Why I send you to a physio even when nothing hurts

Training can do a lot. It can strengthen what is weak, teach a movement you have never done, and even out a side that lags behind. What it can't do is examine why one shoulder moves differently from the other.

That's where my work ends and a physiotherapist's begins.

I go myself, and I don't wait for pain

I'm dealing with three things: my back, my shoulder and my Achilles tendon. None of them stops me from training, and none of them started with me being unable to move. They started when I noticed a difference. My shoulder didn't go overhead as willingly as the other one, my Achilles complained after I added kilometres, my back after sitting for longer.

If I had waited until it really hurt, I would be dealing with it six months later and for three months longer. This way I know what to do between sessions, and in training I don't avoid anything I don't need to avoid.

What I hear most often at the first session

“My back bothers me sometimes, but it's nothing serious.” That sentence usually means it only hurts now and then, so nothing is done about it.

But “only now and then” has a cause, and the cause can be found. When the hip barely rotates, the lower back makes up for it in every squat. In training it hides behind technique and behind the fact that it still works. At an examination it's found in ten minutes.

The same goes for a shoulder that won't go overhead and an Achilles tendon that always complains after more volume. These aren't things a stronger muscle will fix. They're things where I want to know what is behind them before I add load.

Physio isn't only for pain

This is a misunderstanding that costs people the most time. You go to a physiotherapist even when nothing hurts:

• After an old injury that has healed, but the joint has moved differently ever since
• When one side behaves differently from the other and you can see it yourself
• Before we add load that I want to be sure about
• When you sit for eight hours a day and want to know what it does to you

An examination takes an hour, and you learn more from it than from a year of putting it off. If your doctor has already given you a restriction, after surgery or an injury for example, I write about training with it in When your doctor has given you restrictions.

What I do with the findings

A physiotherapist's report is a brief for me, not a warning. If it says the hip has little internal rotation, it means the thigh bone doesn't turn far enough in the joint. What the hip can't give, the lower back adds at the end of the squat. The pelvis tucks under and the back rounds at the bottom. So we don't stop training legs. The squat goes only as deep as the hip allows, mobility work comes before it, and the load goes up once the pelvis holds at the bottom.

With a shoulder it's similar. The end range overhead narrows the space between the head of the upper arm bone and the bony tip of the shoulder blade, which is exactly where the tendon gets irritated. So for a while I keep the presses below head height, on an incline bench or with one end of the barbell fixed to the floor, and add work for the shoulder blade and for the small muscles around the shoulder that turn the arm outwards. That can be done without the arm going overhead. We go back overhead gradually, as soon as it's painless. With an Achilles tendon, the running volume changes, not whether you run at all. The goal isn't to cut training down, but to build it so that what is being treated doesn't get worse.

The shoulder overhead and by your side, enlarge

It works the other way too. When something isn't right at a session, I write it down and the client has it with them when they go. They don't have to remember on the spot what exactly hurt last week and during which exercise.

What you can start with yourself

This doesn't replace an examination, but you can start with it at home or in the gym straight away.

When the shoulder doesn't go overhead willingly

• Move the presses to an incline bench at 30 to 45 degrees, or to a barbell with one end fixed to the floor.
• Add work for the shoulder blade below shoulder height. A low cable row to the belly, a one-arm row, a face pull led towards the breastbone rather than the face.
• Turn the arm outwards with the elbow at your side against a band. Two sets of fifteen on each side.

When the hip has little internal rotation

• Sit in 90/90, both legs bent at a right angle, one in front of you and one out to the side. Lift the back foot off the floor and hold for five seconds. Five times on each side.
• Sitting on a bench, put a band around your ankle and pull the shin outwards while the knee stays put. Fifteen repetitions.
• Squat only as deep as you can go without the pelvis tucking under. A goblet squat with the weight in front of you or a squat to a box work best for that.

Who I go to

I send clients to Mgr. Marta Mojžíšová at Na Struze 230/6 in Prague 1. She focuses on manual and fascial techniques and on laser treatment. You can book directly at the clinic, and you will find the contact in the Who I work with section.

I get nothing for recommending her. I go to her myself and I send clients there because her report tells me how to carry on with training.

What to take away from this

You don't have to wait until the pain gets bad enough to take seriously. Physiotherapy is an examination, not a last resort, and the sooner you know what your body can handle, the sooner you can train at full capacity.

Sources: dos Santos et al. (2021), Scapular Retraction under Adduction Load, International Journal of Environmental Research and Public Health 18(17). Prehab Guys, Pelvic Tilt and Squats: Butt Winking and Posterior Pelvic Tilt.

If you aren't sure whether this applies to you, write to me. If it's something for training, we'll deal with it together. If not, I'll know who to send you to.