Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 May

Joint Mobility: Reader Question Roundup

QuestionsI got a ton of feedback from my series on joint mobility. As comprehensive as I tried to be in my joint mobility series, I couldn’t possibly address every single malady a person might have. In the comment sections, readers discussed their own specific issues with joint mobility or joint pain, and while I hope my general recommendations for overall mobility helped, more targeted, specific advice is needed for targeted, specific issues. I want to help, so here are my answers to some of your questions. Add your own thoughts in the comment board to participate. Thanks, everyone!

Hips

I’m recovering from a hip fracture suffered 18 months ago. Long story short, angulated fix, osteoporosis and post-surgery dvt. I’m trying very hard to regain my earlier active life. I need something gentler to start with. Any thoughts on exercises or anyone with a similar situation willing to share their recovery strategy?

Exercise after deep vein thrombosis is a tricky subject. Most doctors will tell you to avoid exercise, especially strenuous exercise. Anecdotal accounts from places like the CrossFit forums and other exercise communities report success with post-DVT exercise – as long as they avoid pain (and swelling, and anything symptomatic of more DVT). This study (membership required for access) seems to suggest that post-DVT exercise isn’t harmful, and it may even be beneficial to patients looking to resume pre-DVT activity levels. “The results suggested that higher physical activity levels at 1 month may be protective against worsening of the PTS score over the subsequent 3 months.” I wish I could be more specific with exercise recommendations, but avoiding pain is always a good place to start. Good luck!

I have very “tight” hip flexors. Every time I do these exercises (even just the front-to-back swings), I end up with intense pain from my hip to about halfway down my quad. It hurts for several days. Do I work through it?

Sounds like IT band pain. Most IT band syndrome manifests as knee pain, but the band itself extends up to the hip, and if you have tight hip flexors, the pain will reside in the hips and outer thighs. If I were you, I’d focus on hip flexor stretches and IT band foam rolling. For the stretches, try doing deep lunges while letting the hips drop as low as is comfortable (pain-free).

Thoracic Spine

This may sound like a dumb question but- when doing the initial mobility test, does it matter where the pain is? When I do the test, I feel some discomfort but mostly pain in upper arms, especially when my wrists get close to touching the ground.

Yep. That’s a sign of thoracic immobility. Remember, our parts are interconnected and highly interdependent. Immobility in one area manifests as pain in another.

My shoulder width is slightly over 45cm. The foam rollers apparently comes in either 45 or 90 cm length. 90 is just unpractical long. Is 45cm too short for me?

PS: I must say that 45cm seem like a really stupid size…

Spring for the larger size. Move some furniture if you have to. And I agree: 45 cm is a pretty silly size.

Wrist and Ankles

If we’re supposed to be landing with a dorsiflexed ankle during sprinting aren’t we landing with our heels, promoting shock up the bones into the joints? Or is there something more subtle to the form that I’m missing?

Take shorter strides. In barefoot running, you can land dorsiflexed and forefoot first as long as you take shorter strides. Avoid the mindset of longer strides being superior. Remember: running and sprinting aren’t composed of miniature leaps with outstretched legs. You’re pulling yourself along with compact movements.

Thanks Mark, I hope your post tomorrow addresses ankles that have been twisted. I have had some bad ankle twists in the past few years that have left me with poor ankle mobility and prone to more twists.

and

Mark-or anyone else-do you have any ideas? It’s unstable on full heel lifts compared to the left ankle-wobbles in and out-yet the left ankle is the one that I am prone to turning. I’ve done myriad versions of heel lifts, but I don’t think it focuses on the right part. Am I hopeless?

How’s your one-footed balance? Are you still wearing shoes, especially big heavy clunky ones? Work on closed-eye, single foot balance (with both feet, not just the injured one). Do it in bare feet. Try not to use your flailing arms and body weight to maintain balance; instead, focus on “grasping” the ground with your feet and activating your lower leg and foot muscles. Stabilize yourself. Keep doing this until it’s second nature, and your improved foot and ankle proprioception will help prevent any future sprains. Also – learn to function barefoot and stop taping up your ankles (if that’s what you’re doing).

Shoulders

My husband has been dealing with Adhesive capsulitis (frozen shoulder) in both of his shoulders for almost a year now…. But, my husband is also diabetic which seems to play some roll in it but we’re not sure what….

I know a bit. I know that adhesive capsulitis incidence is elevated in diabetic patients. Inflammation also plays a big role in its development. Is your husband taking fish oil? I’d consider upping the dose to around 5-6g per day to reduce inflammation. Maybe add in some glucosamine, chondroitin, and MSM supplements (or drink your bone broth and eat your tendons). Avoid stress, and do what he needs to do to get plenty of sleep. Eat an anti-inflammatory diet – drop all grains, excessive starches, vegetable oils, and sugar. Another risk factor for adhesive capsulitis is the presence of autoimmune disease, so you’ll definitely want to avoid grains, legumes, and anything containing high levels of lectins or gluten. Anything that can increase intestinal permeability and start the autoimmune chain reaction is to be avoided. Hopefully that will help speed the physical therapy process along. Good luck!

how about everytime u do a pull up or sit up and one of your shoulders makes a popping sound over and over like something in my socket is moving? it doesnt hurt at all, but it feels weird and puts me off doing more reps than i want to.

