The 4 key deficiencies that are common amongst athletes are discussed below. These deficiencies can be corrected for performance gains in training and sport, and even more importantly the injuries manifested out of these deficiencies can be decreased significantly. We thank our sister practice and fellow sports medicine colleagues up in Orange County, Paradigm Performance Chiropractic, for allowing us to reproduce such valuable information from a recent article write up they authored.

Scapular positioning ("wing bone") is the root of all Glenohumeral (shoulder) pathology. Throwing a 100+ pitch game, overhead snatching (for reps) or even worse, falling onto an outstretched arm can cause injury to the shoulder, but even within those type of injuries lies the scapular mechanics that lead to the imbalances that eventually caused the bicipital tendonitis, impingement syndrome or labral pathology (tear, fraying, degeneration). Furthermore, if the lifter lacks scapular positioning, they will struggle to achieve a proper bench or squat setup, due to their inability to create a good shelf for the bar to sit on in the squat or tight base to lay on as they press. If you are not lifting for sport, chances are you are lifting significant weight in daily life (groceries, boxes, pets, babies, children, suitcases, books, briefcase, etc).

So what are the proper mechanics? Professionally speaking, the scapula should initiate movement at 15 degrees of gleno-humeral abduction with an upward rotation glide and slight depression upon end range. This is how a shoulder should move, (for abduction) however biological variabilities from one person to the next makes this difficult to quantify, especially in performance. Proper mechanics can also be defined as the absence of as many abnormalities as possible.  Faulty scapular position and function is known as SICK scapula:

S- Scapular mal positioning

I- Inferior medial border flaring

C- Coracoid tenderness

K- Scapular dysKinesis

We can add a ME component, M- Medial border winging and E- Scapular Elevation. ME SICK.  Correct each of these components of a ME SICK scapula the other defining abnormalities begin to functionally correct themselves. This is why scapular retraction and depression exercises are most often prescribed by sports medicine professionals.

Hip pain and tightness will make it very difficult for an athlete or lifter to squat to/below parallel or get into proper position to begin a deadlift. A common functional cause of biomechanical tightness or pain in the hip at smaller angles as the hip is flexed is due to posterior hip capsule tightness. Asymmetry in hip internal range of motion demonstrates a tight posterior hip capsule on the decreased range side. The capsule becomes tight and drives the femoral head forward into the acetabulum.

Like with all injuries or abnormalities it is important to rule out underlying structural pathology. Femoral Acetabular Impingement (FAI) is characterized compression of the femoral neck against the acetabular rim, which may occur by two mechanisms known as 'CAM' or 'pincer' impingement, although most commonly by a mixture of both.  CAM impingement is often a result of the head/neck of the femur losing its sphere like shape and forcefully being jammed in to acetabulum tearing away at the articular cartilage. Pincer impingement is often a result of  extreme joint angles which cause the labrum surrounding the acetabulum to tear away from the femur. Both CAM and pincer impingements lead to significant pain and disruption to athletic performance and activities of daily living in athletes.  Femoral Acetabular Impingement (FAI) syndromes may also present with angles that cause retroversion (backwards) or anteversion (forward) positioning of the head of the femur.

Ankle injuries often take months to fully recover from, making ankle prehabilitation part of your routine is crucial to your longevity in any sport.The ability for the ankle to dorsiflex (point foot/toes up towards the ceiling) has major implications for knee and hip mechanics. Lack of ankle mobility will cause an athlete to shift their weight onto their toes as they descend in a squat, thus limiting the ability to engage musculature of the posterior chain (gastrocs, soleus, hamstrings, gluts) and increasing stress on the patella tendons. The problem with lack of dorsiflexion is that there are often times no subjective manifestations of this biomechanical error. Some people will over time complain of plantar fasciitis, anterior ankle pain or medial foot pain.

Typically this is an abnormality that needs to be seen objectively in a squat assessment, or lunge maneuver. If a sporting demand requires the base of an athlete (foot/ankle) to achieve that 25-35° the body will get what it wants. If dorsiflexion is not possible 1 of 2 things happened:

1- catastrophic injury such as talar dome fracture, or Achilles tendon rupture

2- the body compensates and achieves it through compensatory movement.

*The 3 main compensatory movements that will occur are whole foot pronation, knee valgus collapse, and hip internal rotation. For athletes, not good things if your squatting, lunging or on the field of play single leg load bearing.

Lumbopelvic (low back and pelvis) mechanics are truly the most important mechanics in the body and fortunately it is the simplest to train. The function of our “core” has very little to do with how we traditionally have trained our core. A common problem among lifters is posterior pelvic tilt, or the loss of low back arch when the hips rotate under the body, this is detrimental to both low back health and maximal lifting ability. Posterior pelvic tilt is a symptom of poor pelvic positioning.

As the Lumbar spine and Sacroiliac joints are held relatively stable, the hip should perform its multi-directional motions we need it to. In this manner we spare injuring tissues in the lumbopelvic region by reducing rotatory and shearing forces. From a sports performance point of view, the core is important to transmit forces produced by the body from one end of the chain to the other. This brings up the utilization of a very rudimentary sequence of neurologic control:

1. Pelvic tilting to achieve a neutral lumbopelvic positioning is a very important piece of the prevention performance paradigm
2. Achieving pure hip hinging with a neutral lumbopelvic alignment is the next step
3. Stress the structures by implementing asymmetrical weight and dependence on one extremity.

This sequence of neurologic education is vital in the preparation to sports performance and injury prevention. These prehab exercises, along with others for SICK Scapula, hip and ankle dysfunction, will be demonstrated in next week’s Topic of the Week.

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