Master Instructor Roundtable: Cervical Spine – Part II

Posted by National Academy of Sports Medicine

In the second half of this two-part series, Wendy Batts and Marty Miller review the most common compensations and provide corrective exercise techniques and programming to expand your knowledge when dealing with cervical spine compensation.
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TRANSCRIPT:
 
Marty Miller:
Hello, everybody and welcome to this week's "Master Instructor Roundtable." I'm Regional Master Instructor Marty Miller here with my fellow Regional Master instructor and dear friend Miss Wendy Batts. Wendy, how's everything going today?

Wendy Batts:
I am great. How are you?
 
Marty Miller:
Awesome, awesome. So today, Wendy, we are going to continue on that cervical spine. We reviewed Part One last week. So if you're new this week, and you're like, well, what happened in part one? Well, good news is you can go back and check it out. Go to any SMS, Facebook page or YouTube channel, we went through some awesome content. And that set us up here perfectly to move into Part Two today, where we're going to get into the compensations. But really some program designed around the importance of including these parts of your program when you're looking at cervical spine. And we really went through last time how important the cervical spine is and how it affects other parts of the body. And why Unfortunately, sometimes this kind of forgotten about. So Wendy, if you want to maybe give us some more tips and pointers on where we're heading today. And we'll get right into it.
 
Wendy Batts:
Sure, if we look at the the next slide, you can tell you exactly what we're going to discuss. And I think the main thing is, is doing a review of the knee and at the anatomy, we want to think about the key muscles that we need to focus on in order to correct movement imbalances, especially in the upper extremity. More specifically in the cervical spine, we are going to talk about the assessments that I think are the easiest way to identify these compensations. And Marty to your point, we often see it, but we just mainly see more of the forward head. But I think we really need to look a lot about rotation and lateral lateral rotation as well. So we are going to talk about some of the common movement impairments. And then we are going to give you two specific program designs one for the forehead, and another one a little bit for the rounded shoulders because it can affect what's happening at the cervical spine as well as in the neck muscles. So hopefully you will like today and you will find it very helpful.
 
Marty Miller:
Of course they will Wendy and then that's going to make them so want to go back and watch cervical spine part one, of course, always. So let's dig into the muscles. Why do you do you want to take us through the key muscles and why we even need to think about these muscles.
 
Wendy Batts: 
Sure. So you know we if you love the anatomy, we go more into this in the corrective exercise specialist, we covered obviously, to a certain extent in our certified personal trainer course. And it's important to know these muscles. But if you're not really familiar with the anatomy right now, and this is something that's newer to you Don't worry about it, you can just go by what you see in the movement impairments. If you see the forehead, if you see a rotation, these are the muscles that will be involved. But you can still work with somebody and fix their posture and get the head in the right position without having to know all of what these muscles do. But we would always encourage you to continue to think about these muscles continue to look into them, because then you will just get more specific with the compensations that you see. But as I said before, if you see the forehead, you see the rounded shoulders, these are the muscles that are going to be involved from an overactive standpoint here. And then we'll talk about the ones that deep cervical flexors would be the underactive and the mid trap, low trap.
 
Marty Miller:
But it all comes back to posture, we're always going to try to be resetting posture into neutral, the five kinetic chain checkpoints. But we do like to list these out, we're not going to cover them in specific, one by one we'll mention these muscles throughout. But like I said, Don't get caught up in the anatomy as much as the positioning of the body and getting people back to the proper ideal posture. And I think it's important to, you know, just remind you guys, we have that solutions table.
 
Wendy Batts:
So to Marty's point, we are going to talk about the assessment portion next. But if you're still not sure what to do exactly, just pull out that solutions table and allow it to help you, it will tell you what muscles, you're going to want to foam roll if it's in a position to foam roll, what muscles you need to stretch, then of course, what we need to strengthen. So it's you know, think about if it's overactive, it's still weak, if it's under active, it's weak. And so we're going to still have to work at trying to get proper movement throughout that that joint as well as you know, get proper alignment throughout the tissue. So therefore it's going to make you look better feel better and better. As I say every week. I remember way back when, when we were learning this to teach it you know, the anatomy can somewhat be a little intimidating. But the more you go to your solutions table, the more you use that. That is one of the best ways to learn the anatomy than just looking at the book and trying to memorize muscles, right because that's rote memorization. But when you see it three dimensionally, and you go back and find the solution disable To me, it was another easy way to start remembering all these muscles.

