The most important thing an athlete can do to prevent injury and attain his goal is something most never bother to do.
By Daniel Duane
Before my old neck, shoulder, and knee injuries flared up, and before I learned that “postural alignment” and “muscle imbalance” were more than buzzwords bandied about by crackpot chiropractors, I loved my workouts. I was running. I was surfing. I was even doing a home-brewed version of CrossFit, blending Olympic power lifts and sprints with kettlebells and old-school body weight stuff, like dips and pull-ups. Then my joints began aching worse than ever, my progress slipped, and I decided it was time for answers. I’d once heard Andy O’Brien, strength and conditioning coach for the Florida Panthers NHL team, talk about how serious training with an imbalanced body can lead to serious injuries, so I made him one of my first calls. He immediately connected me with Dr. Steve Dischiavi, the Panthers’ team physical therapist.
“If you’re talking nontraumatic sports injuries from chronic overuse, 95 percent of them are caused by bad postural alignment and muscular imbalance,” Dischiavi told me. In other words, we don’t get hurt just by playing hard; we get hurt by slouching through life and strengthening some muscles while ignoring others. Take me, for example: I slump in front of a computer all day, then go do a lot more push-ups than back exercises because I can see my pecs in the mirror.
“So what you’ve done over the years,” Dischiavi said, “is you’ve adaptively shortened all the tissue in the front of your body, building up your chest, and that causes your shoulders to pull around. It caves in your chest and pulls your head forward. Now couple that with a sedentary job, and you’ve become imbalanced.”
Even as we spoke on the phone, the source of my neck pain seemed like a no-brainer: Tilting my head down while jotting notes causes a lot of strain on my neck. My shoulder problem was caused by tight pectorals and a weak upper back, which can shift a shoulder joint forward, out of its proper position. When you paddle a surfboard, or even play catch, the ball of the joint won’t rotate properly in the socket.
My knee problem was the most interesting. I’d had so-called patellofemoral syndrome for years, meaning my kneecap doesn’t track properly on top of my thigh bone. Dischiavi explained how posture can be the culprit: He told me to stand with my feet side by side, arch my lower back so that my belt buckle slumped forward, and notice how it rotated my thigh bones inward. “Now stand like an old man,” Dischiavi said, “with your butt tucked, and you’ll see how your pelvic bone rotates upward, the arches of your feet pick up off the ground, and suddenly you’re bowlegged.”
Neither of these rotations is a big deal when you’re walking down the hall, but when you start running hard they can make your thighbone grind painfully against the underside of the kneecap. Dischiavi told me I needed to start strengthening my weaker muscles to cure my imbalances — and fast — before I got seriously injured.
Every sport — and for that matter, every chair you sit in — forces your body to do unnatural things, over time. Just like a desk jockey’s head and neck crane ever farther forward until he’s got constant upper back and neck pain, Dischiavi’s hockey players spend huge amounts of time bent forward on the ice, their upper bodies rotating mostly toward their strong stick sides, until they can barely stand up straight. And there’s now very little disagreement in the sports medicine and training communities that postural alignment and muscle balancing are critical for athletic performance.
The first step for anyone who wants a less painful and higher functioning body is a personalized analysis. “You have to look at your posture, figure out which muscles are overactive and strong, which are underactive and weak, and then overcome those things,” O’Brien says. “Otherwise you’ll just keep reinforcing faulty movement patterns and get injured.”
I live in San Francisco, not Fort Lauderdale, where O’Brien and Dischiavi are based, so my next calls were to Lance Harriman, a physical therapist, and Callum Keith-King, one of the best-known trainers at Diakadi Body Personal Training and Wellness Center. (To find an alignment-savvy trainer near you, look for one who’s a certified manual therapist.) Both guys recognized my posture problems after a minute of looking me up and down, and both understood that a remedy meant teaching me proper posture, developing personalized exercises to maintain it, and then attacking specific muscle imbalances (see above).
Harriman started by getting me down on the floor and putting me on a hard foam roller. He moved my shoulders through different positions until he figured out exactly where it hurt. Then he showed me ferociously intense chest and shoulder stretches that I’m now doing at home, every day. Keith-King focused on the strength aspects: leg presses with a lightweight ball between my knees to strengthen my vastus medialis muscles, which would allow my patellae to track properly; a battery of cable pulls to strengthen what’s called the “rear shoulder girdle,” meaning all the muscles that counteract the pecs; and exercises aimed directly at postural muscles, like lying stomach-down on a mat and flexing up into a Superman pose.
Two months in, I’ll admit I’m not completely fixed. Dischiavi also cautions that back exercises and chest stretches might not get me all the way home. I’ve had bad posture for so long that some of my tissue may be too stiff and “fibrotic” — to use Dischiavi’s word — to loosen up without direct intervention, meaning I may eventually need a physical therapist to get in there with his knuckles and break down tight tissue. But my push-ups and military presses don’t hurt my shoulders like they did even a month ago. My post-run ibuprofen count is down from four Advil to two, and the best part has to do with a mystery that’s been plaguing me for decades. At age 18, I measured 6-foot-2-1/2 during a routine physical; throughout my 30s, that number declined. Now, that posture work has me standing tall and back to my old height.
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To see our exercise regiment designed to cure muscle imbalances and prevent injury, click here.
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This article originally appeared in the July/August 2009 issue of Men’s Journal.
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