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Andrea Dowd at Precision Sports Therapy INC, Calgary, AB (2026)

09/03/2026

Scapular Control and Shoulder Pain: How Your Shoulder Blade Affects Shoulder Function

Scapular control has a strong relationship with shoulder function and pain, particularly because the scapula provides the stable base from which the humerus moves. Poor scapular mechanics don't necessarily cause shoulder pain by themselves, but they can increase stress on the shoulder when combined with weakness, mobility restrictions, or load intolerance.

How the scapula influences shoulder pain

1. The scapula needs to rotate upward
As you raise your arm, the scapula should progressively rotate upward. This helps the humeral head and glenoid stay optimally positioned.
If upward rotation is inadequate, the shoulder may have to compensate through excessive humeral movement or other muscles.
2. Posterior tilt matters
The scapula should posteriorly tilt as the arm elevates. This helps maintain space and appropriate mechanics around the anterior/superior shoulder.
Poor posterior tilt can increase mechanical demand on tissues such as the rotator cuff.
3. External rotation of the scapula
The scapula normally externally rotates during elevation. Limited or poorly controlled external rotation can alter how the glenoid faces the humeral head.
4. Serratus anterior + trapezius are critical
Good scapular control isn't simply "pull your shoulder blades back."
The serratus anterior, upper trapezius and lower trapezius work together to produce controlled upward rotation and positioning of the scapula.

A common clinical pattern
One pattern I often see conceptually is:
Limited thoracic extension/rotation
↓
Altered scapular position
↓
Reduced upward rotation/posterior tilt
↓
Poor humeral head mechanics
↓
Greater demand on rotator cuff/biceps/subacromial tissues
↓
Shoulder pain

But the relationship can go the other direction too:
Shoulder pain → altered muscle activation → protective movement → poorer scapular control.
So scapular dyskinesis may be a contributor, a consequence, or simply an adaptation rather than the original cause of pain.

What I would assess clinically
Rather than simply looking for a "winged" scapula, I'd assess:
• Scapular upward rotation during elevation
• Posterior tilt
• Scapular external/internal rotation
• Serratus anterior function
• Upper/lower trapezius coordination
• Thoracic mobility
• Glenohumeral internal/external rotation
• Rotator cuff strength
• Scapular control under load
• Whether correcting scapular mechanics actually changes the patient's pain

That last point is particularly important: if changing scapular position or assisting scapular movement immediately changes the patient's symptoms, it provides much more useful clinical information than simply observing that the scapula looks abnormal.

Video Demonstrations for Related Exercises:

https://youtu.be/rchjzSTIbCc?si=2RDDzRaBCGDz4D6S
https://youtu.be/nPtimU0dHtI?si=dMIkIDYTbMli39Hi
https://youtu.be/ba8gqQUrz_0?si=a8OgDPNYg6iOm2SC

06/25/2026

Spinal Stenosis: Causes, Symptoms, and Effective Treatment Options for Lasting Relief

What is spinal stenosis?

Spinal stenosis is a narrowing of the spaces in the spine that can put pressure on the spinal cord or nerve roots. It most commonly occurs in the lower back (lumbar spine) and the neck (cervical spine).

What causes it?

The most common cause is age-related degeneration of the spine. Factors include:
• Bulging or herniated discs
• Arthritis of the facet joints
• Bone spurs (osteophytes)
• Thickening of spinal ligaments (such as the ligamentum flavum)
• Degenerative disc disease
• Previous spinal injuries
• Being born with a naturally narrow spinal canal
• Less commonly, tumors, infections, or inflammatory conditions

Common Symptoms for the Lumbar (low back) stenosis:
• Low back pain
• Buttock pain
• Leg pain, numbness, or tingling
• Leg weakness
• Cramping or heaviness in the legs when walking
• Relief when sitting or leaning forward

How is it treated?
For mild to moderate spinal stenosis, treatment usually starts conservatively:
Exercise and physical therapy

Focus on:
• Core strengthening
• Glute strengthening
• Hip mobility
• Walking or cycling
• Flexion-based exercises (often more comfortable than back-bending)

Examples:
• Pelvic tilts
• Knee-to-chest stretches
• Bridges (if tolerated)
• Clamshells
• Bird-dogs (if comfortable)
• Walking with slight forward lean

Activity modification
• Avoid prolonged standing if it worsens symptoms.
• Take breaks and change positions frequently.
• Use proper lifting mechanics.

