Contortionist: Caty Mae, Instagram: @catymaecircus
ATTENTION: Circus artists with back pain!
Here's a REALLY interesting (and SCARY) statistic on the NUMBER ONE PREDICTOR of if your have surgery for low back pain....
Yep. The number one predictor is HOW MANY SURGEONS ARE IN YOUR ZIP CODE!! Surgeons like to do surgery.
What's the second predictor? Whether or not you get an MRI.
Here's why: When you have back pain, you go to the doctor. Maybe urgent care, maybe your primary care physician, maybe the ER. That doctor does one of several things: refers you to a physio, gives you drugs, or refers you to an orthopedic surgeon. If you end up at an orthopedic surgeon's office, they will do an exam and either 1) send you to a physio, or 2) order an MRI.
Here's where issues arise. MRI findings are NOT always correlated to pain and dysfunction in the lumbar spine!! What does this mean? This means that disc degeneration or disc bulging is a normal part of the aging process.
Take a look at this chart. This study examined MRI's on over 3,000 people WITHOUT BACK PAIN. You can see that over one third of people over age 20 showed findings of disc degeneration, and 30% had a disc bulge.
Here's where the problem is: if you have back pain and end up with an MRI, your surgeon MIGHT say something like "you have a disc bulge. Surgery will fix this! Let's do surgery." This makes sense, right? Plus, there's something very comforting when, as an athlete in significant pain, someone offers a seemingly logical solution.
PUMP THE BRAKES
But what if the pain ISN'T coming from that disc? Then, you just went through a LOT of expensive imaging, had an invasive and risky procedure done, and it didn't even fix the problem.
To avoid this scenario (and potentially save A LOT of money), go see a PT. They might be able to offer a different perspective, and just might get you back on your apparatus quicker, more efficiently, and with more cash in your pocket.
Fun fact: The zip code with the highest incidence of surgery for low back pain is in Denver, Colorado!
Handbalancer: Zoe Jones, www.zoemjones.com, @handstandswithzoe
Thoracic mobility to physiotherapists is kind of like coconut oil to hippies…it fixes EVERYTHING. Low back pain? Shoulder pain? Bet your thoracic spine is stiff. Neck problems? Hands ripping? Fear of heights? Time to work on t-spine mobility.
If you’ve been keeping up with the circus shoulder posts, you’re probably noticing a theme. Even though you feel pain or discomfort in your shoulder, the actual PROBLEM is likely coming from elsewhere. We like to call this “regional interdependence;” it's an impressive, multisyllabic phrase that means “everything’s connected.” It’s always important to look beyond the region of pain, and see what the rest of the body is doing (or not doing). More often than not, the cause of the problem is NOT the same as the location of pain. This is why I REALLY want to stress the importance of seeing a physio if you have ANY lingering aches or pains...they can help you solve your #circusproblems, because the answer is not always obvious!
So far in this shoulder series, we’ve talked about the lats, the rotator cuff, and the pec minor. This week, I’ll be discussing the importance of the thoracic spine in preventing and addressing shoulder pain.
If you haven't read the earlier shoulder blogs in my series, you can read the series intro here. Post number one covers common misconceptions about your #circuslats. Post two covers how to properly attack tight lats by leveraging shoulder and back muscles. Finally, once you read this post on the pec minor, you'll be all caught up. And now, moving on...
Anatomy and Mechanics
Your thoracic spine consists of the 12 vertebrae between your neck and low back. This is also where your ribs connect to your spine, which means that by nature, your thoracic spine is much stiffer than your neck or low back- and therefore has less movement. Your shoulder blade is connected to your t-spine by several muscles, and also sits on top your ribcage. Because your thoracic spine directly affects ribcage position, it also plays a HUGE role in scapular position and shoulder mechanics. A “normal” person might be able to get away with having some thoracic stiffness, but for the circus artist (or anyone who plays a sport where your arms are overhead at ALL), the slightest bit of increased stiffness can cause some big problems.
