Last month, we interviewed Michele Frances, aerialist and PT, based in Austin, TX. She provided a video tutorial on hip anatomy and shared her perspective on aerial training as a coach and physical therapist. When asked her opinion on the most common errors in training that lead to injuries and how they can be prevented, she said shoulder biomechanics, rhythm and range of motion.
So, we decided to continue the topic of physiotherapy, and connected with another PT who writes the Cirque Physio blog, Dr. Jennifer Crane of San Francisco. Jen explains that PT’s can address physical limitations and injuries, and let you know if you should change the way you train, stop training and/or see an orthopedic physician to get an xRay or MRI. They can also assist in meeting your goals or help you with performance enhancement by way of manual therapy or targeted stretching, and prescription of injury prevention programs to make sure you’re training in the smartest way possible.
Earlier this year, she published a shoulder series on her blog, and we’ve summarized some of the points below for a high level overview. Since there’s so much material, we will break it into two separate posts and will include plenty of links to the source for more detailed information and instruction.
To lay the groundwork on the shoulders, Jen provided a basic outline of the muscle groups and their function. She broke it down into two different types:
“Movers” the big muscles – lats, traps, and pecs, who’s purpose in the shoulder is to produce big and powerful movement, like climbing up a 30 foot silk.
“Stabilizers” the smaller muscles that fine tune shoulder movement and ensure optimal shoulder-to-shoulder blade alignment. The major stabilizer muscles in the shoulder are the muscles that make up the rotator cuff.
There are four muscles that make up the rotator cuff: the supraspinatus, infraspinatus, teres minor, and subscapularis. All of these muscles originate on the scapula (shoulder blade) and attach on different parts of the humerus (the top of your shoulder). They keep the head of the humerus positioned in the middle of the socket while your arm is moving, which is very important for circus practitioners. ‘If you’re doing a meat hook, climbing a silk, or working on a one arm handstand,’ she says, ‘your rotator cuff BETTER be in top shape.’
We will explore the role of the rotator cuff muscles and how to strengthen them in next month’s post.
Her next post in the series took a look at one of the big ‘mover’ muscles, the #circuslats. It’s muscle most aerialists love when they’re using them, but hate when they’re trying on clothes in a dressing room, especially if you get stuck!
Jen explains that the lats are a huge muscle that affect many regions of our bodies. They attach from the midback to our sacrum (T7-L5, and sacrum), the lower part of our shoulder blade and the lower three or four of our ribs. They course under your armpit and attach on the top part of your upper arm.
They can affect way more than just your shoulders, resulting in pain, stiffness, or dysfunction in your low back, hips, thoracic spine, ribs, and of course, the shoulders. If your lats are too tight or dysfunctional, she mentions that these tricks might be extra tricky:
• Backbends – with or without arms overhead
• Moves on silks/rope involving a flamenco grip
• Attaining or maintaining a straight line through your shoulders in a handstand
• Generating power in the ‘sweep’ component of your swing on flying trapeze
• Controlling the descent of a straight arm inversion (straps, silks, rope trapeze)
• Keeping your ribs in during a handstand or hand-to-hand
How do you know if yours are too tight? Jen provided a ‘lat wall’ test to help self assess.
Starting position: back to wall, scoot feet forward and flatten your low back completely against the wall. Engage abs to keep ribs in.
From here, raise one arm in front of you slowly as far as you can, with your thumb up. Use your other hand to monitor the point at which your back comes off the wall. Take a photo at the point right before your back arches off the wall. This is your functional lat muscle length.
Hand balancers, contortionists, and aerialists for example, need adequate lat flexibility and control. Jen recommends at least an angle of 180 degrees of active range of motion, but reminds us that the best way to determine your specific needs and goals is to obviously see a sports medicine provider to properly assess you.
Since the lats are such a huge muscle, her subsequent post went into more comprehensive ways to improve lat flexibility, and injury prevention. She outlined the difference between active and passive flexibility, and end range control as they relate to this topic, and the importance of balancing the ratio between them in your practice.
Passive flexibility: The total length a muscle can stretch when it is being pushed by an outside source, like sitting in over-splits, or in contortion class when your instructor is cranking your leg into flat middle splits.
Active flexibility: The ability of the muscle group opposite of the muscle being stretched to overpower gravity (WITHOUT assistance from an outside source) and move the limb as far as possible into the stretch. Like a dèveloppé into arabesque in contortion.
