Victory Friday | Issue 129
Orthopedic Insights: Orthopedic Secrets (Reminders) • “Twisting My Arm!”: Shoulder/Hip Fascia Release (with an Elbow Twist) • Joe’s Pigeon Hip Extension • Spring (Pitching) Shoulder Landscaping.
“A man with outward courage dares to die; a man with inner courage dares to live.” ~ Lao Tau
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Spring is here! Time to get that fascia unwound, warm up those throwing arms, and open up those hips. Here are some key reminders to help you stay mobile and active as the weather warms up: the importance of addressing the all sides of painful joint, freeing the superficial fascia, the often-overlooked “shoulder landscape” (ribcage and scapula) for pain-free throwing, how to safely check and restore full hip extension, and why “landscape work” delivers rapid results for shoulder issues in pitchers and other elite athletes. Enjoy!
What I’m Into: Orthopedic Secrets (Reminders). A few reminders I experienced in the clinic this week.
• The Spine Has a Front. A lot of pain, stiffness, mobility deficits and nerve tension lives in the front of the spine. In the low back, this means caring about the viscera1. In the neck, this includes the cartilage and fascia, including the carotid sheath. It all needs to move. If tight, it can restrict movement. Address it, clear it.
• The Knee Has a Back. Most knee pain is experienced in the front and sides. But joints are three-dimensional, and — like the spine — what happens on all sides affects any side. Relevant structures to consider in the back of the knee include: posterior joint capsule (and Baker’s cyst), popliteus muscle, hamstring and gastrocnemius tendons…
…and the sciatic nerve (and the tibial and fibular nerve branches)
• Treat the Shoulder Landscape. It’s baseball season. I have yet to treat a pitcher with a throwing shoulder issue that did not have significant “landscape” deficits: position and mobility restrictions of the cervical and upper thoracic spine, ribcage, or scapula2. To throw 90+ miles per hour — sustainably and pain-free — the ribcage must allow the shoulder blade to fully retract and depress (in wind-up), then release upward and forward with follow-through.
• Free the Superficial Fascia! No matter what mobilization you do, if the superficial fascia around a given joint, muscle or body segment is, gets or remains tight, it will undo your best efforts to mobilize that area. I greatly respect the profession of chiropractic, but they (among others) frequently miss this: they find a stiff joint, mobilize or manipulate it, yet the joint only “feels good” or moves properly for a day or two. This is often because the external fascial layers are tight, and have remained tight. No matter what is moved within that, if the external “shrink-wrap” remains tight, that tension will ultimately lock down the treated area, again and again.
With each passing year I find more and more relevance to this rule. Evaluate and treat the superficial fascia!
• Terminal (Minimum) Running Velocity. It’s spring marathon season, and the time of year where runners challenge themselves to run faster and farther. For the latter…many runners opt to slow down in order to cover the distance.
But in doing so, many run too slowly. At a certain minimum speed, slow running is more stressful to the body than medium or faster running. This is the Terminal (Minimum) Velocity3.
Runners and their medical team should always ask about pace when deciphering the contributions to running pain. Then assess what the stride looks like at the (“easy”) pace.
Cool Exercises I Like. “Twisting My Arm!”: Shoulder/Hip Fascia Release (with an Elbow Twist). I am relentless in my quest to find mobility strategies that satisfy the “Low Effort, Low Pain, High Yield” standard for effective mobility exercise.
So it seems, quirky systems-based fascial exercises often fit the bill: combining an extremity motion with spinal movement to level up mobility throughout the system.
For those with stubbornly stiff shoulders, ribs and hips (who doesn’t), this elbow-twisting fascial mob from Jason van Blerk (@jasonvanblerk), co-Founder of Human Garage:
Simply put: try it.
• twist the elbow outward, then
• flex the shoulder overhead, then
• sideband away, and
• breathe six times4
See how much it unlocks:
• shoulder flexion
• hip and pelvic mobility
• spinal sidebending!
Joe’s Articles (& More Cool Exercises I Like). Joe’s Pigeon Hip Extension. Efficient hip extension is crucial for both optimal running and pain-free life. A strong, full hip extension utilizes the glutes, minimizes lower leg stress and is a key for a strong, healthy low back.