Marty Miller:
Yes. And I think too, if you memorize something, you're not really thinking about what it does. I mean, you can say, yeah, it starts here and it finishes here. But if you don't really look at what it's doing, because there are things that flex it, there are things that rotate it, there's things that are happening only on one side. And I think oftentimes people when they're looking at assessments, we think that if I'm so is overactive on the left, then we meet, we probably missed it on the right. And that's not always the case. So that's why it's very, very specific when we discuss the assessments next, that it's okay to identify if you're only seeing something on one side. And that is very, very common, I think, in the cervical spine.
 
Wendy Batts:
Yep, absolutely.

Marty Miller:
Moving forward. So, you know, a great, great slide, I'm sure when if you want to recap it, but you know, we both thought it was so important to put it back in what because unfortunately, this is what we're seeing, we're seeing this more and more walk into the gym, we're still seeing people doing this, while they're on a treadmill doing this while they're on some piece of cardio equipment, even checking in between reps to see if they got a text message or an email. And unfortunately, because most of us are, quote, still working from home, we're able to take our technology and our work with us, no matter what we're doing. And over time, you can start to see the amount of excess stress that we're having to put on our poor cervical spine by looking down so much, and looking specifically at our phones or looking at computers or just even being in that position for longer periods of time. And remember, compensations occur when you're continuously doing it over and over, and then your body thinks that's kind of the new norm. And so because it's going to take the path of least resistance, if a muscle is always overactive, and it's in a shortened position, and it's chronically that way, then our brain is going to be like, Well, you know what, we're just going to keep it that way. And then you're going to compensate in order to do whatever movement you're trying to do, even though you may not be using the correct muscle to do it. So and then, you know, we talked about this, when you sleep, very few people sleep with their neck in neutral, I like I said, I like to be a left side sleeper, for the most part. So again, I had to purposely try to train my body to sleep a little bit on both sides, I had to evaluate my pillows, but then we also go in the gym, and somehow people then feed into this position with the exercises they choose. So this is why it's so important to try to get people out of that position.
 
Wendy Batts:
Yes, and we talked so much about the five kinetic chain checkpoints. And if you look at this individual, even the one where it says 10 to 12 pounds, like it's not necessarily that this person, or this figure, which is the first one that you're seeing on the left, it's not something that is like there's a big difference between the top left and the bottom right. However, over time, the top left becomes the bottom right, because it happens over and over. So even if there's a slight compensation, that's why we always say you want to note it, because if not, it could get worse. And those compensations will exist. And if you can get yourself out of some of these positions, again, what I mean the amount of headaches and just tension, you know, stress that you're putting in your neck and everything. And guys, I met walking testament of how important it is to really take care of your cervical spine, you can easily when you're in this position, start to lose it lose the curvature of your neck, and then you're really going to have a lot of issues in your discs and the vertebrae. And you know all the surrounding muscles, and it is definitely not fun to deal with. Nope, no one. And again, we tried it in last week. But look what's happened already at the scapula right. So this isn't just the cervical spine, but that's why Part One was part one. That's right, and then what the scapula starting to get winged, then your shoulders not functioning right, and then it's gonna lock down even more of your neck and then when your shoulders aren't functioning right, your lower backs probably gonna have to do more, which is gonna affect your knee because your hips tell your knee what to do, but also does your ankle. So I mean, it's, it's a lot of us don't want to exercise and you gain 30 pounds, right? Oh, yes. Okay, that's that's, that's not a positive way of looking at this. So another reason why this is important.
 
Marty Miller:
Exactly. That's right. So let's talk about how to identify it. So if we look into the next couple slides, we are going to talk about shoulder mobility. And you know, when we think about shoulder mobility, and we think about the assessments, I think mobility is something because it's new. We don't talk about it enough. Now we have in the past really gone through uni using a goniometer. So remember the human protractor where we're measuring specific joints, and we're saying from ideal, where is this person and what can we do to make them more ideal and specific ranges of motion. And so if you haven't gone through the new CES content, I think It would be very, very beneficial for you to do so because this takes seconds, it's nothing that takes a lot of time. And either you put them in this position and they pass or they fail like that.
 
