The Foam Rolling Knee, Back, Hips, Shoulder Pain thread

Discussion in 'Fitness & Nutrition Archives' started by fatmoocow, Feb 18, 2010.

  1. fatmoocow

    fatmoocow bored OT Supporter

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    Major update 1/15/11

    Alright, since I've been doing a whole butt load of this shit, and virtually everyone has the same problems, we're going to cover how to fix you up.

    First off this should cover 80% of guys who do lots of sitting in front of computers (all of OT) or who do too much bench (all guys who go to the gym), but ideally you need to go to a real trainer who knows what the fuck they are talking about to diagnose your specific problems. The PT at your chain gym or your average physical therapist is not going to do it. We'll cover how to find these people at the end. 4 weeks of this work has made a 90% decrease in my shoulder pain.

    The basic diagnosis for most dudes is something like this:

    If you're like most guys who've done 3 chest movements for every back movement, your chest is tight, shoulders are pulled forward. When you relax and face a mirror your palms face towards your back rather than your sides.

    If you sit all day for several years you generally end up with short hamstrings, weak glutes, tight hip flexors, and to much flex in the lower back rather than hips. This causes anterior pelvic tilt (your ass sticks out) back pain, knee pain, hip pain, etc. because you use hamstrings, quads, and your lower back to do work that your glutes should be doing. Trying to stretch the back or directly treat the area that hurts generally doesn't work, because the problem is more systemic.

    So how do you fix this? You stretch all the stuff that's tight and strengthen all the stuff that's weak. The key thing to understand with a lot of these movements is that you are fixing your brain as much, if not more, than you are fixing your body. You need to learn to use your glutes more than you need to strengthen them. This requires you to concentrate on perfect form and squeezing the right muscles. Slowing down will also help. Do a 3 count on eccentric movements, and even slowing the concentric will help you focus.

    Step 1: Foam Rolling

    Go get a foam roller. You can get them at walmart next to the yoga shit or get one online http://su.pr/2UThDL When you first try your foam roller you will think it's too hard. It's not. You'll also need a tennis ball.

    On a daily basis or at least as part of your warmup for each workout

    - Roll your feet on a tennis ball for 30 seconds each. Push down, don't be a pussy about it.
    - Do the same with your calves. Sit on the ground roll your calves on the tennis ball, reposition the ball as needed.
    - Foam roll the IT band
    - Foam roll the piriformis
    - Foam roll the quads
    - Foam roll/run a rolling pin on the hams (rolling pin is easier to get at)
    - Foam roll the scapula

    http://www.youtube.com/watch?v=8caF1Keg2XU&feature=player_embedded

    As you work your way up you can move on to pvc pipe and from large to small.

    Step 2: Dynamic Warmup routine - Do this before every workout. It will prevent injury and start moving things in the right direction. Doing a warmup and foam rolling will add 20 minutes to your routine, but it's worth it. If you do nothing else do this.

    - Glute bridges
    - Side leg lifts
    - front leg lifts
    - groiners
    - scapula wall slides
    - finger wall slides
    - pushup plus
    - quad stretch


    Step 3: Routine changes

    Most of you are probably doing some sort of split routine. I can post up a full routine dedicated to just this, but first we'll cover some basic changes to make to your existing workouts.

    Chest to back ratio: You back is way more complex than your chest. You should be doing twice as much back work as bench and that's if nothing is wrong. If your shoulder's hurt when you press or incline bench. Stop doing it. Don't think of the back in terms of just rows or pull downs. You need to work all three sets of traps as well as the rear delt, lats, and rotator cuff. Moving the scapula correctly is as important as moving the arms.


    Variations on your current routine

    Rows: Go to one arm cable rows ideally in a split step (opposite knee forward). This forces you to squeeze the glutes and core to balance while you pull. You can do these for both horizontal or pull down type movements.

    Squats and Deadlifts: modified single leg and/or split step These require more stabilizer and glute for balance.


    Additional exercises you probably aren't doing

    - face pulls
    - prone ITY
    - side and front bridges 2x10 - 5 second hold, 1 second rest
    - step ups - 2 sets, drive with the heal rather than toes, slow on the way down, squeeze the glutes, can be done weighted
    - external rotation/rotator cuff
    - pull throughs: bend the hips rather than squating, keep chest out, but don't hyper extend the lower back.





