Thursday, November 19, 2015

If I told you your back could be strong for a lifetime by just using just one technique..
The not so secret truth about sparing your back using the concept of a  neutral spine. 

It's a universally agreed upon notion..
You have always heard "lift with your legs and not with your back", but what does that really mean?  When it's discussed here in our office, a common excuse not to, is that "my knees are too bad to squat and lift". But as you will find the squat lift is not the only way to protect your back.  There is a common theme in exercise and rehabilitation, it's the ability to move at the hips without moving at the back. This dynamic protects the back and allows the force to be carried where it designed to...The hips.
The basic athletic stance

The dead lift

The Yoga half standing forward bend
Drum-roll please!
This one secret  movement is called the Hip hinge. Iit can and should be used in all phases of life, and is essential in day to day lifting or leaning over a counter. When applied to exercise; it is the basic athletic position that all athletes get ready to play from, from heavy olympic lifting (Crossfit), to the Half standing forward bend in Yoga.  It's an essential piece of mobility that comes from the hips. It allows us to move from where we are designed to move as explained in my previous blog hereand here, and finally here. 
Is the force with you or against you?

Our lower backs can handle some movement, but when you add weight to those movements or repetitions (working out or manual labor) you start to add deleterious forces(shearing vs. compressive) to the spine.  While the spine can handle a large amount of compressive forces, even small amounts of shearing forces can damage discs, facet joints and strain muscles.  Keeping in mind the fact that low back pain is an epidemic in this country it's easy to understand how common poor mechanics are. Professor McGill at the University of Waterloo likens the lumbar spine to a wire hanger, you can only bend it so many times before it breaks.

The spine can support hundreds of pounds of compressive force

Mastering the Hinge
There is usually a certain technique that works for each individual when training the hip hinge.  Some pick it up very quickly, while others struggle.  The following are some really simple approaches for moving the right way, moving in a way that ensures you'll be "living to move"!
The Waiter's bow
Place your index fingers stacked where you feel the top of the pelvis.  While sticking you buttocks out, try and bring your chest to the ground. You will definitely feel a hamstring stretch. A verbal cue we have had success with is reach for the back wall with the bones you sit on. This is a intuitive way to learn how to hinge, remember everyone's capacity to perform this will vary. If you find there is very little movement before the fingers separate, patience will be required. 
The take home message here is, if the fingers separate, that repetition should stop at that point
The Face the wall mini squat
This move is great for training a proper squat, with weight bearing through the heels of the feet, but the hinge is a integral part of the beginning of the squat so using a shorter range does a excellent job of programming this movement with out any external cues.
Hinge with dowel assist
Using a dowel(broomstick or pvc pipe) is another great way to learn to move from the hips while keeping the lower back stable(which is, what it's designed for).  To perform, take the dowel and put it behind you. The contact points are the base of your skull and the middle of your tailbone.  The most important aspect of this activity is to maintain contacts at all points.  It's less important how low you can go, that part will come with posterior chain mobility and time. 

The Hinge in day to day activities. 
The Golfer's lift
Now that we know how to hinge, we can apply it to some daily activities that may cause injuries.  Using a one legged hinge to pick smaller objects is a great idea, the lower back isn't really designed to bend over and over, so any time we can avoid bending we should. You will note the strait spine in this picture. Using support makes it even safer if balance is an issue, the good news is that you will also get a balance component out of lifting off the ground like this. 

Standing Hamstring stretch
We can get a great stretch through the hamstring and calf by hip hinging, this is one of the top recommended posterior chain stretch that I recommend.  Note how flat the back is, this subject leads through the chest to get the desired stretch on the upside leg. This can also be performed with the heel on the floor.
Toes up, heels down

The stiff legged deadlift(around the house)
Lifting mechanics are the same all around, whether it's a 300lb barbell or a laundry basket. The less we wear out our spines the longer they will serve us, and the more active you can be.  Again note the flat (1) back posture compared to the rounded back (2). 

Conclusion; With a little bit of awareness and some time invested, you can spare you and your lower back a lifetime of heartache.  All of these techniques are prerequisites for the best type of exercise...The functional type that makes you stronger, more durable and lean.  If you need help with any of these concepts or exercises, feel free to reach out or stop by!!
 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 

Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.


