Tony Comella Physical Therapy

SMALL CHANGE, BIG IMPACT When making subtle changes to our shin and torso angles, we can perform the split squat a variety of ways. . By doing so, we manipulate the moment arms and force vectors which can be considerations for both individuals looking to train around pain or maximize performance.... . 1. Forward torso and forward shin 2. Forward torso and vertical shin 3. Vertical torso and vertical shin 4. Vertical torso and forward shin . What variation(s) do you think are potentially better for knee pain? Hip pain? . Is there a variation you think is more adventitious for quad development? Glute development? . If you want to learn more, I have 3 separate Youtube videos on the topic which you can watch on the E3 Rehab YouTube channel (link in bio), or if you aren’t into videos, I have a blog on the topic you can read at e3rehab.com/blog/split-squat-biomechanics. See more

WRIST PAIN AND PUSH UPS In college, I broke my wrist twice and as a result, I could not perform push ups with my wrist fully extended. This went on for a long time until I finally built up the tolerance to it. Then last year, I ended up injuring that same wrist again. Occasionally, I can tolerate bodyweight push ups with my wrist extended but sometimes I can’t or if I add weight, it definitely requires me to adjust my hand position. Therefore I default to one of the options... shown (my personal preference is plate and dumbbells). . If you are someone who has wrist discomfort with push ups, hopefully one of these options will also be helpful for you! . Plate: hanging the fingers off a plate will put less tension in the forearm flexors, thus potentially allowing the wrist to be more comfortable in the extended position. . Barbell: we can perform these with either wrist extended or neutral (picture shows extended). The position can take the forearm flexors off tension, or place wrist in neutral. The barbell is just another modality to consider. . Dumbbells: by moving the wrist into a more neutral position, it is typically more tolerated. The dumbbells also allow one to play with various angles. (If you are performing on fists, this is good alternative). . Towel: if you lack gym equipment, here is a simple solution. A towel placed under the heel of the hand will minimize wrist extension. Alternatively, you can also use it as similar set up to the plate. . These are all modifications for the wrist, a common area of discomfort. To learn about how to modify the push up when other joints are hurting, head to link in bio to check out a YouTube video on the topic! See more

Looking for some home workout ideas? Check out the Copenhagen plank. This video dives into the research, how to perform it, progressions/regressions, as well as provides sets/reps.

HARDER THAN THEY LOOK Some of you will think these exercises seem easy, but I challenge you to try them out before making any judgements . . Hamstring isometrics focus on an activating our hamstrings while not actually moving our hip or knee (the joints hamstrings are responsible for moving).... . By using a longer lever arm (legs almost straight), we create a very challenging environment for our hamstrings. . Bridge variations. Find an appropriate knee angle, bridge up, and hold. If you struggle with 2 legs almost straight, just bend the knees to an angle you can hold. Once mastered, move on to marching and then finally single leg. . GHD variations. Also known as Sorenson holds, these will require increases work of the low back too (compared to bridge). You can perform double or single leg options. Marching not recommended . . Start with holding for as long as you can double leg. If too easy switch to single leg and build up your capacity for longer holds (>60 sec). . How long can you hold these positions? See more

BANDED SHOULDER DRILLS There are numerous exercises we can perform for overall shoulder health. Here are just a few options, utilizing only a band: . 1 Snow angels. Goal is to keep elbows straight and not let the band pull our arms forward. As we move our arms above our head, it gets increasingly challenging, so keep tension on the lighter side.... . 2 Face pull Y press. We cover a lot of ground with this move- high pull into external rotation into overhead press (y position). . 3 Diagonals. We cannot ignore the simple movements. Diagonals are a staple in a lot of prehab/rehab programs because it simulates the shoulder beyond sagittal (front/back) and frontal (side to side) planes. These are 3 simple shoulder exercises to mix into your warm-up or exercise routine for overall shoulder health. . Tag a friend who could use these shoulder exercises! See more

ROTATION BASED MOVEMENT Movement in the transverse plane will include exercises involving rotation of the hips and/or trunk. . We don’t use these a lot in traditional strength training (i.e. squat, deadlift, push, pull), but they should be a consideration for athletic development, as well as simply exposing the body to movement variability.... . Here are a few exercise to sprinkle into your current routine: . 1 Cable lift and chops. You can do these standing, kneeling, half kneeling and even lying down. Depending on the variation, it can include trunk with or without hip movement. . 2 Medicine ball toss. There are a variety of variations but shown are standing and shuffle. These will obviously include rotation with emphasis on power. . 3 Side plank. Typically a frontal plane movement, this variation gets a dash of rotation. . 4 HK rotational cable press. What is your favorite rotational exercise? . See more

