Monday, October 29, 2007

Physical Therapy Summary

Thursday I met with the physical therapist.  45 minutes with him revealed a specific diagnosis and set the stage for developing a good treatment plan.  Here is what I am working with:

DIAGNOSIS
My pelvis is in a constant state of anterior tilt, which forces my lumbar back into exaggerated lordosis.  Essentially, I stick my butt out and then arch my back to compensate for it.  Since I am not a playboy bunny, this is a bad thing.

This problem is associated with three muscular dysfunctions:

1. The hip flexors, especially on my right hip, are overly tight
2. The abdominal muscles on the front of my stomach are weak and overstretched
3. My posterior chain (spinal erectors and hip extensors) is in a constant state of contraction to compensate

As a result, I am unable to achieve a posterior pelvic tilt in the standing position

CAUSE
I think the root cause is my misapplication of the standard advice to avoid rounding the back when lifting.  I have interpreted that as "allowing a posterior pelvic tilt at any time is a terrible thing to do and should be avoided at all costs".  I think that has allowed the other problems to manifest, but addressing those problems without fixing my postural patterns will do no good.

The physical therapist also pointed out during my snatch sets I am risking serious injury by misapplication of the "no rounded back" advice.  As the kettlebell leaves my hips, I hyperextend my spine to "thrust with the hips", since the actual thrust I should be performing requires full hip extension, but I am incapable of it due to the tight hip flexors.

TREATMENT
The biggest key to resolving this problem is appropriately aligning my posture with the demands of the movements I perform. When standing or lifting weights from the waist up, it is ok to have some posterior pelvic tilt.  My butt should be underneath my torso, supporting my weight, not behind me.  The advice to strongly arch the back is only valid when pulling from the ground or performing a deep squat.  Even then, it should not be excessive.

In addition, I need to focus on strengthening my abdominals with crunches and stretching my hip flexors.  My total avoidance of direct ab work has been misguided.  It is actually necessary in a situation like mine, to help counter the pull of the tight hip flexors and allow my body to achieve a proper resting position.  

While I was trying to stretch the hip flexors before, the physical therapist pointed out to me that I actually was not.  Over the past 10 months my "hip flexor" stretches have been poorly executed and primarily stretched my abdominals.  This is exactly what I don't need.  In order to properly stretch the hip flexors, I have to keep my abs and glutes tight while performing the movements.  That nuance was lost upon me and really emphasizes the importance of working hands on with an expert.

RESULTS
I met with the therapist on Thursday.  It took 45 minutes and cost me $60 for a car rental.  The results so far:

1. By the conclusion of the session Thursday, my right shoulder was sitting considerably better.

2. Friday I focused on walking with my spine in a neutral position.  Over the course of the day a tremendous amount of tension was release from my lower back.  It was painful, but also felt really good.  My shoulder continued sitting better.  My abs were straining the entire day, just from the simple effort of holding neutral spine.

3. Saturday I walked 3.5 miles and focused on maintaining the appropriate tilt in my hips.  Every single step put a stretch on my right hip flexor.  The right hip flexor is much tighter than the left, which flags it as the most likely imbalance causing my foot to externally rotate on deadlifts.

4. Sunday I walked 5 miles, getting the same stretch.  Interestingly, the pump on the right side of my back that typically follows such a long walk was completely absent.  I also lifted, experiencing no loss of strength from the altered posture.  Making time for the crunches highlighted just how weak my abs are.

In just 4 days my body is feeling considerably better.  Prolonged application of this lesson will definitely reduce my risk for injury and improve my performance.  I should have gone much sooner and am very happy to have invested the time when I did.  In addition to improving my deadlift and reducing the risk of back injury, I think this could be the missing link for full recovery of my shoulder.