Thursday, March 12, 2015

Keys to recovering so you have a successful next workout.. sooner. Part 1; Feeding the machine

Consistency in key in all matters!
In all matters of life and success the key is always being consistent.  The same holds true in exercise and fitness, but what are our limiting factors when working out?  Certainly time and family obligations can get in the way but many times it's the soreness or lack of recovery (of the previous workout) that prevents us from getting to that next workout. This two part post will address what sports science has to offer to allow you to reach your goals faster, by knowing what the professionals know. 
When Soreness Attacks..

Post workout muscle soreness is nothing new to anyone who has exercised. It's universal- no matter what type of workout you do; running, local muscle endurance, body building or power. Its usually and indicator that you've accomplished what you set out to do, whether it was to get faster, gain endurance or achieve a better physique.
Why Am I So Sore?
Post workout soreness occurs from several elements, lactic acid is usually the main culprit. Lactic Acid causes cramping  & is a normal byproduct of muscle metabolism. Lactate clearance is one of the things your body gets better at as you work out more and more(known as a hormonal adaptation). By understanding whats causing your soreness you are better equipped to deal with it.
Know Thy Enemy..
The production of lactic acid is balanced by your body's ability to clear it out, when this process falls behind, the lactate begins to build up faster than it can be cleared. There are ways to speed up this process and providing your body with what it needs certainly is a great start.
Feed The Machine!   (water it too!)
In an earlier post we discussed how far in advance calories and hydration were required to be available for your workout (click here for that post). The truth is that you have to consider what you're eating as well as when you're eating it. Foods rich in B complexes are essential to keeping the energy synthesis moving, and avoiding falling behind with the lactic acid buildup. B1, B2, B6, B12, Folate and Niacin are all needed for the process to work. Getting these vitamins from foods as opposed to pills (Marco-nutrients are superior to Micro-nutrients) also makes a difference. 
Thinking Big (Macro)
Your body can digest vitamins from food quicker and easier than from pills so here's what you need to know;
Thiamin(B1) needed to metabolize carbohydrates

Riboflavin(B2) involved in carbohydrate metabolism
Niacin (B3) involved in protein metabolism

Pyridoxine (B6) Runners should be sure to stock up on these foods as hemoglobin(carries O2) is synthesized from B6, needed for protein metabolism

Folate (B9)

B12 this is a big one!! Needed in Fat, Carb and Protein metabolism, can have serious consequences if missing. If your low on energy, there's a chance you may have a B12 deficiency. Also keep in mind you need B6 to absorb B12, so being deficient in one leads to a deficiency in another!!!
Lay Off the Sauce
How do you feel after a night out on the town? Usually run down and tired, correct? The enzyme we use to metabolize alcohol robs us of the ability to create energy (from Fat, Protein and Carbs). Niacin is the first and greatest vitamin to be affected so if you're going to drink, make sure to boost your B complex and specifically Niacin. Also consider the effect alcohol has on hydration and you can see the double whammy effect drinking has on not only recovering from your last workout, but getting ready for your next one. 
The takeaway message is get plenty of whole foods, lean meats, fish and poultry, and limit alcohol consumption after or before a workout to ensure peak performance.

Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.

Thursday, February 5, 2015

Back to the future, with simple, functional and
intense exercises

In today's world  everything old is new again-retro fashion, paleo diets and now fitness. To help understand why some of these exercise techniques may be right for you, it's best to examine what and who they can benefit.
Each system has its roots in the fitness industry evolution, most are combinations of several systems. It seems some of the conventional wisdom we heard when we were young like "sit up straight" or "eat your vegetables" were actually time proven wisdom. Here's a picture of President Truman's gym; note the rings, medicine balls and gym mat. This was state of art at the time, but let's look at the rings and what that has come of it since then.
Suspension training is nothing new, high school gymnasiums included climbing ropes and rings in simpler times. TRX is a regressed form of gymnastic training.  Bodyweight training is always functional (click here to learn more about functional training), since you have to control the weight you're using which trains your stabilizer muscles, allowing to avoid overuse and ballistic injuries. TRX also allows for some great stretching activities. does a great job putting together just a few of the stretching activities that can be performed.
Who's it good for? Suspension training is excellent for the beginner who cannot handle their full bodyweight in compound movements like the squat, push up and pull up.  As you get stronger (which should occur in the first 9-12 weeks) you continue to progress your training by moving foot or hand position into a more weight bearing position. TRX coerces  you to brace your core promoting "stiffness" and forces you to integrate your core in your basic movements.  
Low back pain patients would greatly benefit from this type of program after rehab that would include addressing  mobility and pain issues. This work out is a great example of a local muscle endurance "military" type work out. It builds capacity, allowing you to work harder for longer.  It's a great segue to a hypertrophy "bodybuilding" workout, since you should be able to perform compound movements correctly before you start adding weight to your moves.
TRX, the ultimate "road warrior" getting in shape and staying in shape takes consistency (read more about it here).  TRX is light  weights and supremely portable for the home gym or busy traveling professional. It comes with a door anchor that can be used virtually anywhere. 

