There are quite a few stubborn myofascial instigators that can hold clients back, but with a little know-how, any fitness professional can learn to identify these culprits and address them. Working as a sports doc and rehab specialist, I get to take clients through the entire process of rehabilitation, injury prevention, and all the way to performance optimization. I will share with you three of the biggest culprits that I encounter in my practice so you can be prepared if they make their presence known in your client’s programming.
Quadratus Lumborum, or “QL”, is the first thing to freak when the back feels uncomfortable. It’s the muscle that goes into spasm when someone says their back is “out” and can’t even stand up. In all honesty, (if you can forgive the personification), QL is just doing its job. What is that job and how do we communicate that to clients?
Think of QL as an accordion, closing down laterally on one side as it opens on another, as in during a side bend motion. When the low back gets “tweaked” from lifting too heavy or sleeping oddly or too much time traveling, the QL tightens up on one side (or both) in an attempt to stabilize. Our bodies are tension systems and we’re all experts in building those systems.
Here’s the best way to address and prevent QL tantrums:
The three phases of breathing are supported by rib movement. QL tends to lock down the lower ribs and disallow that delicious, micro-massaging effect that ribs are supposed to provide to the back muscles on each breath.
There are a thousand techniques to get your client breathing properly – use your favorite! 2-5 minutes.
Posterior Pelvic Tilts
I love pairing this with breathing patterns, but as far as the technique goes, I typically have the patient supine with their knees bent, slowly rolling the pelvis back and pressing the low back into the ground.
Guide two slow, full breaths per tilt, relax for a second back to neutral. Complete 10 reps or two minutes.
Modified Psoas Stretch
The half-kneeling pose may require a pad for the back knee on some sensitive clients, but otherwise, get them in the deep lunge position with one arm in full flexion overhead (same as back leg). Add a little lateral flexion – flexing to the opposite side of the back leg and reaching arm.
Use a vertical foam roller on the other side to help them balance, and add in belly breathing to assist and augment the stretch further.
Hold for 15-30 seconds per side and turn it into a PNF stretch if appropriate.
This one is a little hellion. The “key” to your knee drops down in a “V” formation from the upper outside of your knee to the lower inside, crossing the joint posteriorly. Much like QL, when the knee gets “tweaked”, popliteus jumps to the rescue and locks the whole thing down.
This can be problematic when the client’s activities demand a lot more than just flexion and extension from the knee, like pivoting or another tri-planar exercise. If you don’t suspect something more serious, or have a go-ahead from their doc, or are just trying to avoid the issue altogether, try these:
Either sitting on a mat with the leg out or loaded on a machine, get the patient to “pump” the quad and practice getting the knee used to full extension. This is a great way to stretch one side of the joint and strengthen the other. Make sure there’s full, slow, controlled contraction without letting the patella jump around.
I typically guide 5-second holds at 10 reps.
From a seated position, have the client do an internal and external rotation of the tib/fib. Initially, if there’s not much control or ROM, have the client put a few fingers on their tibial tuberosity (the lower part of the patellar tendon) and feel for movement. You can also watch the foot placement as you pivot on the heel through the rotation. Two second holds on each side, 10 full pivots per side.
Single Leg Balance
Any variant of this is helpful. It’s the intersection of strength and stability, and fully supports motor control throughout the lower extremity and associated myofascial chains. Place a “Bosu” or “Airex” pad down to assist in perturbation. The less stable the surface, the better, but meet your client where they’re at.
Work toward three sets of 1-minute holds.
The rotator cuff can be a mystery sometimes, but fear not – supraspinatus is a push-over (if you know where to push). The superior-most rotator cuff muscle sits in the self-titled “supraspinatus fossa” atop the shoulder blade. Its main job is to stabilize the humeral head in the fossa, but it also aids in shoulder abduction, especially from 90 to 180 degrees.
Overlaying these bad-boys are the upper traps, and occasionally levator scapulae or rhomboids can join in the myofascial-mix when there’s an issue here. This muscle, like the previous two mentioned, can be the chicken AND the egg…
If all else is fine and supraspinatus throws a fit, everything falls into disarray, as well as its behavior of characteristically overcompensating for imbalances elsewhere in the shoulder. So how do we appease this beast? Simple:
Lacrosse Ball SMR
Pin a ball against a wall at the top-inside of the shoulder blade, where the levator and rhomboid attaches. Let the opposite shoulder come off the wall so your chest is pointed about 45 degrees off parallel. Now let the pinned-side arm reach across the body, using your free arm to assist the stretch. 20-30 seconds per spot, 3 spots per side.
After, find a doorway or column and bend over at the waist, pinning the ball at the upper trap/supraspinatus region.
Do at least 20-30 seconds per side for trigger-point therapy, being sure to hit three spots per side, and waiting for some release in the muscle.
Side-lying Shoulder Abduction
This is the most proven exercise for full rotator cuff activation. Have the client lie on his side with arm resting on the body and then lift a lightweight or “BodyBlade”-like bar from neutral to about 45 degrees if possible. Perform three sets of 12 reps.
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