In the properly functioning t-spine, each of the 12 vertebrae is able to move SLIGHTLY on the vertebrae above and below it. We call this “accessory” motion. It's too small to quantify, but very important nonetheless. Accessory motion at the thoracic vertebrae should move allow for forward, backward, and rotational movement. This is VERY small, more of a glide than a large scale motion. However, this little glide between all 12 vertebrae allows for a larger COMPOSITE motion from the thoracic spine as a whole. The thoracic spine should be able to flex, extend, rotate, and side bend. Here’s why we care as circus artists: when the arm goes up overhead, whether we’re in a handstand or doing beats on trapeze, the healthy thoracic spine should EXTEND slightly. This helps put our shoulder blades in the most optimal position to keep the rotator cuff from being impinged.
Where it goes wrong
There are a lot of possible causes for decreased thoracic mobility, the most common of which is probably SITTING. And texting. And working at the computer for extended periods of time. When we sit, especially with poor posture, we tend to hunch forward and slump into a more rounded back posture than normal. This causes our shoulders to move forward, and our heads to jut out, and it all goes downhill from there. Generally, I think I see the most issues with the circus artist who’s the “desk job by day, circus star by night” type. If you sit with bad posture for hours a day, years at a time for work, you’ll probably develop increased stiffness in your t-spine. If you take this increased stiffness and throw it on a trapeze, or in a contortion class without addressing it, you’ll probably end up with issues SOMEWHERE. If our thoracic spine can’t extend when our arms are overhead, we have issues.
What does "wrong" look like?
Photographer: Arielena Reed Photography
There are a lot of different circus skills that will be negatively affected (or especially difficult to attain) if you have a tight t-spine. Most commonly, the basic back bend or bridge. If you look at your back bend, and you have nice movement through your hips and low back, but it looks sub-par from the mid back up, it could be your thoracic mobility causing the problem. Additionally, here are some skills that require a VERY healthy dose of thoracic mobility:
There are SO many awesome ways to mobilize your thoracic spine and improve overall spinal flexibility. One problem I see with a lot of circus artists is that they only focus on the extension aspect of thoracic mobility, when you really need to work both extension AND rotation. If all you’re doing to warm up your upper back is rolling on a foam roller a few times, you’re missing out! Because of the architecture of the t-spine, the rotation and extension movements are coupled- this means that if you want to improve extension, you MUST also work on rotation..and vice versa. The following are my favorite exercises to get your upper back moving. These are great to add in as part of your warm up before class….especially if you know you’ll be doing a lot of back bending!
Peanut thoracic extension
What’s a peanut? If you train at the San Francisco Circus Center, you may know the “peanut” as the “sock and balls.” Whatever you want to call it, its my FAVORITE tool for improving thoracic mobility on your own. To create your very own peanut, take two tennis or racquetballs and either tape them together or put them in a sock and tie off the end with a hair tie. For this exercise, first place the peanut on either side of your spine, at mid-back level. Take a deep breath in, then as you breathe out, drop your butt and head to the ground at the same time, so you “hinge” over the peanut. Do this between 5-8 times at each level, between mid back to where your shoulders and neck meet. You can also do the same thing, but alternating arms overhead instead of hinging over the peanut.
For extra intensity, do the same movements with the peanut on top of a yoga block. This gives you extra neck extension, which will increase the intensity of the mobilization!
Resisted quadruped thoracic rotation/extension
For this exercise, you’ll need a theraband tied to stall bars, or something similarly fixed. Hold the theraband with the arm furthest from the stall bars while on all fours. Engage your ribs, and on the exhale, rotate up towards the ceiling. Try to initiate the movement by drawing your shoulder blade towards your spine. Hold at the end of the rotation for a complete inhale and exhale.
For bonus points and an AWESOME core exercise, do the same thing in a plank position. You're welcome.
Straddle thoracic flexion/rotation
This exercise is SUCH an awesome multitasker. You not only get thoracic mobility, but also lat flexibility on the opposite side, and obviously a bit of a leg stretch too. Start with a foam roller parallel to your thigh and the back of your forearm on top, palm up. On the exhale, roll forward and into the rotation, while reaching your chest through your arms and towards the ceiling. This is nice, because you get a different stretch in different degrees of straddle, so try a few out!