Medicine and Smash Balls
We have been working with balls ever since cave man threw his first boulder at a saber tooth. Medicine ball training started with Persian wrestlers and later with ancient Greek healers. They got the name "medicine" balls because they served as functional correctives for people with injuries and sickness.  The point with tossing or smashing activities are to use your legs and core to develop the power in the toss.  Too many times athletes striking motion, be it kicking or throwing, are DETACHED from their core. This dynamic causes a "leak" in energy in the athletes kinetic chain (movement chain). An excellent example was mentioned in this post that mentioned MLB pro. pitcher Tim Lincecum
Who is it good for? Everyone could benefit from Medicine/Smash balls but high school, college and pro athletes have the most to gain. They can provide a local muscle endurance(military training) type work out or a plyometric type workout. Both types could be used for recovery, endurance or calorie burning. 
A must for an aspiring pitcher in the off-season training program
Working with balls you can enhance several different movement planes of the muscular system
One of the high level trainers I look up to Todd Durkin is training Drew Brees here with smash balls in the diagonal plane lift. Todd works with MLB pitchers and NFL athletes, he rarely trains just one movement plane,  and is one of the best trainers anywhere.
What was once old is new again..
When I'm at the gym, I see people doing the same thing, day in and day out. It's a fact of sports science that if you have been doing a certain type of training for long enough, that you are losing out on gains in strength and weight loss.  I'm a personal example of this, and when I became informed and changed my ways, I was rewarded with less injuries, a leaner physique and a stronger body. I now try and share that knowledge, check out some of these great techniques with a trainer that knows WHY and HOW to do it properly. 

The following establishments are qualified and local for those close by.

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.


Friday, December 12, 2014

Time saving techniques for getting strong, fit and awesome.

In today's busy lifestyle, we tend to get caught up with our day to day duties & forget to take care of ourselves.  I frequently have patients report an inability to come in to get relief from their ailments, when we do catch up we find that one of the reasons their condition has not improved is they have not found time to do their "self care" exercises and their condition has degraded.  The purpose for the self care exercises is to allow them to continue improving on their own-when there's no time for even that, you know people are busy.  It seems as if we're all in the same boat, especially during this hectic holiday season.  The workout is the first thing cut, ironically meal making is a close second.  According to WebMD many put an average of 1.5 lbs. of fat on during the holidays .

Several factors determine your ability to keep on track of your fitness goals;  the two main are diet & activity.  You can read my past posts on diet here and here. Activity would include daily living activities and exercise. While we should all increase the amount we take the stairs vs. the elevator, let's consider exercise in this situation. Staying on track with your exercise regiment during busy times depends on a) how long it takes to work out, b) how long it takes you to get to your gym or work out spot and c) ability to continue without injury. With so few factors that we can influence there's really only one thing we can control; how long and hard do we work out. A recurrent theme in this blog is doing more with less. In this case it's time, so here are some great ways to minimize time and maximize results. 

Pull ups either assisted with a band or performed independently

Diagonal hops in place

In a superset alternate muscle groups(push/pull or upper body/lower body) are worked with low rest intervals(~30 sec.). The superset may be popular but there's room for improvement. Those who know my blog will recall Strength from the ground up this involves compound movement (i.e. squat, lunge, step up).  Using concepts such as compound movement and plyometrics (i.e.hops, jumps, throws) you will alternate the types of muscle used and the type of energy used (creatine vs. glucose). This type of superset will allow you to recover in the lower body & strengthen the upper body, then switch that on your alternate days. Three strength exercises and two plyometric exercises for 3 to 4 sets should get the job done for medium level enthusiast. Form is always important and performing bad repetitions reinforces bad patterns so work until you see your form suffer then stop. Below are examples of exercise that could be an alternate workout.
Wall ball squat throw (plyometric)