    EQI - eccentric quasi-isometrics

    I'm not the guru on these but they help stretch shit out and they will kick your ass if done right. You basically hold the bottom or mid point of a movement for 2 minutes. If you can do more than 2 minutes up the weight. You should be shitting your paints from the lactic acid at 2 minutes, but you stop if you form goes to hell. Do one set of these at the end of your workout. You will feel an immediate improvement.

    - Dumbell Fly EQI: hold the bottom of a dumbell fly (should feel light stretch).
    - Romainain Dead Lift EQI: hold the mid point of a RDL. Knees are only slightly bent, bar is slightly above knees, keep your back straight, slight stretch in the hams/glutes. Pain is your new best friend.



    Step 5: Lifestyle changes

    No amount of foam rolling will make up for 12 hour days of sitting hunched over a laptop. Set your computer on a cabinet so you can stand part of the day. Fix your position while sitting down. Save your nickels and buy a herman miller chair if yours sucks. Get up every 20 minutes, drinks some water, pull your shoulders back, move your arms out palms up, neck back, stretch. Foam roll at lunch. Put some tennis balls under your desk. Raise your monitor (phone books are usually easy to find at the office).

    http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/

    Ideally just go get a tall desk (above waist height and then get a shelf to mount your monitors at slightly above eye level). Then get a tall bar stool/chair to sit on till you can completely move off of sitting I was able to do this by simply turning my desk around backwards as it has an elevated monitor stand, that is now where my keyboard goes.

    Work on keeping your head back, chin tucked in, and shoulders back/down, when you're working. Just stay straight.
    http://trainoutpain.blogspot.com/2008/09/forward-head-posture.html
    http://trainoutpain.blogspot.com/2009/10/cervical-posture-and-consequences.html



    Step 6: Diet and supplements

    An anti-inflammatory diet will do wonders for your joint pain. The two most important components of this are increasing the amount of omega-3 fatty acids you consume, and reducing the amount of processed carbs you consume. Generally most of the things that make you less fat are also things that reduce inflamation and autoimmune response.

    What works:
    - Fish oil, get the entric coated kind without salmon
    - Lots of green vegetables, and foods low in acid
    - grass fed instead of grain/corn fed animals
    - meat lower in Arachidonic acid (avoid turkey and limit pork) http://en.wikipedia.org/wiki/Arachidonic_acid
    - water, obvious but everyone forgets it
    - fiber

    Stuff that is supposed to work, but probably doesn't
    - Flax seed: From what I've seen flax seed isn't readily converted into the stuff you can use
    - glucosamine chondroitin: mixed reviews, did nothing for me

    Step 7: Sleep

    I think we need to add this in here. Quality of sleep has a tremendous effect on inflamation and immune response. If you aren't having relatively fucked up dreams on a regular basis, you're sleep isn't good enough. Lack of dreaming all together is a possible sign of sleep apnea. When I got my sleep squared away, pain went down a lot.

    - Your room needs to be dark. Put tape over all the stupid lights on your VCR, TV, etc. Buy some heavy curtains.
    - Maintain air quality. A $20 humidifier goes a long way (get the kind without heat, they don't get as gross). Keep it clean and change the filter regularly. This helps especially for those with sleep apnea. The white noise from the fan also helps block other shit out.
    - Don't eat buffolo wings and mexican pepperoni's right before bed.
    - Some carbs before bed will help you sleep.
    - Buy a new, high quality bed that is the right stiffness for your sleep style....and replace it again when it starts to sag. For me (side sleeper) that was a soft one.

    If you have sleep apnea, get it taken care of. For me all it took was a daily spray of rhinocort (nasal steroid that opens everything up). For some of you it may take a cpap. But either way, stop being a fat fuck, it's not worth it.

    Step 8: Stress

    Easier said than done, but stress controls everything from your cortisol, to your shoulder structure, to your immune (inflammatory) response.

    Simple example: you're sad/pissed whatever. You look down more as a result, forcing your neck forward, shoulders move forward to compensate. Your ass must then move backwards to counter balance your upper body. What's this? Anterior pelvic tilt because you're having a shitty day, month, year, life.

    Cortisol, it's made from the same stuff that you eventually make testosterone out of. Being stressed out is keeping you from getting jacked. So my advice, whatever it is that is fucking up your life, fix it now not 10 years from now. Your job sucks, do something about it. Your girlfriend sucks, kick her to the curb. When you have the big things in your life squared away (job, house, relationships, car) you have more freedom to make drastic changes without having a lot of overhead stress distracting your from your goals.