. CORRELATION IS NOT CAUSATION You have low back pain because your core is weak. .... Have you ever heard or said this statement? . It is important that we, as healthcare providers and coaches, are mindful in our word choices and explanations, as they can have a huge impact on an individual’s beliefs, promote fear, and lead to fear avoidant behaviors. . 1 Words matter. The explanatory model that insufficient muscular support (i.e. ‘weak’) results in a vulnerable spine can have a dramatic impact upon people’s lives. Are your words creating a nocebo effect or are they empowering? . 2 Pain is complex. Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components. To say pain is strictly due to a biomedical reason (i.e. lack of muscle) is incorrect. There are more pieces to the puzzle. . 3 Core exercises are NO different with long term outcomes than general exercise for treatment of persistent low back pain. Find activities that are meaningful and patients will actually do. . 4 Although engaging core exercises can make you feel better, we cannot rule out 1) time and/or 2) the analgesic effects of isometrics. These exercises are commonly prescribed because they are safe, limit overall spine motion, and can reduce pain pressure thresholds (isometrics). . 5 Individuals with chronic low back pain exhibit higher global trunk muscle activity. Some research shows more core activation in those with low back pain vs non painful populations. There is nothing wrong with providing planks, bird dogs, side planks, etc., but we need to be more conscious in the narratives we use. . For more info- check link in bio! . . . . Darlow B et al. The enduring impact of what clinicians say to people with low back pain. Kosek E et al. Modulation of pain thresholds during and following isometric contraction in patients with fibromyalgia and in healthy controls. Ghamkhar. Trunk muscles activation pattern during walking in subjects with chronic low back pain: a systematic review. Wang et al. A meta analysis of core stability exercise versus general exercise for chronic low back pain. See more

. DOLPHIN POSE FOR SERRATUS ANTERIOR The serratus anterior is commonly trained in protraction (shoulder blades apart), but it is also an upward rotator of the shoulder blade. Dolphin pose is a movement that emphasizes both shoulder blade protraction and upward rotation in a closed chain position. Here are 2 variations: .... 1 Transitions. Move shoulder blades together then apart (scap push up) then transition in to dolphin pose. Transition back and repeat. . 2 Scapular push ups in top position: once you reaching top of position, hold and move shoulder blades together and apart. This will facilitate protraction and upward rotation, maximizing serratus. The shoulder and its muscles work as unit when we do tasks such as reaching overhead or moving weight. With that said, don’t solely focus your training or rehab on isolation exercises for muscles (i.e. serratus anterior, low trap) because we will be missing out on the bigger picture. Larger movements like overhead pressing and pulling are extremely important. . A final consideration is utilizing both closed chain (i.e. push ups) and open chain exercises (i.e. shoulder press) for overall shoulder health. Although I am sure many people have done this movement before (and probably better), credit to @dr.surdykapt who I learned it from first. Tag a friend who could use this! See more

. MODIFICATIONS FOR WRIST PAIN The push up (and plank) requires about 90 degrees of wrist extension. If we are limited with this motion or an injury has made it unrealistic to tolerate the position, we have a couple options. We can stop doing the activity or we can modify. I am an advocate of modifying an activity for the individual, especially if such activity is meaningful to them. The push up/plank can be modified multiple ways, allowing one to potentially tolerate, or ...work around pain temporally (with ultimate goal of resuming normal standards). Plate: hanging the fingers off a plate will put less tension in the forearm flexors, thus potentially allowing the wrist to be more comfortable in the extended position. . Barbell: we can perform these with either wrist extended or neutral (picture shows extended). The position can take the forearm flexors off tension, or place wrist in neutral. The barbell is just another modality to consider. . Dumbbells: by moving the wrist into a more neutral position, it is typically more tolerated. The dumbbells also allow one to play with various angles. (If you are performing on fists, this is good alternative). . Towel: if you lack gym equipment, here is a simple solution. A towel placed under the heel of the hand will minimize wrist extension. Alternatively, you can also use it as similar set up to the plate. The expectation is that pain, injuries, and/or discomfort are a normal part of life. It doesn’t mean we need to stop doing the activity we love, it just means we may need to modify it temporarily and/or provide a different stress. Tag a friend who might need this! See more

. TRACKING PROGRESS The push-up can be a challenging movement from some. Maybe you can only do a handful of reps before your forms breaks down, or maybe you are still building to your first full rep. .... In the previous post, we talked about some drills to help develop strength in the top and bottom position, which ultimately will help you master the push up. But maybe you want implement full reps into your program, or the class you enjoy going to uses the push up and you need a modification to match your current level. . This is where the incline, or elevated, push up can be useful. You can simply use a box or bench as an alternative, but the value of the barbell comes from tracking your progress. Here, we ware able to place the barbell at a particular level to match your desired rep range. As you progress over, you can simply lower the bar to match your new strength levels, until you are able to get to the floor. There are a wider variety of levels to chose from and this is easily replicable to other gyms. . Remember there is no set rule saying you MUST perform push ups from the ground. Find an appropriate level for YOU and build progressively over time. See more