability: water provides dynamic resistance and perturbation stimulus. The faster you move in water, the more resistance, challenging both mover and stabilizer muscles. Moving (wavey, turbulent) water creates irregular, unpredictable perturbation, challenging the neuromuscular system to stabilize.

For low-functioning clients nothing is better than water to get them to quickly level up.

What to do in the water? There are many things you can do, ranging from deep water (non-weight bearing) running1 to various “aerobic” (arm and leg mobility and strength) movements.

But the best may simply be, fast-walking. Getting into waist- to belly-deep water and:

• walking with long strides

• “paddling the arms” — reaching forward with one hand, while “paddling” (pushing back) the opposite

This creates a ripple effect2. It:

• facilitates good shoulder motion

• maximizes hip extension (and ankle dorsiflexion) motion

• facilitates spinal rotation

2. Max Muscle Blast, Minimal Strain: Resistance Machines. After the pool, the biggest bang-for-buck is resistance training. But weightlifting is risky for an aging population: fall risk can be very high, and strain (and even fracture) potential is significant.

However, the potential gains from strength training are huge in two areas:

• neuromuscular. The stimulus of weights is a massive wake-up to a sleeping nervous system. There is nothing better (and relatively safer) to stimulate the brain and neuromuscular system than strength training.

• hormonal. Strength training is a major squeeze of the endocrine system to secrete anabolic hormones — at any age.

But if you’re nervous to put your grandpa (or aging parent) under a back squat bar3, how do you get the gains of near-maximal neuromuscular effort with minimal risk of fall or injury?

Machines.

Isolated “circuit machines” are an ideal way to load the muscles in a safe, supported manner. With next-to-no fall risk and minimal strain potential (outside the area of focus), machines allow a person to heavily load a muscle group and simply push hard — with no balance challenge and minimal coordination, required.

Just sit, select and blast away.

Most gyms recognize this and have created a “circuit area” — a group of machines targeting different muscles throughout the body: a sort of multi-vitamin for strength training!

While this may be limited in functional development — it’s not going to overtly improve grandma’s single leg balance — it delivers all the neuromuscular and hormonal gains in the biggest — and safest — dose.

3. Mindful Movement: Yoga & Tai Chi. After significant repetitions in the pool, restoring mobility, stability and balance; then adding gym machines, awakening the nervous system and rebuilding real muscle mass, it’s finally time to take it, weight bearing.

Mindful movement practices such as yoga and tai chi bring it all together: stability, strength, mobility, balance and coordination — but done mindfully and (as needed) slowly and patiently.

I love yoga for runners4. But I love it for everyone: the thoughtful movements, checking in with each side of the body and slow, controlled movement and stability — all paired with deep breathing.

This is a perfect coalescing activity, bringing together the overt gains of mobility, stability and stamina from pool activity, the strength gains from the gym and combining to create smooth — if not elegant — functional movement.

That’s my fountain of youth, and I’m sticking to it.

And if you have a loved one who lost the pep in their step, consider this trio of strategies to get them moving and feeling great again.

Cool Exercises I Like. Hamstring(-Hip) Speed Drills. My colleagues at Capacity Performance Therapy (@capacity.pt) posted this great trio of run-specific drills emphasizing the hamstring in fast running.

But they benefit much more than the hamstring:

The trio of exercises:

• Wall Run Snap
• Hamstring Box Switches
• Hamstring Fast Leg Raises

work on the coordination of hip strength — both strong mobility and stance stability — in conjunction with a strong, active hamstring.

This hamstring-hip relationship is crucial for your fastest and best running. Give ‘em a try!

Victory Friday. Another Aorta Achievement! A few months back I shared some curious and powerful orthopedic wins after mobilizing a restricted abdominal aorta5:

The cases:

• A 50+ year-old woman with chronic right hip and pelvic pain. In addition to stiffness and pain in the right hip and posterior pelvis, she presents with a stubborn right torsion/rotation of her pelvis.

• A 50+ year-old woman with chronic, stubborn neurogenic anterior left pelvic, hip, thigh and knee pain. She is nearly two years post-hip replacement, but complains of pain, tension, and neuralgia over her left thigh and knee, limiting activity.

• A 40+ year-old man with chronic back and hip pain, with a painful, stubborn lateral (trunk and pelvis) shift.

Each experienced sustained improvement in pain, mobility and alignment after improving the side-to-side mobility (“play”) of the body’s biggest artery.

This week I had a similar case: this time involving a long-time client, in his late 60s, with a stubborn and dynamic lateral shift: his pelvis shifting left (and trunk counter-shifting right) on right stance phase of both walking and running gait.

We have previously employed many strategies to correct this shift in the realms orthopedic (hip, pelvis, lumbar, thoracic, ribcage) and visceral (intestinal, diaphragm). Uncertain what he needed to correct this “pull” of his pelvis from center to right, I performed Barral Institute General Listening Technique.

The technique emphasizes both a location and a character: where you feel an “energy”, and what it feels like.

Often, the “feel” is simply a “presence” — a tone or density, often indicating an orthopedic or visceral structure.