Wendy Batts:
Okay, move on to the other side, pass or fail done. So for example, you'll see the person in the pictures up above, they're doing shoulder flexion, they're laying on a table, they can lay on the floor, they can lay on a mat, whatever it is that you have available, they have no bend in the elbow, they keep it in line with their shoulder and can they successfully touch their whole arm to the floor to the table to the ground, whatever they're laying on without compensation, if they can, they pass. However, we also can say now that we look at the overhead squat, if their arms fell forward, then unfortunately, okay, arms falling forward, but they pass the mobility test, I think it's really important to stress that, then it's going to be the underactive muscles that are allowing that compensation more than the overactive that's restricting that joint. And I think that's the beauty of some of these mobility assessments. And I'm using shoulder flexion as the example. But the same thing with internal and external rotation, going through abduction, and then thoracic extension, and rotation, all of those assessments can tell you so much about what's going on in the upper extremity, and it can help just break it down even more specifically. And then you can compare what you saw on the transitional assessments with the mobility assessments to really design a very individualized program to help someone increase their mobility, and, you know, maybe even get out of some chronic pain that they've been feeling. Because, as you see, in that picture, there's a lot of discomfort that can happen in that position over time. And I think the important thing of since you brought just mobility assessments in general, is for years, we've been told, what if somebody can't do an overhead squat assessment, and we've worked around that most people can. But if you really do a series of mobility assessments, you're going to know pretty much what their overhead squat would look like. So the middle mobility assessments are another great way to have that tool in your arsenal, that in case you run into somebody that really doesn't want to do an overhead squat, or can't, you can start going body part by body part with the mobility assessments, and you're going to pretty much know what their overhead squat would look like. And oftentimes, if I'm doing, you know, these mobility assessments, and let's say, I'm doing them in a place where I can't have them lay down, or even if my client can't lay down for some reason, you can actually have this person stand up against a wall, their back completely flat with their heels, their glutes, their shoulders, their head, maintaining contact with the wall, and then having them go through these specific exercises, with the exception of the thoracic extension and rotation, of course, and you can say, pass or fail, because what we're really focusing on is what's happening at the hip complex? And are we getting that range of motion? To do it in our arms, but we're sacrificing what's happening at the hips? And is there some kind of movement? Or if they bring their hands, for example, overhead? Do they kind of go out into more of the scapular plane in motion, because they don't have the extensibility in their lap, if they do any of those things, or bend the elbow or the arm just they just can't do it. All of those are, quote, fail, which means they can't, which will allow you again, to determine what's happening at that specific joint and what you can do to best fix it.
 
Marty Miller:
Yep, absolutely no, very well explained. And this is why, you know, we really want to make sure that people feel comfortable with these, because there's such a great tool, and it really helps you then communicate to your client tell on why you're choosing those exercises or programming that you are. So it's just it's another great way to, you know, solidify that you have an idea of what is going on, and you can fix it. And here's why. And again, take seconds, it's not anything that takes a while, like what the goniometer still love it. still love it, because I use it. And if you don't have that practice, under your belt, it takes a long, not a long time, but it takes time. You've got to get to the position, have the client hold it, get the right measurement, write that down. versus when do this, do this, do this. Yes, no. Yes, no. Okay, let's move on. So, and I think you know, it's important. I know, we kind of went out of order, but I wanted to talk about and I know you did, as well, Marty, we wanted to talk about the mobility first. So now when we can talk about the ones that were more comfortable with, which are the transit, you know, the transitional assessments that you're seeing here, there's other ways that once you get that you can be done. Or if you want to add those other ones in, it's just a little deeper dive. But of course, these are going to be your initial assessments that you do.

Wendy Batts:
Absolutely. So again, we're always going to talk about the importance of assessments when you hear from any of us but Wendy and I we're gonna definitely belabor the point that we're going to do all these assessments because it's just such value in every exercise, every rep, every set is an assessment, but we want to see where they're starting so that way we can create the best program for them.
 
Marty Miller:
Yes, and you know, overhead squat, if somebody can't do it, do the push, pull, look for other things like you can see this person on the bottom right? She's elevating big time, big time. And so you know, maybe you miss that during the overhead squat. And so I think, doing push pool, I don't really make them an assessment, I may have them just teaching them how to do proper movement mechanics. And I want to see how they move. One of the first exercises, I may put them on as long as they can, you know, stand and the correct position is maybe a staggered stance, chest press on the cable. Again, that's a pushing assessment, I'm just seeing how does their body react? So I'm giving them an exercise doing something they like. However, I'm still assessing, even though I'm not saying I'm doing an assessment, and the same thing with the pool, I think the pool or the row tells me so much information, because I can see can they get into depression retraction? Are they spinning up the shoulder? Do they increase internal rotation? What's happening at the neck? And how far back? Are they going? Do they elevate is one side going back further? So just little things like that? Remember, every exercise and every movement that occurs at like, during that time with you or at the gym? You should always be assessing? Because if we're not assessing, we are
guessing.