I’ll direct all cracking and popping questions to Steven Low’s excellent article at Eat. Move. Improve.: “Cracking and Popping and Clicking, Oh My!

I have trouble with my arm going numb when my arm is forward. I have front shoulder pain and know that I have a pinched nerve between my 5th & 6th verebrae. I personal train 3 times a week & other strenuous exercises the rest of the week. This shoulder pain is inhibiting me from my full potential as an athlete. looking forward to your articles

C’mon, man! Your arm is going numb on a regular basis, you have a confirmed pinched nerve, your shoulder hurts, and you’re still engaging in strenuous exercise all week long? Take a full week off. Rest, ice, and start taking fish oil if you haven’t already. Explore your range of motion (without weights) and move on from there. Do the shoulder mobility and stability drills, and check your posture. Do you slump forward at the shoulders? Do you sit at a desk or hunch over a laptop? Fix that before you start working out again or you’ll truly risk inhibiting your full athletic potential. Good luck, and don’t be afraid to rest!

Mark, thank you! I have messed up my right shoulder twice now and have sort of become gun shy with weights. I stopped wide angle pull ups and military press because my rhomboid section closest to my spine locks up and twitches. I have been doing a bunch more power yoga to try to loosen it, but even that hurts sometimes. I can’t figure out if it’s my AC joint or rotator cuff that clicks. Do you have any suggestions as to what exercises I could do to help loosen it up?

When you do pull-ups, are you engaging your scapular retraction, or are you going kyphotic and letting your shoulders slump forward? Do the former and avoid the latter. When doing pull-ups, visualize your elbows slamming against your ribcage; this will help you engage your back and keep your scapulas retracted. Avoid jerking movements (like kipping pull-ups), which can throw your joints out of balance if you’re not careful or if you’re already lacking in mobility/stability. Instead, work on slower, controlled, more deliberate lifting for the time being.

I hope these answers helped, and if you’ve got any more feel free to hit up the comment section!

You want comments? We got comments:

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  1. Great Post, you answered some crucial points made from the orginal post.

    I personally like the pullup answer, as i’m a big fan of using the bodyweight with exercises.

    Take Care,

    Richard

    Richard Huntley wrote on May 27th, 2010
  2. Great posts Mark! A couple of tips for ankle proprioception… After you master barefoot balance, try it on a pillow…brush your teeth or wash dishes on 1 foot. Toss a ball against a wall (both forward and sideways) and try to maintain that balance. Keep challenging yourself!
    A good shoulder stabilization exercise is pushups with your hands on a stability ball. Start with feet on the floor and move up to feet on a bench. Don’t let your scapula wing out!
    Good luck!

    maureen wrote on May 27th, 2010
  3. I went over to the article on joint noises, and it was very enlightening and exhaustive. Largely backs up what I’d heard that if you don’t hear some noise, then there could be an issue.

    Given the ties between inflammation and heart disease, plus just about anything else you can name, shouldn’t everyone be eating an anti-inflammatory diet?

    John Solter wrote on May 27th, 2010
    • Quite and as a guy posted elsewhere which really made me smile ‘wheat is murder’ …

      Kelda wrote on May 27th, 2010
  4. Thanks Mark – this whole series has been very helpful. BTW, it is very easy to cut the foam rollers if they are too long. I just used an ordinary serrated bread knife.

    Kathy wrote on May 27th, 2010
    • That’s a great use for a now redundant bread knife :-)

      Kelda wrote on May 27th, 2010
  5. @ the guy about foam roller size. Get the big one and cut it. I imagine you could buy a cheap saw from Walmart or something and spend under 5 minutes cutting one to whatever size you desired.

    Paul Von Tersch wrote on May 27th, 2010
  6. thank you for addressing these questions mark!!! the link about clicking and popping was very informative.

    norcalgal wrote on May 27th, 2010
  7. There’s a guy I know who has made a ton of sturdy rollers using padded PVC pipe. Some of the local Crossfit affiliates get theirs from him, and my wife and I bought two from him for a pretty reasonable price. His name is Declan Cummings and his email is dentity1024@gmail.com – I’m sure he’d be happy to make you one any size you want and ship it to you.

    -jag

    Joshua G wrote on May 27th, 2010
  8. Mark thanks for the articles and links they have been very enlightening. I’m probably one of the stiffest joint and muscle people you would ever meet. Can anyone recommend a book and a DVD that covers all or most of the parts of the body covered by Mark? My back, neck, shoulders and hips are the worst but my whole body needs to be more mobile. I want to increase mobility before I start my strength training.