Even more important? Symmetrical hip extension: both hips able to extend fully and powerfully behind.
But there’s a big challenge: how do you extend the hip without over-extending the low back?
A few years back, I came up with a solution: the “pigeon hip extension”:
The key: a full knee-to-chest (“pigeon pose”) position of the resting leg locks out the lumbar and sacrum from extending, isolating all the motion to the hip.
This is a powerful tool to both diagnose and restore hip imbalances in runners and non-runners, a like. Give it a try.
Victory Friday. Spring (Pitching) Shoulder Landscaping. Spring is here and so is another competitive baseball season.
A couple weeks ago, another high-level pitcher presented in-clinic with various shoulder and arm pain. Referred by his coach — who recognized a problem early and sent him my way — he recently began to have shoulder, bicep and elbow pain and discomfort…
…a few weeks after experiencing random but severe mid-thoracic rib pain while pitching in a game. It was severe enough to cause him to leave the game early. He noted pain with breathing for a few days. It gradually improved.
Then, within a week, his pitching arm became painful.
Since, pitching volume and intensity has been limited.
Upon evaluation, he presented similarly to my elite thrower a year ago5:
• a throwing-side upper and middle ribcage “stuck” in elevation and posterior position
• a restricted scapula, unable to fully retract and depress (into full wind-up)
Additionally, he had demonstrated:
• substantial myofascial restriction in his right mid-thoracic paraspinals — suggestive that he’d been overusing this area, substituting some sort of thoracic extension (instead of efficient scapular retraction)
The Treatment. I saw him for two sessions. On the first visit we found and treated:
• elevated and posterior right ribs: we used a Systems & Dimensions approach6 that included mobilizing the thoracic vertebrae, costal joint (posterior and anterior), and the lung and internal fascia,
and…
• right mid-thoracic paraspinals: this dense, restricted multi-segment area (between T3-T8) was likely the culprit in the initial rib pain event (that caused pain with breathing). This was mobilized aggressively with strumming and sustained pressure.
• scapular mobility: primarily restoring retraction and posterior depression, but also freeing elevation.
• scapular posterior depression strength: we “re-educated” the scapular movement pattern by facilitating the posterior depressor muscles (rhomboids and mid-lower trapezius). This was surprisingly sluggish and difficult for him.
His home plan included:
• foam roll ribcage mobilization: particularly mid-thoracic rib depression in sidelying:
• staggered cable row: given that he has gym access daily at practice, we used the cable system to reinforce scapular retraction/posterior depression on his throwing arm, similar to this:
After that treatment, he reported immediate improvement in shoulder mobility, ease and pain relief. He was the starting pitcher by week’s end and had a solid (but pitch-count limited) outing with only mild pain.
For visit two, we:
• reinforced the previous thoracic spine and ribcage treatment, but turning more attention to the full ribcage, including the anterior and left side: thus working the whole “ring” back toward neutral and efficient.
• more myofascial and superficial fascial treatment to the upper thoracic, scapula and anterior clavicle, making sure now fascial layers were limiting full athletic motion.
Then we finally got to:
• glenohumeral mobilization: a lateral gapping and anterior-to-posterior glide using a belt (key strategies learned from the Institute of Physical Art and Founder Gregg Johnson)
After that treatment, both he and his coach reported a huge improvement, not just in pain and mobility, but function: full and sustained improvement in pitch velocity and control. He pitched a full start, allowing no runs and only a few baserunners.
Takeaways. Tend the Landscape, First. No matter what is going on in the “ball and socket” (glenohumeral joint) or the rest of the arm — bicep, elbow, forearm — an efficient shoulder landscape must come first.
The two primary objectives:
• a ribcage that can “rest” in neutral: and not be “stuck” in elevation or posterior position
• a scapula that can: rest in neutral on the ribcage, fully retract and depress for full wind-up, full slide upward and forward for a full follow-through
Is Ribcage Dysfunction in Elite Pitchers Inevitable (and Does It Require Maintenance)? Considering how often I see elevated and restricted ribs in the throwing arm of elite pitchers, it begs the question: is this movement/position dysfunction inevitable?