Wendy Batts:
Moving on. So now you have obviously the mobility assessments that we talked about specifically with the shoulder itself. We're going to now talk a lot about the cervical mobility assessments. And Marty, I think these are so underutilized. We say often, you know, what, in the transitional movements, do you have a forward neck? Do you are your arms falling down? Do you round your shoulders? Yeah. Okay.
 
Marty Miller:
Yeah, well, and interesting. You know, last week, we both talked about our issues. There's so many, but you got to go back last week to wash up. But I remember probably what beginning of the year, we were out in Arizona, and I was having some, like, a little spasm in my left rhomboid area. And I knew it wasn't like, just let me foam roll and try to work that out. But because you know, it's always easier when somebody else has an assessment, you looked at me quick, you looked at my neck rotation, we looked at a couple things, it was all coming from my cervical, I was tight on my left side, which was causing problems in my shoulder, and my movement, and my rhomboid was feeling the wear and tear of it. So as soon as I adjusted fix my corrective exercise program, no issues, right. So I don't you don't have to live sometimes with these chronic like minor aches and pains. We're out here to treat injuries. But you know, just that nagging like yeah, my left this or my right that. So again, there's so many people have such a lack of range of motion and good control in their cervical spine. And then we are going into exercise that feed into it like the plank where their head falls off in a sense, or the crunches where they're yanking on their cervical spine, then the way they sleep and the way they're sitting at their computer. And then we wonder why when we do the assessments like oh, my God, you have like a third of the range of motion, you should. So these are very easy to do. You can see this person here just sitting in the chair. And we have all the specifics on how to in our content. But to get somebody to go, you know, into cervical extension, cervical flexion, very easy. You don't have to be overly skilled with the range of motion and the percentages because it's it's very simple, right? Can they tuck their chin to their chest? Can they look straight above the up towards the ceiling. And then when you look at the lateral flexion, everybody knows 45 degrees. So thank goodness, that's the normal range of motion. Right? And then with the rotation, it's can they get their chin without all these body parts moving over the opposite shoulder? There's some nuances to it because people will rotate and cheat and sometimes you'll miss a little bit. But these to me, Wendy are pretty glaring with the past fails. Yes. And one one that I think is pretty funny is the lateral flexion. I do this all the time with my clients. And I usually use my hand as a point to because it allows me to kind of dictate that if I put my hand here, I kind of know someone's head and I can say Does it hurt your touched my hand? That's, that's more of a cue to say, Can you do that? If they can't, most of the time, they're like, look how far I can go when there's like eyes are completely looking at the ceiling. They're doing everything they can to try to hit that specific point. And you're going to cue them you're going to do whatever you want to do that's going to best give you the results that you're looking for. And just know that I would say 90% of my clients will fail a majority of these just because they are so locked up in in their cervical spine or their shoulder or something that's causing the decrease in lack, or a decrease in range of motion. So very useful, very helpful. Yes. And that's what I like doing them in a seated position because I always see like the I'm a little teapot thing where people like, they're trying to get their ear down their whole body's going. So putting them in a chair just really takes out the hips and has less ability for them to compensate. But I would tend to say, Wendy, even with my athletic population, I'd say over 70% fail the majority of these higher.
 
Wendy Batts:
Oh, absolutely. And when you tell them that they've you know, like, again, you're not saying, oh, fail, but you know, some sometimes, yes, you're not going to have ideal range of motion. Yes. So when Marty and I are casually talking about this, we want to teach you how quick this can be done. But remember, your rapport building skills throughout all this? Don't be like it's a big fat fail. I say that to you guys. Meaning I say that to Marty and Ken joking around sometimes when they're like, hey, on the mobility, what do you think? I'm like, No. Do you guys know, but we've also have a relationship for over 20 years, so I feel comfortable being able to be like, you know, nope. And then you do the same for me. I mean, my walk and Marty's like, what is your foot doing? And like what's attached, and he's like, going the wrong direction, fix that. And so you need to have people and like, Look at yourself, because there are things that to Marty's point, he didn't realize that he might have you know, that he was kind of locked up in certain areas. And I was going through some basic mobility assessments and basic range of motion that he wasn't able to do, we were able to really pinpoint what he could do to help correct some of his issues. And it took like two days to feel a difference. I mean, that's the crazy, I mean, the first session, you know, you're on the right track, but two, three days, and then again, doing the whole model. I was like, boom, I'm back. Like, that's the beauty of it, if you catch it early, yes. Because if not, you have to get an MRI and they'll tell you what, you're going to have a distant blows, and you need to get surgery, and then you're going to say, No, I'm not going to get surgery, I'm going to try to do some corrective exercise first, and then you're going to show them that you didn't need surgery. And all as well see, look, back to go back to
one. And you'll know that story.
 