    Finding a real trainer

    A lot of these movements require very specific form. A strength coach who is knowledgeable in rehab and corrective exercise is worth their weight in gold. What you want is essentially a physical theropist who can squat 500. They are not easy to find, but they are often surprisingly cheap. I pay $50 a session for one of the best in the country. Start at strenthcoach.com and search around. Find out who the strength coach is at your local division one school or pro sports team and ask them for recommendations. They are usually approachable and these guys often have blogs too. Go to conferences if you need to. Also check out http://www.powerliftingwatch.com/gyms for real gyms in your area.

    You can follow the basics, but someone who will put you on a table, measure your movement, etc. can give you a routine tailored to your problems.

    When you start moving correctly your lifts and progress will increase much more dramatically. If you are having regular pain, take a break from trying to add strength and focus on getting your movement right.



    Reference materials and articles

    http://www.tmuscle.com/free_online_...performance_repair/neanderthal_no_more_part_i
    http://www.tmuscle.com/free_online_...erformance_repair/neanderthal_no_more_part_ii
    http://www.tmuscle.com/free_online_...ng_performance_repair/neanderthal_no_more_iii
    http://www.tmuscle.com/free_online_...erformance_repair/neanderthal_no_more_part_iv
    http://www.tmuscle.com/free_online_...performance_repair/neanderthal_no_more_part_v

    http://www.synergyclinic.net/lowercrosssyndrome
    http://stronglifts.com/how-to-improve-your-ankle-mobility/
    http://stronglifts.com/7-dynamic-stretches-to-improve-your-hip-mobility/
    http://stronglifts.com/how-to-optimize-posterior-chain-power-glute-activation/


    Blogs
    http://ericcressey.com/
    robertsontrainingsystems.com
    http://trainoutpain.blogspot.com/

    Videos worth subscribing to
    http://www.youtube.com/user/PerformanceU
    http://www.youtube.com/user/CampbellStrength
    http://www.youtube.com/user/RobTrainSystems



    The OT Generic Corrective Workout


    Since we have so many people with jacked backs, who can’t bench comfortably, here’s a generic corrective workout that will address the most common problems. It’s no substitute for a proper assessment, but it should work for most people. Note that you can get very strong doing this and you shouldn’t think of this as a temporary thing. Most of these movements should be included in any decent workout and will keep you lifting healthy for longer.

    Each day includes a main compound lift, some complimentary accessories, oblique work, and some shoulder correction. Upper back to chest volume is 2/1. Generally you will perform the first compound movement by itself (bench excluded) and then accessory work can be done as super sets of 2-3 exercises.

    Sets/Reps can be performed however you want. If you are not well trained, have significant issues, you’re fat, or are restarting after a long break, shoot for 3 months at high reps 8-12 low number of sets (2-3). After you’ve gotten used to some consistent volume drop it down to 5-8 reps for compound movements (ie 5x5). If you want to get strong, then use 5/3/1 for compound lifts, and 6-8 for accessory lifts. Shoulder work, particularly rotator cuff, should always be done at high reps. Do a deload week every 4th week, dropping both sets and reps, then re-evaluate your rep scheme. This will significantly increase your gains.

    All leg movements should be performed with knees no farther forward than mid foot (split squats, step ups). This may require you to move way down in weight (body weight in many cases). The purpose of this program is to build up your glutes, hams, obliques, etc. to straighten out your posture and take some pressure off your shoulders and knees. All upper body work is generally performed with shoulders locked back and down. Fix your form and get some mobility before you add load to bad movement (reinforcing it).

    Energy systems should be performed post workout if you need/want it. Suggestions:
    Prowler sprints
    Sled drags
    Battling ropes
    Kettlebell swings or snatches
    20-45 seconds on off 30-90 seconds off for 3-10 sets depending on how much difficulty you want.