This time, I felt something different:

• in the left-central abdomen
• and a rapid “UP-DOWN” shooting energy, of about six inches length, from lower to upper abdomen, then instantly back6.

I wasn’t sure what to make of that, until I did a closer Listening, then motion test.

“The aorta!”

His abdominal aorta was restricted: tight and restricted on his left side. This seemed to be the force that was pulling his pelvis left.

But I felt something else, too:

It felt glued down to the tissues around his right hip and pelvis, including his viscera (large and small intestine) and psoas muscle.

Mobilizing both arteries — the aorta to improve right medial play; the right iliac artery to free it from the hip and improve superior-inferior (“elongation”) mobility — resulting in a substantial improvement in alignment and gait.

Wild stuff, but plausible:

• he’s a life-long runner who has both used (pumped) and impacted those vessels with tens of thousands of fast miles

• a tight aorta will pull the pelvis left; a tight right iliac will “shorten the hip”, causing a trunk and pelvic sidebend right!

Take-Aways. As I said before:

Blood Vessels Need to Move! (Especially the Big Ones). This is yet another reminder:

….tension around both nerves and vasculature can cause not only pain but sustained — and profoundly stubborn — orthopedic mobility and alignment deficits.

I like to say, “The Brain only cares about itself and its nerves.” But what’s most important for the brain and nerves? It’s blood supply.

Keep checking in on those big, impactful blood vessels!

Issue 134 is complete!

Help people move, function and feel better: please share this publication!

Share Renegade Orthopedics

Thanks for reading, and have a great weekend,

Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:

Subscribe now

(In)Stability is the theme of this week’s Victory Friday: how it often masquerades as stubborn stiffness and tightness, or hides its true cause in adjacent “side door” tissues. Even as we age — and feel (or act) increasingly stiff — we can still harbor significant joint instability.

The good news? Targeted stabilization work can cut through the paradox, delivering lasting improvements in mobility, strength, pain relief, and function.

What I’m Into: Unstable Old Guys: Signs of Instability in Older Populations. When an orthopedist thinks about a typical “instability client” — a person with passive tissue (joint or ligament) hyper mobility, or active core stability deficits — it’s easy to jump to an image of:

• young
• athletic
• female

Hypermobile body types, super-”bendy” and in activities like ballet and gymnastics.

But what about old guys?

They seem to be the opposite, don’t they?

• old (> 40)
• (less) athletic, but still active
• male

Yet old guys1 are among the biggest sufferers of orthopedic instability and the issues that come with it:

• chronic pain
• weakness
• repetitive injury and functional limitation

Can older populations — particularly men — experience problematic orthopedic instability?

Absolutely.

Yet the instability often goes unrecognized for a couple of reasons:

First, most instability issues in older populations are isolated to a single joint, or a few joints: the spine, the shoulders, or the hips.

Most orthopedists are taught about the Beighton Index: a measure of systemic hypermobility found throughout the body from head to toe, used to screen for instability.

Yet few older clients will ever test so highly — and pervasive — under that index. Instead, their instability is more subtle: isolated to one (or a few) joint systems.

Secondly, old guy instability is shrouded in a murky mess of “stiffness and tightness”. This sore-stiffness ranges from run-of-the-mill orthopedic hypo-mobility — stiff myofascial and joint tissue that is increasingly common in most older clients — to more focal, painful and problematic tightness.

One example: chronic hip and hamstring tension: caused not because the hamstring is tight, but because the hip is unstable. (see this week’s Victory, below)

Signs of Clinical Instability in Older Populations. If you’re wondering if your client or you (as a fellow old guy) have instability masked as something else, here are some possible signs:

• “Too mobile”. Old guys (and gals) may not present as true hypermobile, but they often present as…more mobile than they should be.

Unless they perform specific life-long activities that demand full range of motion, if and older client presents with “really good” mobility, they are likely hypermobile and succeptible to instability issues.

Excessive mobility metrics for older clients include:

• cervical rotation: >80 degrees
• cervical sidebending: >50 degrees
• lumbar extension: >45 degrees (able to look to the ceiling or behind them)
• hip flexion: >130 degrees
• shoulder flexion: >180 degrees

Notably: some complementary motions — including lumbar flexion or hip extension — might be significantly (if not profoundly) tighter: either because the hypermobility is unidirectional, or the instability is significant enough to create compensatory (protective) stiffness that “locks up” this motion.

Which leads us to…

• Chronic stiffness. The paradox of instability is how it can cause chronic stiffness. This was covered in a previous Victory Friday2:

Instability creates stiffness and tension for two potential reasons:

• muscles overwork to stabilize a joint. They get stiff and tight as a result of the excessive (or inefficient) work.

• a nervous (or vascular) system under strain will create myofascial tension around sensitive areas to protect them.

• Easy come, easy go. This is the real hallmark of instability. When you treat an “old guy” — who should be stubbornly and densely stiff — yet a modest amount of hands-on treatment creates a rapid restoration of motion…that seldom lasts very long — days or hours — before “re-stiffening”3.

But the good news? Instability in older populations is…

• Highly responsive to stabilization exercise. Also noted in a previous Victory Friday, targeted stability exercise has immediate and significant improvement in not just strength, but system mobility and overall function4.