Marty Miller:
Yes. But remember, these are going to be the muscles that we talked about in the first few slides when we're talking about the specific muscles. And so if you do see any kind of deviation from ideal, whether you're doing the mobility assessments, whether you're doing the movement assessments, just keep in mind that there are going to be muscles that are causing those compensations. So we say those are the shortened muscles, and then the lengthen muscles are going to allow those compensations. So when you see shortened, that means that you're going to want to roll or do some kind of self myofascial technique. And then you're going to statically, stretch them to try to increase proper range of motion. And then you're going to think of what was on the other side of that. And then you're going to do some very easy activation exercises to try to get it to reengage to do what it was meant to do in the first place.

Wendy Battis:
Yeah, and that's the whole, the most important thing is I think that identify what you need to focus on, but do it in its entirety. And what I mean by that is, if you need to just work on the mobility, you're good. If you need to work more on activation, that's great. But if you need both, you're not going to get as good of outcome if you only do one of the four steps. And that's the beauty is with the mobility, you're going to kind of be able to determine where your time is best spent. Mine was more of a mobility issue than it was an activation. Now again, if I have lack of mobility, I guarantee you there is a weakness. But as soon as I increase that range of motion, get back in good posture, I'm going to be activating those muscles anyway. So that's why the correct that's why both Wednesday night We do this because we love the model, because it truly has changed our career. Because it gives us that blueprint and Tez and you will be different, you will be different and people are like well, I you know, other people aren't doing that. That's okay, be different. And I like to be different, because I'm going to also get results, that's going to lead to positive testimonials. And there's going to be coming back. So I'm going to build my business because I'm different. And I'm only different because I care and I'm looking at what is with their body in comparison to what I read in a magazine, which is the exercise of the day. So just remember that there are specific things that are causing certain compensations, find out what those compensations are, review this again, take a screenshot of this slide and you're going to be able to help someone feel and move so much better, especially if they're having constant headaches.

Marty Miller:
Absolutely. And that's where if you get people's head and neck moving Well, there's so many they're awesome things that they're going to be able to do down the line. Yes, thoracic mobility is what you're looking for cervical, and lumbar stability are what you're looking for. So if you've got a lot of mobility in places you need stability there are going to be multiple issues that will be the ripple effect.

Wendy Batts:
Absolutely.

Marty Miller:
Moving forward, if we look at now, some of the differences when we're talking about the programming now that we've kind of talked about what you're seeing here and the results, we're gonna talk about the forward head first. So when we say forward head, remember, when you're looking at the five kinetic chain checkpoints from the lateral view, your ear, your shoulder, your hip, your knee, and your ankle should be in one straight line, if you see the head, even if it's slightly forward, but it's not ideal.
 
Wendy Batts:
And remember, if they've got rounded shoulders, you don't want your and filter to be in line you want to say from if I drew a straight line, you would go all the way down from joint to joint that I just rattled off, not making a C, you know, like, you've got your your ear and your shoulder and then you come back to normal and then it flares off and does something or maybe even a bad s. So just think about that. And then Marty, do you want to kind of take us through some of some of the four step process, if you will?
 
