Assess and Correct Q & A
We’re already getting great feedback and questions regarding Assess and Correct, so I thought I’d start this week by answering a common question.
Q: Bill, I noticed that you, Mike, and Eric use the seated 90/90 position as part of one of your progressions in Assess and Correct. I read somewhere that some people had concerns about it irritating the posterior hip capsule. What’s your take on this?
There are some therapists and trainers that are concerned that the hip capsule can be stretched to often resulting in a “loose hip capsule” and hip joint instability. My response to this is that it’s possible but unlikely during intentional stretching activities.
If you consider the way capsular tissues adapt to stress in actually adding length, you need very long duration, low load forces applied repeatedly over a long period of time. Doing so results in what are called plastic adaptations. This means that the tissues adapt by adding true length to the collagen fibers that make up the capsule which is a relatively permanent adaptation.
Occasionally, we’ll have to use this type of stretching if we encounter a shortened capsule in the PT clinic or in the gym, but it is truly an exercise in self-discipline and determination as it is not very comfortable and may last up to 20 minutes at a time several times a day. Most plastic changes in the real world are a result of repetitive behaviors or postures that place tissues on stretch under low load conditions such as chronic postures or crossing your legs the same way for extended periods of time as many people do rather than the result of typical stretching protocols.
Considering the volume of total exercise, the protocols used in Assess and Correct, AND the way connective tissues adapt to stress, it’s doubtful that hip capsule will be overstretched. The exposures aren’t long enough to result in plastic capsular changes.
Bill
11 Responses to “Assess and Correct Q & A”
Mark Young on November 2, 2009
I have to agree with you Bill. Capsular stretching is not something that will just happen from a few mobility drills. I’ve personally experienced the “pleasure” of this type of stretching and it was tedious to say that least.
By the way, got the A&C manual already and am waiting for the DVD stuff. Looks incredible…not that I expected anything less.
Cheers,
Mark
Bill on November 2, 2009
Glad you like it so far Mark. Just wait ’til you get the DVD!
Jack on November 3, 2009
Bill,
Have you ever encountered a patient who had significant capsular restrictions in both the shoulders and hips, to the point where logistics actually became a problem/limiting factor? e.g. multiple areas needed extended bouts to the point where it became hard to fit it all in from a “practical” standpoint
Perhaps what I am asking is entirely unrealistic, but if you have seen such an extreme, what would be the general plan for starting to attack it and cut into those issues? Would it simply be a matter of focusing on one or two areas at a time andthen moving on to the others, essentially requiring additional patience?
Bill on November 3, 2009
In this case, you’re going to be heavily reliant on a home exercise program. Teach the client how to position themselves appropriately and have them do most of the work at home. We’ll do this with just about any client/patient with a capsular issue as you need enough frequency of exposure to make the capsular changes.
Stuff You Should Read: 11/12/09 | EricCressey.com on November 13, 2009
[...] Is the Seated 90/90 Stretch Safe? – This great Q&A with Bill Hartman emerged following a question from a reader after we released Assess and Correct. It’s definitely worth a read. [...]
Joe on November 13, 2009
Bill,
Firstly, great job on assess and correct!
Have you had anyone who can’t do this stretch due to stress on the outside of the knee? Have you any thoughts on what you do to correct this?
Thanks,
Bill on November 13, 2009
Joe,
Try elevating the knee slightly and supporting it with a foam roller or something similar. This should reduce the load on the lateral knee structures.
Brian Nelson on November 14, 2009
What is the advantage for a golfer to purchase your Golf 1.0 DVDs when Inside Out and Assess and Correct are already on our shelf?
Bill on November 16, 2009
No doubt there’s going to be some overlap, and you’ll do quite well with I/O and A & C.
On the golf DVD there are other corrective exercises including the use of EQI’s (eccentric quasi-isometrics) and the special golf flexibility circuit that I use with my golfers. This circuit takes components of the golf swing and reinforces them under dynamic conditions of varying speed.
Bill
Bryon on November 20, 2009
Bill,
I am enjoying the Assess and Correct series however I have continually looked for solutions to a particular problem that I have noticed that has yet to be specifically addressed by yourself, Cressey, or Robertson. The problem at hand is when one of the pectoralis muscles are visibly lower than the opposite side. The pectoralis and shoulder have a dropped or are drooping in appearance. I immediately consider scoliosis, anterior tilted scapula, and weak serratus anterior however regardless of how much lat stretching, pec minor stretching, or serratus strengthening I have not found a resolution. I’m sure others have presented with this case and I’m hoping there is a simple explanation for such a simply identified problem. I have a picture to go along with my question that may help shed some light if your interested
Bill on November 20, 2009
Glad you’re enjoying Assess and Correct.
It’s virtually impossible to provide any feedback based on your description as there are multiple potential influences. A photo may shed some light.