Overhead squat (compound strength)

VO2 Max
Another way of getting the most bang for your exercise buck would be a VO2 max workout. This type challenges your aerobic system and is one of the best calorie burners you can perform when time is a factor.  Your body is consuming the maximum amount of oxygen in this workout so it burns the largest amount of calories. 
It's a challenging workout, but it can be modified and scaled back according to your exercise level. It's a superior workout  not only challenging the aerobic system (so it's heart smart), but strengthening the muscles as well (anaerobic).  The rest intervals are  shorter than supersets (~15 sec.) and the exercise performed is done for the same amount of time (~15 sec.). 
Exercise selection is important with this type of workout, it must be a compound exercise- Kettle bells are a great choice. Those who are interested in picking a great postural reinforcing exercise should check Kettle bell training out here. This workout can be performed for 15 to 30 minutes and in some of the more elite athletes up to an hour which would burn approximately 1600 calories (half a pound of fat)!

Body weight blast

The body weight blast is a simple workout but only in theory. It's one to three exercises performed as fast as you can with the only rest period being absolutely what you need. Any compound exercise will do.
A nice example is the burpee; (pictures below)
squat thrust,
another squat thrust,
back to standing,
end with a jump.

Another variant could include a circuit like this;
Squat Jump,
Kettle bell swing 
end with a push-up.
Start with 20 reps, then 19, 18 all the way down to 5. This is an amazingly hard workout sure to wipe you out quick and burn an enormous amount of calories. These types of workouts are frequently put on in group exercise classes at places like CrossFit, we have done some work with the cross-fit organization  here in West Chester  & found them to be knowledgeable, amazing, motivating & fun.
Squat thruster or Burpee

Kettlebell swing courtesy of Pavel

Bottoms up push up
As mentioned before; time can be our greatest challenge, especially during the holiday season! With child, work and home obligations it's easy to see how we all treat our work outs like step children.  These are just a few of the intensity workouts. You're only limited by your imagination, but feel free to explore my blog & check out the links to learn more! As always, please share this with a friend if you think it may benefit them.

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.

Monday, November 3, 2014

Feed Your Work out..Body Type and Sports Science

How your workout goes is dependent on what kind of pre workout nutrition you take in. It's also impacted by how fast your body can get those calories ready to be burned. Last time we discussed how changing the way you look at food can make you leaner and healthier, today we will discuss how to make your workout more energetic by addressing the timing of your pre workout nutrition and hydration. 

Somatotyping has been around 80 years and was developed by a psychologist; William Sheldon. There have been many studies on this topic and while the percentages of Carbohydrate to Protein to Fat is debatable the metabolic styles seems to have been established. The folks at Precision Nutrition do a great job of breaking it down for us.

There are 3 different body somatotypes; 
Ectomorph:  The naturally tall skinny types.  This body type has a hard time adding size.
Mesomorph:  Easy to add muscle, naturally lean.
Endomorph:   Large Joint--bulky -like an NFL Lineman

Depending on which type you are dictates how fast or slow the calories you eat become available, and that in turn determines how energetic you will feel when you exercise. From the time you eat until the time calories become available can vary from 30 minutes for a ectomorph to 90 minutes for an endomorph.  Most of us lie in between types, but knowing your type is helpful in planning and training style.  Timing your nutrition will give your body the energy it needs to have a successful workout.  

Got H2O?
Hydration is another key component, the National Strength and Conditioning Association recommends 20 oz 2 to 3 hours pre workout and another 10 oz. ten minutes before the workout. This chart provided by is a great refrence to gauge your water levels. 

Dehydration is a common problem, it's essential in carrying away and expelling metabolic waste products, delivering fuel to the muscle. Your brain also has a high percentage of water (80%) and blood is also mostly water (83%).  Keep in mind how many diuretics you have taken in that day and the day before (coffee, salt and alcohol) and make sure to keep A balanced.  Hydration affects everything from how you feel to how plump your skin appears, so it's importance really can't be underrated. 