Marty Miller:
Yes. So what do you see the forehead Now let's talk about the inhibit. When we're looking at cervical spine, we're not saying grab a foam roller and roll your neck around on it or softball things like that, right? There is and we go through all this in all of our content, the the do's and don'ts, or you can say are the indications contraindications. So with the cervical spine, you're obviously gonna be careful. So myself and Wendy, we have a touch license ours are different. I'm an athletic trainer. So there's a scope of practice that I'm allowed to do Wendy being a massage therapist, manual therapists, her scope of practice is different fitness, there's no scope of practice for touching the soft tissue and manipulating it. But we still want you to learn how to inhibit, there are techniques with foam rollers, softball, tennis ball, the vibration techniques with like the hyper volt and things like that. But don't just grab it and play with it, make sure you truly have studied it and understand what you can and can't do. So going past that with the inhibit. Sometimes I've always had to send people to massage therapist because their neck is so tight, that I don't feel comfortable teaching them how to do it themselves. And I say, Hey, here's what you need for your best outcome, whether you choose to get a massage or not. That's, I'm just here to tell you how to get your best outcomes. So with that being said, I'm sure when I turn it back over to Wendy, she may have some tips and things like that as well. And all that is in our text, so you'll have access to that you can review that again. But when we look at the lengthening, I truly believe these muscles are ignored. I rarely see people doing neck range of motion. In any fitness center, you might see it in more physical therapy. On occasion, I do see it in the gym, and I'm like, Dear God, they're trying to break their neck off. Where these are gentle, these are not forceful stretches because of the region of the body we're looking into, we're gonna glide in and glide out of these. But the levator scapula is a very important muscle. It's one of these muscles is runs deep in the side of the neck. It elevates your scapula, and it's one of those muscles that gets very overactive and can cause they have a forehead position, upper trap, this is one of the muscles that people like to train, I train muscles that are under active or have good symmetry, I'm not going to strengthen a muscle that's already overactive. So if I see somebody where their natural tendency is to elevate their shoulders, that's telling me the upper trap is plenty strong. Yes, people like to do shrugs and upright rows, but those are not exercises you're gonna see myself and when you do when somebody already in that forward head or that shoulder elevated position sternocleidomastoid we just shorten it to scms. That big muscle I think you call it the big honker muscle in the front of your neck is the one you can grab. I call it the E t muscle because I'm a child of the 80s it's the one that pulls our head forward. But that's the muscle that is always drawing our head forward. So it's going to be overactive. The pec minor is another muscle lies deep under the PEC major that has that ability to pull and draw my head forward. And then there's a lack of thoracic spine extension and rotation. So these that are areas of the body in the muscle that we need to down regulate a little bit.

Wendy Batts:
So we do it with soft tissue work and then the static stretching and then we flip the script and we look at what so those are the muscles causing the bad motion. And then we look at what's allowing it so what's allowing it are the ones that are underactive, that need to kind of wake up a little bit. So these are the deep cervical flexors. So it's the flexor colon flexor capitas. So it's anytime you're doing that Shin tuck position, whether I'm just standing a good posture, why do my biceps or my triceps or from truly doing chin tucks against the wall around the floor and then the cervical erector spine a band resistant cervical retraction, so a lot of people put a very light band. They'll just do chin tucks, they're not doing the weighted exercises like you see the football players do. That's a different conversation for a different time. But these are some things that you can do. And again, it's very soft, very gentle. I even have people do positional isometrics. But if you do a plank well, and you keep your head and neck in the right position, guess what you're doing all those activation exercises right there. So there's a lot of cool ways to do it. And then to wrap this part up the integration, Cobras, bird dogs pushing and pulling and pressing the ball squat, of course, we have curled overhead press, but the one we always would also put in there if you know us squat row. But anything where I keep my head and neck in the right position, I'm getting that activation of the proper muscles. But we do want to start first with the inhibited lengthened, so those other muscles have a better chance of being recruited.

Marty Miller:
So then I see nicely done Barney, compact, short to the point, I like it. Well then if we look at the next one, we talked about the rounded and forward shoulder program, oftentimes, we need to remember that when you have rounded shoulders, or if they're forward, then it is going to affect what's happening at the neck. And so when you think about if you round your neck, or your your shoulders forward, but you even have good neck posture, you can even feel yourself kind of elevate. And as well as what's happening here to that sternocleidomastoid, or my big honker muscle.
 
Wendy Batts:
And the reason why it can affect all that is because it attaches to your sternum, your clavicle and your mastoid behind your ear. And so it really does when you think about the positioning of that and all his origin and insertion a can affect what's happening when there is round, like rounded shoulders. Plus, if I don't have good range of motion throughout my shoulder capsule, it can lock down some of those muscles that I need in order to properly move them as well as what's happening in the lengthened position of the the muscles in my neck. And so when we think about inhibiting, to your point, Marty, when you're using some sort of self myofascial technique, make sure it's smart, you know, you don't want to vibrate, you know, or put something around a muscle that's really close to a vertebrae and you're constantly hitting that vertebrae, some of those machines out there, you're strong enough to chip a bone. So like if you're using the deep muscle stimulator known as the DMS, that one can ship a bone, the hypervolt and the theragun are more forgiving, however, just be smart.
 
