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That's physical therapy....not rehab as in Amy Winehouse rehab. I'm lucky enough to work alongside physical therapists everyday so here are some things that I've learned and some thing's that we probably already know, but were reinforced from a different perspective

1) If we don't have 10-15 degrees of dorsiflexion range of motion, the tibia will be forced to rotate medially atop the foot, contributing to tibia abduction/femoral adduction-medial rotaion (knee valgus), however....

2) Number 1 is a bit too general. Don't fear mobilizing the ankle/foot into pronation. The foot must be able to evert and the tibia must be able to rotate medially atop the foot (closed kinematic chain pronation) in order to trigger the series of muscular reflexes that supinate and propel the body during movement.

3) For overhead athletes. The humerus can't externally rotate safely if the acromion's in the way. Scapular stability and mobility should be the emphasis once again, however...

4) Shoulder "prehab" exercises are about 25% of the answer and that might even be too much. The other 75%? Adjusting posture during daily activities during the 22.5 hours/day you don't see them, thoracic mobility, hip mobility, and healthy ankles and feet. I left something out...

5) Core stability. Yea, again. Although hard-core (pun intended) exercises are kind of the e-book rage, if you can't perform basic bridging and alternating versions, there's no use trying resisted ab wheel rollouts or TRX flutters just because they're badass. Get into a PT facility and watch how closely they monitor compensation during simple exercises - I know, personally, it made me feel a bit irresponsible.

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Comment by Alex Rosenzweig on June 5, 2009 at 10:56pm
1) never leave out the very strong ability of the long toe extensors ability to drive ankle dorsiflexion due to their huge moment arm. I would want to make sure that the person has full muscular participation actively before I start passively "mobilizing" anything.

2) Again, muscular participation/activation of muscles of the feet will do wonders for ROM issues in the hip and therefore the lumbar spine. The reverse is also true. Glute activation (real glute activation) has a very strong effect on eversion of the foot and ankle as well as eccentrically controlling pronation. The tibia also needs to be able to rotate on the femur as well.

3) I hate the word stability since the definition of stability is an absence of movement and obviously there is a lot of motion of the scapula. The humerus can't do anything safely with out proper scapulohumeral rhythm which will be properly controlled by maintaining the proper length tension relationships of the muscles involved in humeral flexion/scapular abduction.

4) I agree that Y's, T's, W's, L's, ER, and IR don't even come close to cutting it. Some focused isometrics will go much further that the aforementioned exercise (I love the iso's so sue me, they f-ing work). The posture stuff is important but what is causing it and should we try to fix it. Joe knows my opinion on posture stuff after Dan's and my presentation on LBP.

5) You hit the nail on the head with this one. Why is it that people are so fascinated by fancy "core exercises" when they couldn't even control a pillar for 10 seconds. My favorite part of going to my gym is watching what new compensations will I see today... I usually laugh and shake me head at them.

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