    Bare Minimum Dynamic warm-up (every day)
    Foam roll (upper back, IT band, glutes, quads)
    Clams
    Glute bridge
    Hip flexor stretch (back foot elevated, split stance) 30 seconds x 3
    Pushup plus (just retract scapula in a pushup position)
    Thoracic Rotation

    3 Day Split (bench, squat, deadlift)

    “Bench Day”

    Flat bench or whatever variant hurts least, swiss bar, floor press, close grip are all fine. If you can’t bench at all single arm grappler shoulder press is probably your best option. (Lock shoulders back and down.)
    Between bench sets: Band pull-a-parts (reverse fly’s if you don’t have a band)
    Single arm row variant (3 point, two point, cable in a split stance, or chest supported)
    Lift Chop
    Shoulder external rotation (rotator cuff)
    Finish with dumbell fly EQI (stretch) for time (failure at 1-2 minutes)

    “Squat day”
    Front Squats (alternatively safety bar or zercher)
    RDL
    GHR (alternatively ball leg curls)
    Planks (Start with regular planks for time, move to lifting one arm off the ground as you get more advanced)
    ITY (thumbs towards the sky, can be done on an incline bench, flat bench, or ground depending on how much difficulty you want)

    “Deadlift Day”

    Deadlift variant
    - Total noobs: cable pull throughs
    - Most of you: Trap bar deadlift
    - After 6 months: sumo or conventional deadlift
    Chin Variant (band or machine assisted if you need it, neutral grip if possible)
    Step ups (keep knee behind toe, focus on front leg glute, land with the heel)
    Split squats (Keep front knee back, sit up tall, move straight up and down, use rear glute for most of the work)
    Face Pulls
    Pallof Press

    4th day/off day
    If you need/want another day, do some warmup and shoulder correction and light energy systems. I use this day to stay loose and help recovery. This usually works best between deadlift and squat days to give you more time to recover.
    Suggestions:
    Facepulls
    Curls
    Tricep variant
    Pallof Press
    ITY

    Not included anywhere in this workout for good reason: shrugs, shoulder press variants, crunches. Give all that a break and see if you feel more awesome.
     
    Last edited: Jan 15, 2011
  2. fatmoocow

    fatmoocow bored OT Supporter

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    Videos

    Foam Rolling

    [y]8caF1Keg2XU[/y]

    Warm Up
    - glute bridge
    - clams
    - quad stretch (not sure about all the extra movement stuff, but the basic form in this is correct, front knee forward)
    - groiners
    - wall slides (squeeze at top and bottom, lower back and shoulders do not come off the wall, feet a little forward if needed)
    - pushup plus
    - split stance rotation (squeeze at the end of the movement and squeeze back leg glute throughout)

    [y]MwNP1Ure28Q[/y][y]5zhAJiBmJRE[/y][y]HaQFZ8TOUfA[/y][y]QMBeNjhTIEk[/y][y]S5ZFcmHEdLU[/y][y]ALzFr2GT-Is[/y][y]0Xe0wIbaguw[/y]



    Rotator cuff - looking for stability here, so go super slow, low weight, not to crazy failure

    [y]eQ0qxpEXfbM[/y][y]jRry9lKQRGo[/y]

    Sleeper stretch
    [y]qN6LnYMwS3Y[/y]


    Back

    - Face Pulls
    - Split Stance Cable Pull Down
    - Split Stance Cable Pull

    Split stance work can be done kneeling or standing up. Squeeze scapula together stay straight.

    [y]Qu4X_DZE_aI[/y][y]ltxfmo97X9k[/y][y]EBSMNJi5nNE[/y]

    excellent explanation on proper row/pulling to stabilize the scapula from Bill
    [y]AE1fm5mfFk4[/y]

    thoracic mobilization
    [y]H5zmkW5EO6s[/y]

    Trapezius work: prone or incline ITYs. These strengthen the traps to move the shoulders back. On these the focus is just squeezing the scapula together not moving the arms. Range of motion is very short. More advanced version is done face down on the ground, put a pad under your forehead and a 2.5-5lb weight in each hand. Pay close attention to the location of the hands (thumbs up)

    [y]AuIyONH795k[/y][y]owOtS66Omxw[/y]

    - prone or incline I (lower traps)
    - prone or inline T (mid traps)
    - prone or incline Y (upper traps)

    [y]l3VVqJeFxk8[/y][y]AAUB8YeMYeg[/y][y]G10em2Ir8OY[/y]

    Glute Work

    - Split Squat
    - Bulgarian Split Squat
    - Pull throughs
    - Step Ups

    [y]zTxUq2NJOJ0[/y][y]uu1T8vzfwX0[/y][y]A2HV_VP5oNk[/y][y]ZUNLaMRWmq4[/y]

    "Core" :mamoru: work: really we're after obliques here, they should be doing more work than abs or erectors

    - side bridge (of death) do a 5 up to 1 down count or hold for time
    - front bridge - remember obliques here, time or reps
    - Pallof ISO 20-30s