    Skids wrote on May 27th, 2010
  9. Hey Mark,

    Thanks for the link back. Love your site.

    If you want me to answer Q’s regarding anything like that feel free to contact me.

    Steve

    Steven Low wrote on May 27th, 2010
  10. >> Spring for the larger size. Move some furniture if you have to. And I agree: 45 cm is a pretty silly size. <<

    Who says you can't cut it to whatever size you want? Grab the 90 and trim it to whatever size you want.

    CJ wrote on May 27th, 2010
  11. Cool! My post about barefoot running and dorsiflexion actually made it onto the post! Thanks Mark, your reply totally answered my concerns.

    Now time to get out there on barefoot full force!

    Allen wrote on May 27th, 2010
  12. Again Mark…your attention to detail is amazing, your articles timely and meaningful and the entire MDA site an indispensible tool!

    Mike Cheliak wrote on May 27th, 2010
  13. Those ankle problems are tricky. I noticed that during times of my life when I did not have any serious forms of active exercise, my ankles became weak and any slight wrong step would quickly result in a sprained ankle because the ankles muscles were not strong enough and fast enough to pull my ankle back to straight in time to prevent a twist. I found that exercise that involves myriad ankle movements and stresses from multiple angles were most effective at strengthening and healing-activies like tennis, badminton, and hiking. The trick was to perform the exercise without accidently twisting the ankle again before it was fully strengthened! I do think that no matter how great your reflexes, if your muscles are weak, it’s very easy to reinjure. Sometimes the ground is just uneven and if you don’t notice that before you take a step, you will want/need those muscles to be strong enough to compensate.

    Eva wrote on May 27th, 2010
  14. My additions –

    1. for ankles – here is a vid of what Marc talks about:
    http://www.youtube.com/watch?v=WasAvem3Lco

    – if you have an exerdcise band, here is how to improve ankle strenght:
    http://www.youtube.com/watch?v=2Opx59IaDQM

    2. For shoulders, if you have any issues, avoid wide griop on any lifts – go with the natural shoulder width grip

    Yavor

    Yavor wrote on May 28th, 2010
  15. this is really an interesting blogpost that i’ve read so far today.

    healthyway weightloss center wrote on May 28th, 2010
  16. Another alternative to a foam roller is to go to home depot and buy PVC at whatever length you want, get some insulation tubing (to fit over the pvc), and some gaffer tape to tape it up. If the tubing deteriorates, just replace it with new tubing and retape.

    Frank wrote on May 29th, 2010
  17. After reading your article on cardio I understand why Tai Chi has so many benefits for flexibility. I find it an excellent aerobic exercise that has maintained my body in an almost arthritis mode for many years.

    Maureen Grantham wrote on May 29th, 2010
  18. Do you have any info on the sacral iliac joint. I suffer episodes of pain and then it eases off only to be repeated. I am of the belief that this is due to tight and/or weak muscles and inflammation. If I am right, which muscles/areas are involved to create pain in this area? If I am wrong, could you please educate me. I speak to a lot of women that suffer in silence from this because we think we we can do nothing about it.

    Thanks!

    kim wrote on June 2nd, 2010
    • Kim,

      If your SI joint pain is chronic and progressive and doesn’t respond to any of the typical treatments, it could be a type of arthritis known as seronegative spondyloarthropathy. Google ankylosing spondylitis and psoriatic arthritis and see if the symptoms match what you are experiencing. These conditions are pretty rare, so it’s probably not this, but you should check it out anyway.

      I suffered for 15 years before I finally figured out what was going on. Luckily there are great meds avail nowadays. I also have to eat a clean, anti-inflammatory diet [no grains, no gluten, no eggs, no dairy, no legumes, no nuts, no seeds, no nightshades].

      Costello wrote on June 9th, 2010
  19. SI joint pain, in my experience, is most typically due to short hip flexors. These can be carefully and slowly lengthened with yoga (cobra pose), laying on the edge of a firm bed and letting the leg sag down while the other and the body are still flat on the bed, and by very gentle, mindful stretching by lifting the foot of the offending leg back, grabbing that foot by reaching behind and, while keeping the pelvis tipped back at the top to protect the SI joint and lower back, opening up the front of the hip joint. Be very slow and gentle with these or you will worsen the SI problem. Heat on the hip flexor on the painful side (front of that hip) while lying on back will help release an already braced flexor and reduce ongoing SI pain.

    Bruce Ammons wrote on June 3rd, 2010
  20. This write-up gives the light in which we can take notice of the reality. this really is extremely nice one and provides indepth information. thank you for this nice article

    Jasmine Kjellman wrote on June 18th, 2011

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