The Case of the Missing Internal Rotation

Math is like Boo to me, mention it and my back goes up, hair on end, incisors flared. The entirety of my scholastic career was spent trying to weather this very logical language of cause and effect:

A+B=C.

My C always had a remainder.

Always.

But statistics took what twelve years of grade school pounded in and said, "Hey Bry, A+B=C...maybe." You first have to prove that C couldn't happen by chance. Chance? WTF. Math is supposed to be so absolute, so refined.

Even better were confounding variables. If I remember correctly, they go something like this: Seventy percent of the people who had heart attacks last year chewed gum. Therefore, gum causes heart attacks. No. No. No.

When someone tells me 14% of this, or 90% of that, I feel sleepy, then I feel stabby.  

The take away from statistics for me was: Trust No One.

The only trustworthy statistic is one that is overwhelmingly significant, meaning it shows a difference between A and B so large, it's undeniable. The first thing any scientist will ask is how repeatable are those results across multiple populations. So when we discover that an overwhelming majority of people with lower back pain also tend to show deficiencies in hip internal rotation, we raise an eyebrow.

After learning this, I started looking. All my clients that presented a history of low back pain had trouble internally rotating at the hip. As a matter of fact, internal rotation tends to be lacking in most of my clients that don't test well in the FMS. And an overwhelming majority of my clients with past shoulder injury, or anyone who scores low on the shoulder mobility screen in the FMS, show a loss of internal rotation in the shoulder.

Where did all the internal rotation go?

In an attempt to prevent an extremity from damage caused by blunt trauma or cumulative faulty movement, the brain seeks to keep it within visual range. Think of why you're put in a sling after a rotator cuff injury. That sling puts you into shoulder internal rotation, right where the brain wants it. If not for the sling, you'd keep it there instinctively, and the brain would pain punch you if you attempted to move it.

To find out what really restricts a joint's range of motion, it needs to be assessed. Going through each individual joint action will expose any soft tissue dysfunction. It's important to make sure to get instant feedback from any intervention, understanding that only consistency restores new mobility and stability to a default setting. An intervention is considered successful when whatever is gained becomes the new normal, be it extensibility or contraction.

It's doubly important not to focus on today's workout as much as today's result. Restoring lost range of motion is smart, but restoration without stabilization paves the way to re-injury, because if you can't stabilize it, you shouldn't load it.

So test it, see if you can do tactical frog. Start in quadruped (all fours), on your elbows and get as much extensibility out of your adductors as you can, don't over do it. From there, slowly push your hips back, horizontally. Press your palms down into the floor so the core fires when you push deeper into hip flexion. Push back a little more each time to find the range of motion you can produce without compensation. Do not create range of motion you don't have. Any compensation means to get you where you want to go, the brain borrows mobility from other joints. This is not the recipe for stability and we cannot create stability without addressing mobility issues first.

And for shoulder internal rotation, try the sleeper stretch shown here: 

https://youtu.be/gtFsE7zMeoM

Statistics rarely garner my attention. But something that proves statistically significant, I'm all ears. Science can be as hard to trust as faith, especially when there are forces that seek to bend your opinion in a particular direction. Besides, anatomy and physiology are amazingly hard disciplines, which is why I try to educate clients on basic anatomy and encourage them to know as much as possible, like having a law degree before chatting with Saul Goodman. It helps you determine if the person you entrust with your health is doing right by you. I absolutely love it when clients ask questions, and love it even more when they challenge me. Nothing is more satisfying than figuring out movement issues with a captive client. It makes me feel like this kid...