1/2/2015

TheManualTherapist:Q&ATime!HelpwithRowers

Q&ATime!HelpwithRowers

JodiSchneider,MS,ATCaskedforhelpwiththiscaseload.

Q:IseealotofnonspecificthoracicpaininrowersonaveragearoundT48,reportpain
withrotation,occursmostlyoninside(ifyou'renotfamiliarwithsweeprowing,the"in"
sideisthesidetheyrotateto,sothey'realreadypredisposedtorotationalissues).Mobility
isusuallyterribleinextension/andbilateralrotation,MMToflowertrap/rhomboids
usuallyextremelyweak,andallareclassicUpperCrossedSyndromes
Ispendalotoftimetryingtoopenupfrontofhipswithsofttissue(IASTM,manualsoft
tissuerelease),focusingon"in"side,psoas,superiorquad,QLandparaspinals.Muscle
energyforanyribdysfunctions,andthoracicrotationsifneeded.ToaddressUpper
Crossedsyndrome,Ialsodosofttissueworktoscalenes,pecminor,andfollowthatwith
deepneckflexoractivationandscapularretraction.HomeprogramIsendthemawaywith
includes
Hipflexorstretchingmaintainingneutralspine,withsamesidearmabovehead
Pecminorstretchingandselfsofttissuereleasewithtennisball
Chintucks
Wall/Foamrollerangels
SideLyingTspinerotationoryouropenbooks
IhavehadgoodresultsonceIstartedaddinginalotofhip/anteriorchain,butihavea
fewpatientswhojustdontseemtorespondtoanythingIthrowatthemandcontinueto
havepain.Rowingwillalwayshavethoracicissuesduetotherepetition,andtheforce
generated,butwouldlovetohearanysuggestionsyouhaveorhowyouwouldtreatthese
patients.

A:ThanksforreadingJodi!Iwillonlyfocusonthethingsyoumayhavemissed,butI
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havetoadmit,youhaveagreatandcomprehensivetreatmentprogramthatisaddressinga
lotofthedysfunctionsIwouldfindinapopulationlikethis.

MDTApproach

ThecervicalspinecanreferdowntoaroundT6ortheinferiorborderofthescapula.
TakingapageoutoftheMDTbook,youmayneedtohavethemoverpressuretheirchin
tuckswiththeirwebspaceontheirmaxilla(Ineverhaveapatientpushonthemandible)
andhavethempushintocervicalretractionuntiltheirsternumrisestomakesuretheyare
goingtoendrange.Havethemperformthisminimumtentimeshourly.Gettingtotrueend
rangeandhourlyrepetitiongetsallthebenefitsofselfmobilizationandcancentralizethe
midthoraciccomplaintsbetter.

Hourlyrepetitionofthe"thoracicwhip"mayalsohelpforselfmanipulation,thisonly
workswellinthecaseofrapidlychangingROMwithtreatment,andnottheslower
improvementseenwithtruetissueandjointdysfunction.
Also,havethemsitwithalumbarrollinallsittingpositions,thiswilleliminatecreep
stretchingofthethoracicparaspinalsandpreventthefacetsfromgoingintoanexcessive
upandforwardposition,limitingrotationandextension.
SFMAApproach

Unweightthemandchecktheirthoracicrotationactivelyandpassively.PertheSFMA
system,iftheyhavelimitedthoracicrotationinWB,testthesamemotionsunloaded
(quadruped,buttocksonheels,onforearmonthefloorelbowbetweenthekneesandthe
otherhandonthehead,havethemrotatetowardtheupperarmactively,thenpassively).
Checkbilaterally,thenperformthesametestwiththehandinthelowerback,thesetest
unloadedactiveandpassiveupperandlowersegmentalrotation.

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startpositionforlumbarlockedupperbodyrotation

endpositionforlumbarlockedupperbodythoracicrotation

startpositionforlumbarlockedlowerthoracicrotation

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endpositionforlumbarlockedlowerthoracicrotation

Ifthemovementwaslimitedinloaded,butnotunloaded,oractively,butnotpassively,
youdonothaveamobilityissue,youhaveamotorcontrol/stabilityissue.Checkrollingas
inthisvideos.

UpperBodySupinetoProne
UpperBodyPronetoSupine
LowerBodySupinetoProne
LowerBodyPronetoSupine,ThankstoSportsRehabExpert.comforgreatdemonstrations
andform!
Thesignificancehereisthatthesemovementpatternsarefromdevelopment.Weshouldall
beabletodothesefromaveryearlyage,andindeedlearnhowtodotheminthewomb.
Youwillbesurprisedhowmanyeveneliteathleteslosetheabilitytorollinonedirection.
Thisisamovementpatternthatonlyrequiresenoughstrengthtomoveactively,itisnota
strengtheningexercise(butitsurefeelslikeit!)Thedifficultycomesfromsequencingthe
movementproperly,firingthecorrectlineofmusclesinthepropersequence,andnot
usingyourlegsforupperbodyorassistingwithyourarmswiththelowerbodyrolling.
Iwouldexpectthosethatarenotrespondingtoyourmanualtherapyandselfcareprogram
havealackofthoracicmotorcontrolduetotheiroverrotationinfocusingmoreonone
direction.Iwouldbefairlycertainthatmanyofthemwillhavedifficultywithupperbody
rollinginatleastonedirection,notcheatingbyusingthelegs(theyshouldbedead
weight).Thismovementmayneedtobebrokendownwithwedgesorfoamrollersto
makeiteasiertogetthemovementdown.Donothavethempracticetheincorrect
movementiftheycannotdoitright,thatwouldjustbeenforcingpoormovementpatterns.
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Iftheyarealsomainlyrotatingtooneside,theirhipsaremostlikelymissingrotationtothe
otherside,checkforrotationactivelyandpassively,andmobilizeifbotharelimited.If
onlyactiveislimited,butnotpassive,againwehaveamotorcontrolissuethatneedstobe
addressedwithcorrectiveexercises.Letmeknowifyouneedexamplesofthose.
Ihopeyoufindthesesuggestionsusefulandletmeknowhowtherollingassessments
workout!

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