Marty Miller:
Plus, think about To me, it rattles my brain too much. I don't do any kind of vibration in the in the cervical spine because I already feel like I'm going to go nuts, I don't like that feeling personally. So manual therapy or something like that, to your point a way to really, you know, get some of those over active muscles in the neck to relax.
 
Wendy Batts:
I think that's an awesome idea. And pec minor, a major Of course, he would go in through inhibiting and then lengthening as well as the lats. So remember, because the lats, a started the lower back and they attach in the upper portion of your shoulder, it can put you into that rounded shoulder position. So the lats are a really important area to lengthen or inhibit and then lengthen. And then to your point, Marty, why we have more of the thoracic spine mobility, we're really looking at more inhibition, because it's in a lengthened position, we need to down regulate some of those muscles. And then also just by going forward and back nice and easily, you're trying to allow your spine to get into more flexion and extension. Because with rounded shoulders, you're stuck in that position. So you're losing the mobility and the integrity that the thoracic spine is supposed to have with with motion. And so that's why that's in there. And the same thing with rotation and trying to get a little bit more movement.

Marty Miller:
Of course, as you work on the overactive or active muscles, we really want to focus on the muscles that were in the lengthened position the other side of the joint. And so it's very important to activate those muscles, we're using a very slow tempo, so more of a four to one type tempo. Or if you're looking at the new textbook, we can say four to one zero. And because we have the four point or four count now in your repetition ranges, but you're going to do something like the ball combo one, you're trying to work on the complete and you know your better range of motion throughout your rotator cuff. That is an unbelievable exercise to do. If someone cannot hold themselves in a prone position. So face down while on a ball, then have them standing, just bend at the hips a little bit. So they're still fighting gravity go through the motion until they work their core and they start to be able to maintain the five kinetic chain checkpoints and then eventually get them down onto the ball doing it that way. Shoulder external rotators if you're in that right deposition, think about the positioning of your external rotators. So doing the band resistant clock pattern, we've talked about this in previous webinars, and we both think it's a unbelievable exercise. But it's basically where you take a mini band that you would do like lateral toolbox, and you would have your hands, pretty much shoulder with the part to start and then you just do a clock pattern. So left hand would go to 12 o'clock, and then nine o'clock, and then six o'clock. And you could do the same thing, you know, going 12 to three, or whatever, whatever number you want to go to, but you're trying to just very light resistance, trying to get your, you know, freedom. So the degrees of freedom back into the shoulder, which will also allow your clavicle to move the way that it's meant to move and rotate, it'll allow, like you talked about the levator scapula, remember, that attaches to the first two ribs. So your diaphragm is going to, you know, also play a big role and be affected with this particular compensation. So, you know, think about doing the external rotation at 90 degrees. So with the cable, just bring it out at 90 or you can even come up this way at 90 depending on compensation.

Wendy Batts:
And last but not least integrate, put it all together Marty number one squats a row, I didn't put it on the other program, because we knew we had it here. I know. But adding the push up with the Plus, we talked about the importance of the plus last week and part one. But remember, we're really trying to get the serratus to to start to activate again. That's one of the primary muscles that become underactive when you've got the wings. So when the shoulder blades come up off the rib cage, so anytime you're just doing a push a little bit of a plus, give it a little more love, make sure when you do that you don't go into spinal flexion. And then the last one that we have last but not least a single leg cable. So again, single leg cable D one pattern. And when we talk about D one, D two, I don't even know you know, it's more diagonal, one diagonal two, but it's almost like you're making an X. So you're going one way would be like D one going another way with D two. And so you think about you're just doing one side of an X when you're going through that and really working through the range of motion going into the scapula plane and then down as well. So, Marty, I don't know if people often say, well, what's this D one thing? That's how I explained it. I don't know if you have a better way?
 
Marty Miller:
No, it's just when we when we will look at the shoulder, it's a ball and socket joint. And we're looking for the ability for it to rotate in all three planes of motion. So I just I just look at it is functional way the shoulders designed to move. So I'm going from internal rotation to extra rotation or extra rotation into internal rotation. So the way that the glenohumeral joint works with the scapula and stable neck, it's just an awesome pattern, I put in the PMF patterns into my shoulder program, almost every single time some version of it.