If you know you’re going to be doing a lot of back bends (or other aforementioned t-spine heavy tricks), throw a few of these exercises in to your warm up and see how you feel! For those of you with desk jobs, I HIGHLY suggest keeping a peanut or foam roll at work…a few stretch breaks throughout the work day will do wonders for your circus shoulder…and probably every other ailment you have! And hey, if thoracic mobility doesn’t solve the problem, maybe rub some coconut oil on it…or better yet, see a physio!!
Is your thoracic spine EXTRA stubborn? Check out my active flexibility program: The Science Behind the Art of Backbending: Upper Back and Shoulders. It has ALL the tips and tricks you'll need to coax that elusive upper back into [safely] bending!
Aerialists: Daniel Stern (www.acrodan.com) and Shannon McKenna (www.circusshannon.com). Photographer: Juan Luis Gonzales
Your pectoralis minor might just be the evil villain to your circus fairytale....dramatic, perhaps, but true. You could have the perfect injury prevention routine, but if your pec minor is too tight, it will all go to waste. In this post, I’ll start off with relevant anatomy of the pec minor, how to tell if its tight, and discuss how dysfunction in this muscle can negatively impact your circus training and lead to injury and pain. I’ll also show a few different stretches and exercises that I find the most effective in avoiding issues and injuries caused by a tight pec minor.
Pec minor: functional anatomy
What if it's too tight?
In past posts, I’ve discussed the mechanics of what happens with overhead movement of the shoulder. The rotator cuff keeps the humeral head (ball) centered in the glenoid fossa of the shoulder blade (socket) as the big mover muscles bring your arm overhead. Here’s where the pec minor can be a real issue: if its too tight, it will pull the shoulder blade forward, which means that as you bring your arm overhead, your humeral head will hit the “roof” of your shoulder blade (the acromion) MUCH sooner in the range of motion. Pec minor basically pulls your shoulder blade towards your ribs, out of alignment, and messes up the rotator cuff’s ability to keep the humeral head centered happily away from any impingement. In the tight pec scenario, your rotator cuff could get pinched between your humeral head and your shoulder blade. This manifests as sharp pain in the front of your shoulder. It could also show up as very diffuse, achey pain around the front and side of your shoulder, even down your deltoid…when the rotator cuff is irritated, it can refer pain anywhere from the front of your shoulder, down your deltoid and sometimes even to your elbow. BUT that’s not the only thing a tight pec minor can do. Because it lies on top of nerves and blood vessels, when it is tight, it can also cause nerve irritation or compression of other vasculature. Symptoms here most often include numbness and tingling down your arm and into your fingers. But wait, I’m not done yet. Research shows that, in addition to irritating rotator cuff tendons and nerves, tight pec minors INHIBIT many important parascapular muscles that are vital for controlling end range shoulder flexibility (see last post on LATS!)
The recipe for a tight pec minor
Ok, now that you're sufficiently fired up about your pec minor, what is it that causes and contributes to tightness in this muscle? SO MANY THINGS. If you have a desk job or spend a lot of time in front of a computer, this lends itself towards tight pecs in general. Sitting, traveling, reading, spending lots of time on your phone or iPad…all of these activities put your pec minor in a shortened position. Circus wise, here are a few things that also can contribute to your probably already tight pec minors: training meathooks, reverse meathooks/side planche, back lever, skin the cats, and most climbs on any vertical apparatus. ALSO: training chin stands in contortion, straight-arm handstand presses, or tumbling/trampoline/flying trapeze involving twisting flips. Oh, and also being a side-sleeper. If you didn’t identify with any of these things, congratulations! You’re a circus unicorn.
Quantifying flexibility (beyond "super tight" and "kinda tight")
Stretch. It. Out.
Now for the good part- how to stretch it! Unfortunately, its a really tricky muscle to stretch on your own. I’ve included a few different methods of attack, some of which include assistance from a friend.
