Here’s a great case of a wide ISA with a lot of compressive compensatory strategy to overcome.
From Tommy:
I’m a wide ISA individual who through years of hard exercise and too many extension based activities got pretty deep into the compensatory patterns. I’m limited in hip & shoulder ER & IR measurements and have difficulties turning. I’ve made some good progress (special thanks to the camporini deadlift), but I’m still dealing with an inability to get dorsal rostral expansion and the muscles at my upper back/neck constantly feel engaged. I’ve tried the “Terry project” move for dorsal rostral expansion but struggle to find success there because my shoulders want to immediately hike up. Lastly, my camporini angle (between the clavicle and scapula is way less than 60 degrees). I’ve tried the manual intervention that you posted to youtube on 12/13/2019, but that causes numbness and tingling down my arm and to my fingers in little time. Curious to get your thoughts as to where this leads me. Would it be wise to focus working from the bottom-up, or try to push through with dorsal rostral specific activities?
Bill Hartman’s Weekly Q & A for the 16% – December 8, 2019: https://youtu.be/dvAufow_1Fg
The QB Docs Podcast with Drew Kiel and Bill Hartman: https://youtu.be/hNmwdAo-k-E
The IFAST Podcast #6 with Mike Robertson and Bill Hartman – Our Client Foundation: https://youtu.be/Y4kmtvla6ZM
Manual Therapy – Mobilization to Increase Shoulder Flexion and Cervical Rotation: https://youtu.be/WgfF-EfEPsM
This week on Instagram (@billhartmanpt):
Treatment sequencing
The Terry Project
Thorax shape and shoulder external rotation/shoulder internal rotation
The QB Doc Podcast Highlights
Videos for The 16%
This week’s questions:
When squatting, what do you believe the risk/reward is for oly shoes or some sort of heel lift. I know the obvious benefits/risks but in you’re opinion, which outweighs the other? Does it put that much more stress on your knees? Does it allow you to stack your pelvis better? Hip IR?
How would you approach working with a patient that was diagnosed with a condition related to central sensitization such as fibromyalgia or complex regional pain syndrome? Are there any specific compensatory strategies you have found to drive central sensitization (or what we may perceive to be central sensitization)?
For a wide ISA individual trying to regain his/her squat pattern, what progressions do you use after goblet/kettlebell/zercher squats? In light of Mike Robertson’s complete coach course I think the safety squat bar will be a good squat progression – allowing you to load the squat pattern and keep posterior thorax open for expansion. Do you use the safety squat bar much to load/progress the squat pattern?
How do you determine if a proxy measure of the extremity is pathological (ex. ligamentous laxity, capsular instability)? On the opposite end, how would you determine a true tissue extensibility limitation assuming you’ve maximized axial position and respiratory variability? How would you treat these two presentations differently?
Piggy-backing off last week’s question, what tests or measures do you apply to determine whether the elbow is oriented towards ER/pronation or IR/supination?
From a practical standpoint, what would be do with a narrow campo angle vs. a wide campo angle? I understand that it is a representation of the superficial helical angle that compresses the underlying axial helices, but how does it actually change our approach to gaining more variability or more performance?
Why might we use rolling activities for a wide infrasternal angle and quadruped activities for a narrow infrasternal angle ? Can you give an example of an activity for both scenarios?
So with respect to internal pressure of the guts and diaphragm with high rate of force production in say a high box jump. You’d want a diaphragm that can concentrically yield and concentrically overcome very quickly?
Please, please, please elaborate on how getting into a cut is “ER” and out of a cut is “IR”. In my myopic, acetabulum on femur way of looking at things, it seems as if “loading” should be acetabulum on femur IR and “exploding” should be the reverse. Thanks for all the content!
In the heterarchy of treatment, I rarely do manual therapies as my first line of intervention.
Patients and clients always achieve more when they can create changes themselves and learn self-management. When a local influence is needed that the client cannot produce themselves, then manual therapy may be useful to create an opportunity to make the change easier for the client to accomplish.
The triangle formed by the clavicle and the scapula with the acromion as the apex (affectionately referred to as The Camporini Angle which we named after my current Padawan) can represent the degree of compressive strategy applied to the upper thorax by the superficial musculature.
If the dorsal-rostral thorax is compressed, this will limit the client’s ability to complete true shoulder flexion and to recapture lower cervical rotation. This is a very easy, gentle scapular mobilization that reduces the compressive strategy, expands The Camporini Angle and restores shoulder flexion as well as lower cervical rotation.