Takeaways. Once again…don’t discriminate against the old guys! Just as all old guys with diastatis aren't just weak and flabby (but instead have covert stiffness)5, what appears — and often feels — like stiffness and tightness may actually be chronic instability.

If stiff and tightness complaints are stubborn to stretching, if hands-on work creates rapid changes that never seem to stick, and if that part (or other parts) of the body are “too mobile”, try some stability work!

Cool Exercises I Like. Basic Upper Cervical Mobility. I like to post fancy, innovative exercises here at Victory Friday.

But I also like to share the very best ones. Even if they seem (or actually are) pretty basic.

I treat a lot of headache and neck pain. And this exercise, while basic, is the most impactful home exercise I prescribe.

A lot happens at the upper cervical spine. It contains:

• the initial passage of the entire spinal cord, leaving the cranium

• upper cervical and occipital nerves

• suboccipital muscles, containing direct connections to the dura mater of the spinal cord

As such, compression of the upper cervical spine can cause a lot of problems, including:

• headaches

• neck pain and mobility loss (namely: rotation)

and, most notably (yet least recognized):

• neuro-fascial tension and pain anywhere else in the body

As such, maintaining an open and mobile upper cervical space may not only relieve and prevent headache pain and neck stiffness, it is often a key to problem-solving stubborn issues…anywhere below the neck!

My favorite quick-and-dirty upper cervical opener is the retraction exercise:

• In sitting, with finger pressure:

• In supine, against a pillow or small bolster:

In each, there is active and/or passive anterior to posterior glide of the head on the upper spinal segments. This stretches open that crucial upper cervical space!

Simple as it may be, it’s a key tool in the maintenance of a healthy upper neck, and a clutch pain reliever for cervicogenic headache.

Joe’s Articles. Hip Mobility Side Doors. This is actually a re-post from Issue 87 a year ago, but highly relevant to our instability theme this week: how “side door” tissue restrictions can cause persistent mobility loss in “primary” motions. And how side-door strategies — massaging and stretching to these adjacent tissues — can sustainably unlock motion.

From iRunFar.com:

Side-Door Strategies for Improving Hip Mobility

TL;DR:

• Core Idea: Traditional hip stretches (focusing on flexion/extension) often plateau; “side-door” approaches target deep, short muscles (rotators, abductors, adductors) around the hip “ball-in-socket” to restore full mobility for running.

• Why It Matters: Stiff deep hip tissues limit the femur’s ball movement, causing big restrictions in stride, pain, or injury (even if asymptomatic). These short muscles are hard to stretch due to poor torque.

• Key Techniques (using balls/foam roller for self-massage):

  • Lateral Hip/Pelvis: U-shaped massage around greater trochanter (glutes & deep rotators) with up/down, side-to-side, and rotational motions.

  • Posterior Hip: Target the “trough” behind greater trochanter with a firm ball for deep rotators/ligaments.

  • Adductors (Medial Thigh): Foam roll side-to-side, with added hip rotation/flexion.

• Prescription & Tips: Pre-test mobility (e.g., hip flexion/extension, pigeon pose); work small areas for a few minutes, reassess; follow with hip strengthening (bridges, clamshells, etc.) to stabilize new range and avoid injury.

• Benefits: Improves cardinal running motions + rotation/abduction; can help related issues like knee, ankle, foot, or low-back pain.

Victory Friday. Old Guys’ Tight Hamstring Cure. This is a blast from my Fellowship year.

As I took over the caseload of the departing Fellow, I got to adopt a cadre of new (to me) clients. One of them was a man in his late 60s. A retiree to northern Colorado, who — like most Coloradans — was highly-active, loved hiking and played golf frequently.

Yet his golf was increasingly painful — and limited to a power golf cart — due to chronic posterior thigh pain.

“My hamstrings are just so tight!”, he told me. Hamstring stretching and massage work helped, but the tightness and pain always returned.

Initial hamstring straight leg raise mobility testing: about 50 degrees.

Pretty darn tight, and painful.

So I investigated the side doors of his hip and hamstring: the medial and lateral thigh and hip. They were dense and restricted.

I mobilized these soft tissues. With about ten minutes of massage work to the inner thigh and lateral hip?

Straight leg raise: 100 degrees!

100 degree is a lot in an “old guy”.

Huh.

“Too much, too easy”, I thought.

That was the first time I’d ever considered an older (otherwise “stiff”) man could have true joint instability.

Freeing tissues around the hip joint — the adductors and lateral hip muscles — freed the straight leg raise.

We then performed isolated three-dimensional hip stabilization. This not only maintained his motion through the end of the session, but it resulted in sustained mobility improvement and pain relief.

He might’ve stuck to the golf cart, but he was quickly back to golf 18 holes with much less pain.

Takeaways. Don’t Let Looks (and Age) Deceive. Older clients can have clinical instability! Look for the signs, and apply focused stability for sustained improvement in mobility, strength, pain relief and function!

Issue 133 is a wrap!

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Thanks for reading, and have a great weekend!

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