Peanut pec minor active release
Peanut active release with parascapular muscle activation
This is the same concept as the prior exercise, but with the added bonus of activating the parascapular muscles (rhomboids, upper and middle trap, rotator cuff). These are the muscles that are inhibited when the pec minor gets too tight, so i LOVE this exercise because it both releases the pec minor while incorporating neuromuscular re-education for the parascapular muscles. Start face down with the ball on your pec minor and arm to the side, palm down. From here, first engage the muscles in your shoulder blade by bringing your shoulder blade towards your spine. Also think about bringing the front of your shoulder away from the floor. From this engaged position, you can bring your arm up overhead slowly.
Partner foam roll stretch
This is a great stretch to do after the first two releases. Lie on a foam roll (either the one thats sliced in half or a normal one, both are fine) with both your head and sacrum on the roll. Rest your arms either on the floor with palms up, or on your belly with your hands clasped. Your partner should sit behind you and apply gentle downward pressure with cupped hands on the uppermost part of your ribs, just below the front of your shoulder. DO NOT PRESS ON THE SHOULDER! X marks the spot on the photo below. Here, you can do some contract relax PNF stretching: relax for 15 seconds while your partner applies gentle downward pressure, then try to push up into their hands against their resistance- hold for 8-10 seconds, then relax for 15. Do this for a total of 2 minutes.
I recommend doing these three exercises before circus training as part of your warm up. It’s also a good idea to do one or two of these as part of your cool down, ESPECIALLY if your training session involved any of the previously mentioned activities that contribute to tight pecs.
Yellow lights and red lights...
There are a few things to watch out for when doing these stretches. Because of the nerves and arteries that lie under the pec minor, you might feel numbness and tingling during these stretches, especially in the first week of incorporating them into your training program. If you feel this, stop the stretch and shake it out. Wait for the numbness and tingling to subside, then continue at a LOWER INTENSITY. The goal is to feel a stretching sensation without any numbness or tingling. Do not push through the stretch after the onset of these symptoms, doing so is counterproductive! You can also try bending your elbow during these exercises, as that may alleviate the tingling by putting the nerves on slack. If you can’t do these without feeling numbness and tingling after making these modifications, RED LIGHT…do not pass go…call a physio and make an appointment.
Another word of caution: I started out this post by talking about symptoms that you may feel if you have a tight pec minor: pain in the front of the shoulder, diffuse pain down your deltoid, or numbness and tingling during stretching. There are a LOT of different structures and injuries that can cause these same symptoms, and some of them are very serious. If you’re experiencing any of these, and they stick around for longer than a few days, thats another red light. CALL A PT! Constant pain should not be a staple in your circus training.
As always, feel free to comment below with questions or concerns! Happy stretching!
Photo by Amourpropre Photography (@enola_gay);
Featuring Mark Keahi (@mark_keahi) and Jen Crane
My last post discussed the basics of latissimus dorsi anatomy, mechanics, and how you know if your lats are an issue in your circus training. I also shared my favorite test to measure and track progress in lat flexibility. In this post, I’ll talk about some common misconceptions I’ve seen in the circus community regarding stretching in general. I’ll also introduce a more comprehensive way we can improve lat flexibility safely and effectively, that also will help to prevent injuries.
There are a few different concepts we need to account for any time we want to improve flexibility of a muscle group. In broad terms, I’ll refer to these as active flexibility, passive flexibility, and end range control. First, here are the working definitions of these terms for the purpose of this post:
Passive flexibility: The total length a muscle can stretch when it is being pushed by an outside source. This could be gravity, like when you’re sitting in over-splits, or it could be in contortion class when your instructor is cranking your leg into flat middle splits.
Huge thanks to the maker of my flat middle splits, Catie Brier <3
Active flexibility: This is the ability of the muscle group that is opposite the muscle being stretched (the agonist muscles) to overpower gravity (WITHOUT assistance from an outside source) and move the limb as far as possible into the stretch. An example of this is doing a develope into an arabesque in contortion or dance- your glutes and posterior leg and trunk muscles have to do the work to move your leg into the highest arabesque position possible without assistance from your arms or your instructor.