As is stiff feet and calves of elite distance runners, there will always be certain tissues and body areas that accumulate the unique and extreme load of that particular activity.
For pitchers, to throw 90+ miles per hours, up to a hundred times in a couple-hour period, is a tremendous energy load. At issue:
how hard must the ribcage and the surrounding fascia work to “decelerate” the throwing arm (to, literally, prevent the arm from flying off)?
My theory: the peri-scapular musculature — the trapezius and rhomboids, in particular — must hold on for dear life to hold onto the scapula at follow-through. This “holding on” is what may pull the ribs into elevation and (paradoxically) into a posterior position.
Yet with every wind up, those tissues need to get out of the way to allow the scapula to slide down and back. It’s an inherent imbalance:
• slow, small (low-energy) scapular wind-up, and
• super-fast, big (high-energy) scapular and arm follow-through
Thus, pitchers may need and greatly benefit from a ribcage and scapular mobilty routine — something I give all of my pitching clients.
But such a plan may prevent many elite pitchers from becoming future clients!
Issue 129 is a wrap!
Help people move, function and feel better: please share this publication!
Thanks for reading, and have a great weekend,
Issue 104: Manual Therapy Microburts. “What happens on the front side of the lumbar, sacrum and pelvis bones is just as impactful as how they move in the back. Visceral fascial structure can play a huge role in lumbopelvic (dys)function.”
Issue 23: The Shoulder Landscape. The “Shoulder Landscape” analogy advocates treating persistent shoulder pain from the core outward: first restore smooth mobility and positioning in the thoracic spine and ribcage (“the foundation”), then improve shoulder blade stability (“the crane base”), cervical integrity (“power supply”), and finally work directly on the shoulder joint itself (“the crane arm”). Sustained pain relief and optimized efficiency of the shoulder requires this systems-based approach.
Issue 18. (HR) Down Low, Too Slow! Terminal (Minimal) Velocity & Running Pain. A case of treating a runner with persistent foot soreness, ultimately traced to running too slowly (13–14 minute miles). At very low speeds, running loses its plyometric efficiency: landing energy is absorbed by tissues rather than stored and released, forcing compensatory form changes that increase braking forces and stress on the lower leg and foot. The solution was simple—run slightly faster with a more relaxed, natural foot strike—which immediately eliminated the pain, highlighting that “slower isn’t always better” and finding an easy, sustainable stride is key to pain-free running.
Issue 80. Running Truth-Bombs. Specific guidelines for minimum velocity: “For a young (<60 years old), healthy (moderate weight, no disease) person running on a flat, smooth surface at sea level, this is about 10 minutes-per-mile.”
If runners cannot do this aerobically, they are better off run(ning at an efficient pace/biomechanics)-walking until fitness improves.
Six-breath exercises: the hallmark of the Fascial Maneuvers methods, acknowledging both the power and connectivity of the diaphragm and lung/thoracic fascia on the rest of the body.
Issue 69: Throwing Off Nerve Tension (Freeing the Elite Thrower). An elite thrower with arm pain and ulnar nerve symptoms (tingling in the hand) during full-intensity throwing showed no significant improvement after two months of standard sports medicine care. Examination revealed cervical restrictions (worse on the non-painful side), positive ulnar nerve tension, and an elevated, stiff right ribcage compressing the brachial plexus and limiting scapular motion. Using a systems-based approach, treatment focused on mobilizing the cervical spine, upper thoracic ribs/lung, and peri-clavicular area, plus a simple home ribcage mobilization; this resulted in 90%+ resolution of nerve tension and pain-free full-intensity throwing within three days.
Issue 41: Systems & Dimensions. Full and sustained pain relief and recovery of function often requires a comprehensive treatment approach of multiple Systems (body areas: spine, pelvis, abdomen, pelvis, hip, knee, etc) and Dimensions (types of tissue: muscle, tendon, bone/joint, fascia, nerves, blood vessels, etc).