Wendy Batts:
It's not loaded heavy, you know, I may have the ability to do a little more load than others because I do it so frequently. But maybe a seven and a half pound weight for me and I have worked on these for years. So I have people just do it with the range of motion just with their body weight, just to get that movement patterning, it's almost like a isn't the right term, but a gliding or flossing type of motion where you're just getting that patterning because our bodies not supposed to kind of just work in one plane of motion. You know, there are parts of the body but rarely. I know, right?

Marty Miller:
I love the PNF or deewan patterning myself, it's just it's always been something because I really like as I come down, I have to essentially chicken roll myself. And then I'm getting into extra rotation, right. That's the way I want my body to produce and reduce for so I am a big fan. Maybe it's because of my baseball days, but a big fan of the patterning. I use bands, dumbbells all kinds of just bodyweight alone. And that can be plenty.

Wendy Batts:
Great point. There, we have a bail available range of motion. So and just remember as you're going up, try to think bring your thumbs up as well. So thumbs up when you're coming up because you want to open up and not go if you're going thumbs down, you would put yourself into internal rotation, which would cause impingement. And it does not feel great. Plus, it's going to limit your range of motion. And if you have forward rounded shoulders, you're putting yourself into that compensation you're trying to train out up. Yeah, so just really important to always think thumbs up and it's going to be safer, unless you know somebody meaning a doctor will tell you otherwise. But in my career, that's never never been the case. And I think the only other point to that is I always tell people think about pulling out a sword because you want to get away from your body. Some people come real close. And it's generally because the weight is too heavy if they're using weight so it's out some if you have a sword, you can't pull it straight out. You have to draw it out away from you. And that's the patterning that we're looking at.

Marty Miller:
For us, I like it, be the warrior be the hero.

Wendy Batts:
So it brings us to our key takeaways. Shocking. But assessment. Number one, I'm so surprised, I don't know, assessments are key. If you're not assessing, you're guessing we will say that every single time because it is that important. Guys, you can train somebody all day long, if they come in, and they're just they have discomfort, they have compensations. And you don't really focus on those, and you're just doing the basic biceps, triceps, leg, chest back, you know, do crunch for five minutes, and then they're out the door, you really are not helping someone, you're not going to, they're not going to reach their goals, they're going to probably stay and, you know, some sort of pain. And again, I'm not trying to say that we can alleviate pain, we're not doctors, however, if we noticed a compensation, and we can train and cue them out of that they're probably if especially if it's compression of like the vertebrae, you can get yourself lined up, right, probably going to get themselves out of pain on their own. And all we did was stretch and activate and then put everything back together with the integration component. So I think that that's one of the reasons I can't stress it enough. If you're really if you're new to this, spend more time on the assessments, start to identify it practice on the friends practice on family, practice on everyone, because you can just have them keep doing it until you see it. And they're a lot more forgiving than when you have a client say, Can you do that? Again? They're gonna be like, No, I just did 30 squats, what do you mean, do it again, you're going to focus, of course, what's causing and allowing those compensations. And then take that sheet where all the notes are designed programs, you can use the program's examples that Marty and I just gave you, there are still some other examples in the new CES content. When we were looking at the mobility stuff, there are specific exercises that you're probably going to find very, very useful. And then, you know, just understand that the CES can be implemented as the extended warm up in any of the phases that you're doing. Just make it specific for that client. And then if you want to add a few more things in the integration component, to prepare them more successfully for that phase of training, that would be the time to do so.

Marty Miller:
And then clearly, finally, use both parts of the model and I use the CES every day. I think it's it built my business. I said that even on the Facebook page, somebody said Well, what do you think either this or this? And I'm like, I love both because it was between two I mean, and yes, I worked for an ASM but I believe an ASM blew y'all like I do it because it works. And in all reality, I think the CES is what was making me different. Remember, I like to be different, but it was it was something that was more of my niche. I could fix people and I only fixed them by being able to do assessments, and then doing something with those assessments that lead to really good results. So very, very big fantasy.
 
Wendy Batts:
Yes. Agree. Agreed. So if you want to find us, you can email me at wendy
dot batts@nasf.org. Or you can find me on Instagram at Wendy dot batts13.
 
Marty Miller:
And then my information is right there. Marty Miller at nAsm dot O R G and Instagram is Dr. Marty Miller seven, two. So Wendy, always a pleasure. I know we got some great content coming out next week as well. So everyone that joined in today, thank you so much. Go back and check out part one and check us out next Thursday. 3pm
 
 

 

 
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