Sylphie Ariella: www.sylphieariella.com
End-range control: This is the ability of the muscles surrounding the muscle group being stretched to hold the limb at the end range of motion and do the fine-tuning adjustments that need to occur to either keep the limb at end range, or move it safely from one position to the other. A great example of this is when you’re working on side-scales. You first start by using your arm to hold your leg as high as possible, then when your leg is as high as it can go, you release your arm. Does your leg drop down a little? This means you may need to work on end-range control of your flexibility.
In my experience both as a circus artist and as a circus PT, we are GREAT at working on passive flexibility. How many times do you get to class and immediately plop down into the splits? We really like passive static stretching—it’s something that is heavily ingrained in performing arts culture. While I don’t think this inherently bad, I think we need to pay equal attention to the other components of flexibility. One of the biggest injury predictors in performing arts is a high ratio of passive-to-active flexibility. If your passive range of motion far exceeds your active range of motion, you are more likely to experience injury at that joint.
Whenever I’m working with a patient on improving flexibility, I always address each of these three components. When assigning corrective exercise programs or functional warm-ups, I usually have at least one exercise for each category, completed in the following order:
Now, lets get specific to stretching the lats. What are the key players involved in improving flexibility and end range control? The muscles that have to do most of the grunt work involved in active flexibility and end range control of the lats are the parascapular muscles and rotator cuff. The parascapular muscles are a group of muscles that attach to your scapula, shoulder, and/or neck and upper back. These are the muscles that need to be strong enough to control all of that range of motion we get from our passive stretching (with or without instructor cranking!) The rotator cuff, as discussed in previous posts, is in charge of the fine movement adjustments that need to occur throughout shoulder range of motion, but especially at end range, to keep the “ball” of the humerus centered in the “socket” of the scapula.
The following exercises are my favorite starters for safe and effective lat stretching. I like to do these before circus training, in order to properly activate all of the parascapular and rotator cuff muscles before putting them through the rigors of aerial or acrobatic training. I’ll typically also do some passive and PNF stretching after training, as well.
Peanut Mobilization: Lats
Start lying halfway between on your side and on your back, with the peanut placed as shown. First, move from internal to external rotation with your shoulder just below 90 degrees:
Then, move from bent arm to straight arm overhead. This often takes some peanut-adjustment to find the appropriate spot, so if you’re not feeling the “hurts so good” muscle release, move the peanut back a little or down a little.
I suggest 10 repetitions per position, per arm, for the best effect.
If you're in the market for a peanut or a foam roller, here are my fav's:
External Rotation-biased Lat Stretch
This is my favorite lat stretch. The classic lat stretch we see all the time in circus arts- where your hands are on a wall or bench, with your back arched, allows for a lot of compensations that don't let the lats stretch fully. This stretch also adds in an extra component of external rotation (from the block). This stretches the fibers of the lats that are responsible for internal rotation of the shoulder, which most typical lat stretches skips. Being in a "childs pose" position doesn't let you substitute by arching your back.
Modified Dead Bug for Active Shoulder Flexibility
This is my favorite starter exercise to encourage parascapular muscle activation and active control of lat flexibility. It also is a GREAT core exercise, if done right!
Child's Pose Shoulder Elevation for End-Range Control
This is a great exercise to focus on activating your rotator cuff and scapular muscles during overhead, end-range activities. It looks easy, but is deceptively difficult!
These three exercises are a great start to SAFELY improving your lat flexibility, and would be a good addition to your current warm up. Be sure to measure your progress, too! Take a "before" photo using the measurement method I wrote about in the last post, then see how you improve in the next few weeks! But as always, LISTEN TO YOUR BODY! If one of these exercises doesn't feel right, don't do it...if you have shoulder pain, go see a physio- you don't need to live with pain!
Questions? Comments? Feel free to post below!
Injury prevention must-haves
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