Get Pissed!
Urine color is a fast and easy way to monitor hydration-clear urine is best. Cramps, headaches dizziness, nausea and decreased performance can be signs that your may be dehydrated. Waiting for the feeling of thirst to hydrate means you're already dehydrated so make sure you get enough. As a side note; filtered tap water has been shown to be better over all than bottled water, as leeching can occur with plastic water bottles; and there is no date on the bottles you can't tell how long it's been sitting there. I have a friend that's in the business that confirmed that fact for me and also informed me that Dasani (Coca-cola Co.) was the worst offender of old water. 
I'm Dr. Gene Serafim, here to make sure your workout is the best it can be.

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.

Monday, September 15, 2014

Getting healthy? It's 80% diet 100% culture..

A Very Wise Sage Once Told Me Fitness is 80% Diet. 
Having worked in and around gym's for the last 16 years I have have worked with fitness professionals, body builders and athletes. I have also  endured my own journey towards fitness and seen many patients change their physique. It's no secret diet and exercise are the cornerstones of fitness.  For me the holy grail of fit was more raw foods and high intensity interval training or metabolic training. Real changes are those that transcend your schedule and lifestyle, which brings  me to my next statement.

You MUST Change How You View Food.
Our ancestors must have gotten a completely different palate, keeping in mind that spices were reserved for the privileged. Food was most likely bland and it was most certainly sparse, my parents grew up in German occupied Greece and even one generation ago, there were people starving to death.  The take home point is that it's only until recently that our culture has put so much emphasis on eating as a social event. Historically food has been viewed as fuel.

Dinner and Drinks?
I have many patients and friends who ask how to improve their body composition(less fat or more muscle), and inevitably the conversation moves to dinning. Going out to dinner has become a common pastime and a weekly occurrence. The individual looses control of the preparation of the food and seldom asks for nutritional information, since they're going out, one may figure "where's the fun in that?" The problem is that just an appetizer alone can account for all of your daily allowance of fat and calories as explained in this Good Morning America post. Add a few beers or glasses of wine at around 150 calories each and you can see even a modest meal turns into a  4000 calorie event. 
Convenient, but obese kids make obese adults.

The Good News? We're Not the Fattest Country Anymore!
Mexico has surpassed the U.S. as the fattest country in the world, perhaps due to the infiltration of Starbucks. All kidding aside, our super-sized portions and Mocha-chino Grande (600 calories) have consistently ranked us among the fattest in the world. A simple way to lose excess weight is to steer clear of drinking calories. 

Prepare for the End - the Bottom End of Course.
Food preparation sounds like a big task, but it doesn't need to be. Baking 5 or 10 chicken breasts at the beginning of the week can give you all of the salad with chicken all week. Boiling 2 dozen eggs, also an excellent protein rich and calorie poor option for breakfast or snack. Put some broccoli florets in a zip-lock and grab some hummus for a balanced, low calorie filling snack!  Greek yogurt is one of the packaged foods that you can eat and feel great about.  There are tons of great ideas in magazines and online, but the sooner you appreciate the power of preparing your meals the faster you'll be feeling and looking great.

Diets Don't Work--You Need a Lifestyle Change
Understanding this is a total shift in how to live and not a diet.  Gradual changes are ones that cause less stress and will be more sustainable.  Limiting half of the starchy carbohydrate that you typically eat at a sitting will be a great stepping stone to eventually eliminating them altogether.  Gluten and sugar have a major impact on inflammation, insulin levels and cardiovascular health. Dr. Seaman did an interview that can be found here explaining how our diet is killing us slowly.

It's better to look good than to feel good
Looking good and feeling good are very much intertwined, in explaining the way to a fitter physique we also extoll the benefits of good health. Not everyone wants a beach body and by following some of the guidelines we have set forth, will not only get you looking better but also improve your cholesterol and triglyceride counts. It's important to keep in mind why we would want to change, it's not all about aesthetics.
You look marvelous darling
Everything in Moderation
We all enjoy a night out and if you're active and practicing good eating habits most of the time you can enjoy a nice restaurant, but overall, most may want to develop other forms of entertainment.  Active hobbies would have a definite impact, increasing activity levels as well as limiting outside meals. Personally, my wife and I have shed our inhibitions and frequently dance like no one is watching in a club full of people way younger(at least chronologically).

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our facebook page.