Pain management
• Heat or ice
• Over-the-counter anti-inflammatory medications (if appropriate for you)
• Physiotherapy
• Sometimes corticosteroid injections

Surgery
Surgery is generally considered when:
• Symptoms are severe and persistent
• Walking becomes significantly limited
• There is progressive weakness
• There are bowel or bladder problems related to nerve compression

Will an inversion table help?
An inversion table may provide temporary relief for some people by reducing pressure on the spine, but the evidence for long-term benefit in spinal stenosis is limited. In some people, inversion can actually aggravate symptoms. Given your MRI findings and difficulty getting up from lying on your back, I'd be cautious and discuss it with your doctor or physiotherapist before using one.

Seek urgent medical care if you develop:
• New loss of bladder or bowel control
• Numbness around the groin or saddle area
• Rapidly worsening leg weakness
• Severe difficulty walking

Back Videos:

https://youtu.be/4liLMPMdGBA?si=4nsQI-Q6-Atf8hBV
https://youtu.be/UEjx3KVyXq8?si=BvNcOZcVmoa1SvgK
https://youtu.be/JiuT0lVg3YA?si=WYqICUQ3oVZrD3oE

Hip Videos:

https://youtu.be/N0SItAVNIkQ?si=1pt20UT1qC246chj
https://youtu.be/o1C6fAGRDME?si=wTJdD-RrHG8Uc2BQ
https://youtu.be/LSprUYhsYD4?si=BpHYZwqlhiQQid78

06/05/2026

How Lack of Hip Extension Causes Hamstring Strains: The Hidden Link Between Glute Function, Pelvic Mobility, and Injury

Hamstring strains are among the most common injuries affecting runners, hikers, athletes, and active individuals. While treatment often focuses on the hamstring itself, the underlying cause may lie elsewhere. One of the most overlooked contributors to recurring hamstring injuries is a lack of hip extension.

Hip extension is the movement that occurs when the thigh travels behind the body during walking, running, climbing stairs, and many athletic activities. When hip extension is limited, the body compensates by relying more heavily on the hamstrings, increasing stress and the risk of injury.

What Is Hip Extension?

Hip extension is primarily driven by the gluteus maximus, the largest and most powerful muscle in the body. During normal movement, the glutes generate force while the hamstrings assist. Together, they create efficient movement patterns that reduce stress on individual muscles.

When hip extension becomes restricted due to joint stiffness, tight hip flexors, poor pelvic mobility, or glute inhibition, the hamstrings are forced to take on a greater workload.

Why Limited Hip Extension Increases Hamstring Strain Risk
Increased Hamstring Workload

When the hip cannot fully extend, the gluteus maximus loses its mechanical advantage. The hamstrings compensate by producing more force during walking, running, and climbing. Over time, this increased demand can lead to fatigue, tightness, and eventually strain.

Chronic Hamstring Tightness

Many people stretch their hamstrings repeatedly without lasting relief. In many cases, the hamstrings feel tight because they are overworked rather than truly short. If hip extension remains limited, stretching alone may not solve the problem.

Altered Pelvic Mechanics

Restricted hip extension often changes the way the pelvis moves during gait. This can place additional tension on the hamstrings at their attachment points on the pelvis, increasing strain and reducing movement efficiency.

Reduced Glute Activation

Poor hip extension is frequently associated with glute inhibition. When the glutes fail to activate effectively, the hamstrings become the primary hip extensor. This compensation pattern can create a cycle of recurring injury and dysfunction.

The Role of the Sacrum and Pelvis

The sacrum and pelvis play an important role in transferring forces between the spine and lower limbs. Restrictions in sacroiliac joint mobility or pelvic movement can reduce hip extension and alter muscle activation patterns.

When pelvic mechanics are compromised, the glutes may struggle to generate force efficiently. The hamstrings often compensate, resulting in increased tension and a higher risk of strain.

Common Signs of Limited Hip Extension
Recurrent hamstring strains
Chronic hamstring tightness
Reduced stride length while walking or running
Difficulty activating the glutes
Low back discomfort
Limited ability to extend the leg behind the body
Hip pain or stiffness
Improving Hip Extension to Prevent Hamstring Strains

A comprehensive approach should focus on restoring normal movement patterns rather than simply treating the hamstring itself.