    [y]4sUufw8MIVw[/y][y]CYLuhUMThNk[/y][y]wADXK_0_Gx8[/y]


    Shoulder Friendly chest work (keep the volume/intensity low)
    [y]EmK43T4YF5A[/y][y]Eu_D9o3UILM[/y]


    You guys asking for shoulder specific stuff: it's all shoulder specific stuff. To fix your shoulders you're not really doing anything to the shoulder itself, other than some basic rotator stability. What you are really doing is working the back to bring the shoulder into alignment. The pain is mostly from not having enough room to move and too tight chest or for me subclavius. So hit those single arm rows and ITYs hard, do some dumbbell fly eqi's to stretch the chest and your pain will start to go away. Same thing with knee pain. There's nothing in your knee to really work, it's all a result of lengthening the hamstrings/hip flexors and activating the glutes.

    ...and finally, as many of you who want to be huge, simply dropping weight will make an improvement.
     
    Last edited: Mar 14, 2010
  3. MaineSucks

    MaineSucks OT Supporter

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    This could be a good one
     
  4. Voltekker

    Voltekker Active Member

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    So if your shoulder hurts you say to stop, whats the best way to atleast exercise your chest ? Can you just go light ?
     
  5. Cumstang02

    Cumstang02 New Member

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    Is it in yet?
    My shoulders only hurt if i don't warm them up before pressing.
     
  6. ices

    ices New Member

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  7. fatmoocow

    fatmoocow bored OT Supporter

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    http://www.youtube.com/watch?v=xaKA3T7Wu9w
    + db fly eqi

    Best way to work the chest is to fix your shoulder problems so that you can bench without pain. As you bench you make the chest tighter. You want to do the opposite so you can get your scapula back to where they're supposed to be. Once you've gotten things in balance you can bench much more. If you are building the chest at the same rate as your back, and the chest has a huge head start, you'll always have pain.
     
  8. fatmoocow

    fatmoocow bored OT Supporter

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    Also don't think of this as permanent. You fix whats wrong and then work to prevent it in the future, but your goal should definitely be to get back to benching or whatever. You should get results and then you can do more chest, quad, etc. being mindful to keep everything in balance.
     
  9. SuperChode

    SuperChode New Member

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  10. PcH

    PcH Guest

    I really gotta start foam rolling, feels good man
     
  11. SuperChode

    SuperChode New Member

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  12. Bacchus

    Bacchus Skinny Guy

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    great post. There's a lot that i've already been doing for a bit - but lots of good information here

    I've seen guys going split rows, or split squats but i never really bothered with them.

    I can say that my IT band problem has almost completely gone away since i've been foam rolling. I'm hoping with further training and some of this stuff, my petellar will get better
     
  13. tantrum

    tantrum New Member

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    Awesome info
     
  14. Bacchus

    Bacchus Skinny Guy

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    hurts so good.
     
  15. Bobert

    Bobert OT Supporter

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    Great thread. I learned some of this stuff spread over a couple years here, nice to see it all in one place. :bigthumb:

    I always do a dynamic warmup before my workouts, and my lifting has felt so much better because of it. I'll have to try out that combination though
     
  16. saturnsrings

    saturnsrings OT Supporter

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    BadAss thread ibceaze
     
  17. Rich Uncle Skeleton

    Rich Uncle Skeleton Lurker

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    oh man, foam rolling hurts so good. I started doing it on my legs, back and shoulders a couple weeks ago. You feel like crying some times, especially on your IT band.
     
  18. knight42

    knight42 OT Supporter

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    nice thread so far... I use a 3.5 inch metal pipe now for half my rolls now
     
  19. Bacchus

    Bacchus Skinny Guy

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    thats mental

    i've heard of some bros using PVC too
     
  20. KingGargantuan

    KingGargantuan ♖♘♗♕♔♗♘♖

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  21. fatmoocow

    fatmoocow bored OT Supporter

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    needs to do more shit with this....too lazy today
     
  22. Elfling

    Elfling New Member

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  23. KingGargantuan

    KingGargantuan ♖♘♗♕♔♗♘♖

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    it's a bit painful but it's all i've got right now, the pvc.
     
  24. Bacchus

    Bacchus Skinny Guy

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    As mentioned in the B/C thread, went for my first physio today.

    told me quads were way stronger then my hams - and that's likely the reason for my issues.

    could have used this thread 8 months ago
     
  25. timberwolf

    timberwolf New Member

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    Worth being a sticky.
     

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