Tuesday, September 9, 2014



Comprehensive Strategies For Addressing Plantar Fasciitis
In today’s clinical environment, plantar fasciitis is a common and debilitating condition. “Plantar fasciitis is the most frequent cause of heel pain in adults, accounting for 15% of visits to podiatrists and approximately 9% of running injuries”(1).   The purpose of this article is to discuss comprehensive strategies that include instrument assisted soft tissue mobilization (IASTM) and functional evaluation techniques. Irritation to the plantar fascia is widely treated with immobilization and injections. Unfortunately these interventions are incomplete and short sighted.  When faced with these types of complex injuries, each provider should ask; is the treatment we are rendering comprehensive?  Many of the patients I have treated have most likely seen other types of providers before seeking our care as a last alternative. Chiropractic is touted as treating the root of the issue, but if we seek to only provide short term relief, how can we hold ourselves to that higher standard.
Form & Function;
Static analysis and Orthotic correction (shoe inserts)  is a common treatment for plantar pain. Traditional approaches to heel pain have come up short fully addressing plantar pain. It’s been brought to my attention that much of the chiropractic (and physical therapy) profession is unaware of the rehab renaissance occurring. Functional movement analysis has allowed those who utilize it to find faulty movement patterns as well as muscle imbalances that are the underlying causes of dysfunction. The work of Janda, Liebenson, and Cook have provided us with screening tests that gauge the “quality” of movement and identify areas of overuse; thereby identifying underlying causes of injury(2).
A staple of the functional testing is the squat, in its performance we sometimes note the subject’s heels lifting off as the squat gets deeper.  This would be indicative of calf/ankle hypo-mobility. Having the patient repeat the squat with the heels in the elevated position and having them perform it with greater competency would further validate calf and foot shortening.  If you cannot deep squat, it may be because of your ankle mobility and that in turn is a major underlying reason your heel hurts!
Plantar fasciitis is surely a musculo-skeletal issue. Let’s investigate the work of Tom Myers “Anatomy Trains” to see what else may be associated with the chain of soft tissue(muscle/ ligament/ tendon) known as the plantar aponeurosis.

As we can see from the illustration above, there is a long track of fibrous tissue that runs contiguously from the plantar aspect of the foot to the top of the skull; therefore shortening  the muscle along the superficial back line would shorten the continuous chain of connective tissue-in other words not only are bones connected to bones, but muscles are connected to muscles. Tightness in one muscle can and will affect other muscles along the same line.  In my own clinical experience as well as medical literature, shortened calf/ heel chords are commonly noted in cases of plantar fasciitis (3). While almost everyone knows how to isolate the Gastrocs calf group, affecting the Soleus calf group seems to elude both patient and doctor.  Most patients that present to my office with a plantar pain issue have NOT been shown this simple and ultimately effective move. Feel free to contact us for assistance in performing the Soleus mobility drill.

When treating movement related conditions it's best to use everything available. Massage, Release technique, avoidance strategies, mobility drills and strengthening rehab procedures. Restoring the amount the ankle can bend upwards (dorsiflexion) is a primary goal.  Muscle energy techniques (contract/relax stretching) should also play an integral role in the muscles situated along the superficial back line as well as any tight/ overactive muscle groups. Restoring ankle Dorsiflexion through joint mobilization (Cook’s tall half kneel) of the ankle in addition to manipulation of the ankle joint will also aid in restoring proper biomechanics. Finally we need to address foot stability, as Boyle’s joint by joint approach(4) tells us, it’s an area designed for that role. 
Self care and long range goals should include activities that would affect the superficial back line (Yoga). Finally, sparing strategies cannot be ignored, as self care will move the patient towards independence in their favorite activities. There is a wealth of tools and techniques available to us, and as my father the carpenter often told me “the right tool at the right time results in the best job”.
Correct form for the tall half kneel.

1. Ranawat, Chitranjan S., and Rock G. Positano. Disorders of the Heel, Rearfoot, and Ankle. New York: Churchill Livingstone, 1999. Print.

2. Page, Phillip. "3; Chain Reaction." Assessment and Treatment of Muscle Imbalance The Janda Approach. N.p.: n.p., n.d. N. pag. Print.

3. Garrett, T., and Pj Neibert. "The Effectiveness of a Gastrocnemius-soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis." Journal of Sports Rehabilitation 12th ser. 22.308 (2013): n. pag. Web.

4. Boyle, Michael, Mark Verstegen, and Alwyn Cosgrove. Advanced in Functional Training: Training Techniques for Coaches, Personal Trainers and Athletes. Santa Cruz, CA: On Target Publications, 2010. Print.