Training Equals Rehab*: My Movement Check-Up

Sometimes, I think the gray areas are great.

In this next installment in the ongoing diary of my “return to rehab” for my shoulder, I have officially entered a gray area. It’s that difficult to define space that exists between ‘traditional physical therapy (PT) exercises’ and ‘back to training’.

What I love about the place where I’m at now is that I have progressed past the kinds of “PT exercises” that so many circus folks are familiar with…but I’m still going to “physical therapy”.

[alert type=”info” close=”false”]*Of the various people whose teachings have inspired me to think about the idea of the Performance Continuum, Charlie Weingrof’s T=R series and concept plays an important role and inspired the title of this post.

Also, this is part three. If you happened to miss part one and part two, click away![/alert]

So where am I? What am I doing?

Admittedly, my story differs from the ‘usual’ in that I went to Champion without really having an injury, per se. I went because I wasn’t happy with how my body was functioning and I needed someone outside of myself to assess things and provide some guidance.

It’s a tricky thing, knowing some things about the body and performance. I feel pretty good about my skills as an observer of movement and designer of training plans…but I’m terrible at doing so for myself. Having an outside perspective—particularly from an expert—is so obviously helpful that it can easily be overlooked.

So just to be sure, I’ll say it now: If you haven’t been making significant progress with your training this year, get an outside opinion. See a physio for a movement check-up. And then, if your physio doesn’t do strength and conditioning training plans, get yourself a strength coach.

I’ve gotten ahead of myself:

My shoulder “rehab” has progressed to strength training…because that’s how it should always go.

There’s a really basic, really critical idea to appreciate here: Dan (that’s my physio’s name) started my treatment with some pretty basic stuff—“letters”—and pretty quickly, these exercises expanded my range of motion and reduced my pain.

To be really explicit here, that was one of the goals of my treatment: to get my shoulder “moving better”.

But, being able to move just the weight of my arm around isn’t exactly setting the bar very high.

So we progressed to making my arm stronger.

Now, my rotator cuff exercises involve weight. That’s right. No theraband for me.

And the goal is to progressively lift more weight to make my rotator cuff progressively stronger.

But wait…there’s more!

We moved beyond just rotator cuff strengthening and into the realm of functional strength!

It’s worth point out here that in addition to being a physical therapist, Dan is a strength coach. Actually, he’s also a Crossfit coach (and working with him is giving me a new perspective and appreciation of Crossfit…which might mean taking a new stance on Crossfit. But not kipping pull-ups. I still don’t like those). But, what’s most relevant here is that Dan (and the rest of the team at Champion) approaches rehabilitation—and in my case, movement optimization—with progression and periodization in mind.

What’s that you say? Periodization?

Briefly, this one ties in to an earlier post that featured “Strength Training for Circus 101”. Periodization is part of Strength Training for Circus 201: it’s the practice of strategically varying exercise volume and intensity over time in order to more effectively improve various qualities, such as maximal strength, strength endurance, power (rapid force production) and the ability to transfer and absorb force.

That’s all rather geeky—and not necessarily my point right now. The point of mentioning it is that physical therapy—especially for a circus artist-athlete (or any athlete, for that matter) exists as part of a larger continuum of performance. At first, your (fill in the blank with muscle or joint name) might need healing and then some low-level degree of strengthening. This is where therabands can be appropriate.

But then you get stronger…but not quite ‘full return to circus’ strong

So what comes next?

In the case of my shoulder adventure, what Dan prescribed next for me were landmine presses. And single-arm pulldowns. And dumbbell rows. And reverse crawls! (Not all at once—I have a workout A and a workout B and I alternate between them throughout the week).

[Videos go here on Tuesday]

Since I returned to legitimate strength training for my shoulders, it’s worth noting that a couple of things have gotten better:

  • That mild pain that was always there whenever I would demonstrate exercises on the floor for clients isn’t really there anymore.
  • I can pull things off the top shelf in the kitchen cabinets without pain.

I mention this because both of these could easily count as the kinds of improvements that one would hope for/expect from “physical therapy”…but they happened as a result of “strength training”…that was prescribed by a physical therapist who is also a strength coach.

Physical therapy—especially for a circus artist-athlete (or any athlete, for that matter) exists as part of a larger continuum of performance enhancement.

And then there’s my hip. (In case you forgot, my left hip was on my list of things that were beginning to bark at me in ways I knew they shouldn’t).

After assessing my hip (and my ankle), Dan asked me a question: is there anything that makes it feel good? This is where I rather sheepishly said: “Well, after I do single-leg deadlifts…and really, any sort of hip-dominant leg strength exercise my hip feels great.

Ah-ha.

So, Dan gave me one (sort-of) stretch to mobilize my hip capsule and encouraged me to continue the ankle mobility work I had started to do… and then prescribed some good ol’fashioned single-leg deadlifts. And reverse lunges. With dumbbells in hand.

I mentioned that in addition to being a physio, Dan is also a strength coach, right?

Funny story: after the first week of workouts, my hip didn’t hurt anymore. And when I remember to do my ankle mobility work (every morning now), I can squat nice and low and without my knee barking at me.

This lower body work has made my glutes and quads nice and sore, but my hip mobility has improved and I don’t miss the hip pain at all.

My hip, knee and ankle didn’t require any “treatment”, per se, because it seems like I just had “an acute case of weakness”…

The basic idea here is that sometimes (and by sometimes, I should be really, really clear that I mean “most of the time”), when it comes to “correcting” movement flaws, adding strength in the right places can make a big difference.

Sometimes—often—strength can be “corrective”

Now, I’m not actually a big fan of using the term “corrective” exercise because I feel like the word carries some baggage with it. However, when bodies (like mine or maybe yours) develop faulty movement patterns, those do need some work.

At the most basic level, when we first screen movement, those movements are occurring without any external loading. All you have to do is move your body around. Only gravity is really challenging you.

But get on an apparatus or try to do a particular skill…and suddenly your body is resisting forces and exerting forces. And that’s when things can get tricky. And sometimes painful.

Pain is, as I mentioned previously, a tricky thing.

Sometimes, doing a thing hurts.

Sometimes, doing that thing hurts because some part of you isn’t strong enough to maintain good alignment and joint positioning throughout the movement.

And sometimes, if you take the time to build up some good old fashioned functional strength, doing that thing doesn’t hurt anymore.

It is, I hope, obvious at this point that I strongly recommend that if you have the means and the access, you should get a movement check-up for yourself. Even if you’re not currently hurting. You know, just to make sure everything is moving well.

And then, if you’re not already engaged in the practice of lifting some weights to make yourself stronger, find yourself a strength coach.

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