End-range control: 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. For example, in a side-scale, once you hold your leg as high as possible and you release your arm, does your leg drop down a little? If so, you could work on more end-range control of your flexibility.
In general, she says her recipe for working with a patient on improving flexibility, always these three components. One of the greatest predictors of injury in performing arts, she says, is the ratio between passive-to-active flexibility. If your passive range far exceeds your active range, you are more likely to experience injury at the joint. When she assigns corrective exercise programs or functional warm-ups, she says she usually has at least one exercise for each category, completed in the following order:
1. Cardio for at least 10 minutes.
2. Passive stretch with a contract-relax component. This is a type of proprioceptive neuromuscular facilitation (PNF) in which she says we can safely “trick” the muscle we’re stretching into stretching a little bit further by first making it contract. An example would be to stretch passively for 15 seconds, then contract for 5-8 seconds, usually about 4 cycles of this.
3. Active flexibility to take the muscle through a full range of motion into end range of motion, usually with resistance via a weight or a theraband. Her favorite type of active flexibility exercises not only activate the mover muscles surrounding the stretching muscle, but also your core…the body works as a whole, not as separate pieces.
4. End range control, typically starting by focusing on activating the antagonist muscles only in the last 10-20 degrees of active range of motion in that joint. This is usually the most difficult component of flexibility she explains, and tends to be incredibly tiring for these muscles. Jen believes it’s this aspect of flexibility training that is KEY in preventing injuries in performing artists.
She provided 3 exercises to target the lats, in a balanced way.
External rotation-biased lat stretch – stretches the fibers of the lats that are responsible for internal rotation of the shoulder.
• In childs pose with elbows shoulder width apart on the bench, and yoga block in hands, let chest sink, hold 10-15 seconds.
• PNF contract-relax: gently push your elbows down into the bench while squeezing the ball/block. Hold for 8-10 seconds, then relax and stretch slightly further.
• Keep your ribs in the entire time; if you let them splay out, you allowing spinal extension, which significantly decreases the effectiveness of this exercise.
If you feel a pinching sensation in the front of your shoulders, back off the stretch and widen your elbows. If it persists, STOP.
Modified dead bug for active shoulder flexibility – encourages parascapular muscle activation and active control of lat flexibility.
• Use a theraband or tubing around stall bars (or similar). Hold ends of the theraband with your thumbs pointing up.
• Engage abs and focus on keep your ribs in. Bring arms overhead and simultaneously lower one leg
• Maintain contact of LOW BACK FLAT ON THE FLOOR. If you arch your back, the exercise is pointless. Return to start position, switch legs. 2-3 sets, to fatigue.
• You absolutely MUST breathe during this exercise. If you hold your breath, you substitute by using your diaphragm instead of your abs for the core strength component.
Child’s pose shoulder elevation for end-range control – activates your rotator cuff and scapular muscles during overhead, end-range activities.
• Start in childs pose with your thumbs up.
• With one arm, engage shoulder elevators by shrugging your shoulder up slightly. From here, lift your arm up as far off the floor as you can. It may not be very far, but thats ok!
• Engage the muscles around your shoulder blade to start to maintain end range position
• Hold this end range position for 5-10 seconds, then switch. 2-3 times to fatigue.
Next month, we will dive into the rotator cuff muscles, the pec minor, and the thoracic spine.
Dr. Jennifer Crane is a physical therapist, athletic trainer and board certified orthopedic specialist. She has been a sports medicine professional for eight years, and has worked with a wide variety of athletes and performing artists throughout that time. Most recently, she spent seven months in China, working and traveling with the Chinese Olympic Teams in preparation for the Rio 2016 Olympics. While in China, she worked with multiple sports teams: diving, weight lifting, fencing, gymnastics, synchronized swimming, and track and field. Of the athletes she worked with, 18 of them went on to get an olympic gold medal in Rio. Now happily back in San Francisco, Jen is resuming her physiotherapy practice where she specializes in injury prevention and treatment of circus artists. Over the past three years, she has worked with performing artists of all specialties and all levels, from the brand new aerial student to professional acrobats, aerialists, handbalancers, and contortionists. When she’s not working with circus artists at her clinic, she can usually be found standing on her hands, swinging on flying trapeze, or spinning on a single point trapeze.
Check out all of her content at http://www.cirquephysio.com
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