Key strategies include:

Improving hip joint mobility
Stretching tight hip flexors
Enhancing glute activation
Restoring pelvic and sacroiliac mobility
Strengthening the posterior chain
Addressing gait and movement mechanics

Exercises such as glute bridges, hip thrusts, split squats, and single-leg deadlifts can help improve glute function and reduce excessive hamstring loading.

Final Thoughts

If you suffer from recurring hamstring strains, the problem may not be your hamstring alone. Limited hip extension can force the hamstrings to compensate for weak glutes, restricted pelvic motion, and altered biomechanics. By restoring hip extension, improving glute activation, and optimizing pelvic mobility, you can reduce stress on the hamstrings and lower your risk of future injury.

Understanding the relationship between hip extension, glute function, pelvic mechanics, and hamstring health is often the key to breaking the cycle of recurring strains and achieving long-term recovery.

Video Demonstrations:

https://youtu.be/N0SItAVNIkQ?si=JagVg-HcKKecvdBa
https://youtu.be/o1C6fAGRDME?si=lFj8tsNOArsOXbAn

05/21/2026

Hip Pain and Limited Hip Extension? Your Sacrum May Be the Problem

A ‘locked” or poorly moving sacrum can contribute to hip pain and reduced hip extension- especially during walking, running, lunges, deadlifts, hills or explosive movements.

The sacrum, Si joint, pelvis, hip capsule, glutes, psoas, and lumbar spine all work together. If one area stiffens, another area usually compensates.

Common Patterns: When hip extension is limited, people often compensate by:
• Extending through the low back
• Rotating the pelvis
• Overusing hamstrings
• Gripping with the hip flexors
• Compressing the SI joint
This can create:
• Deep buttock pain
• Front-of-hip pinching
• SI joint ache
• Groin tightness
• Low back stiffness
• Pain during the stride or push-off

Common causes:
• SI joint dysfunction: symptoms:
o One-sided low back or buttock pain
o Pain rolling in bed
o Pain standing on one leg
o Feeling “stuck” or asymmetrical

Hip Flexor/ Psoas Tightness
• A tight psoas can pull the pelvis forward and restrict extension

Glute Inhibition
• Weak or delayed glute max activation reduces hip extension power

Hip Capsule Restriction
• Especially anterior capsule tightness

Femoroacetabular Impingement (FAI)
• Can cause pinching at end-range extension or flexion

Lumbar Spine Compensation
If the hip lacks extension, the low back often extends excessively instead
Key Movement Relationship:
Hip extension comes from:
• Glute Max
• Posterior pelvic mobility
• Sacral nutation, counternutation mechanics
• Hip capsule mobility
• Thoracic rotation

If the pelvis and sacrum cannot move well, the hip often “runs out” of extension early.

https://youtu.be/LSprUYhsYD4?si=59xmJeOPdTvxb3lL
https://youtu.be/N0SItAVNIkQ?si=UD37AShKcIgSXD4H
https://youtu.be/o1C6fAGRDME?si=-dv02ubQ6EdsSKGp

05/06/2026

How Flat Feet (Overpronation) Cause Knee Pain — And How to Fix It | Calgary Athletic Therapy
I
f you’re dealing with persistent knee pain, the problem may not actually be your knee. One of the most overlooked causes is flat feet (overpronation)—a biomechanical issue that changes how force travels through your body.
At Precision Sports Therapy, we commonly see knee pain driven by poor foot mechanics, not just local joint dysfunction.

What Is Overpronation?
Overpronation occurs when the arch collapses excessively inwards during walking or running. While some pronation is normal, too much leads to:
• Arch collapse
• Heel rolling inward
• Loss of foot stability
This creates a chain reaction up the leg.

How Flat Feet Affect the Tibia, Fibula, and Knee
When your foot overpronates:
• The tibia internally rotates (inwards)
• The proximal tibiofibular joint (on the outside of the knee) loses optimal mechanics
• The fibular head may become stiff or irritated
This forces the knee into a valgus position (collapsing inward), increasing stress on:
• Patellofemoral joint (kneecap pain)
• Medial knee structures
• ACL (higher injury risk)

Signs Your Foot Mechanics Are Causing Knee Pain
• Knees collapse inward during squats or lunges
• Pain with running, stairs, or prolonged standing
• Flat or collapsing arches under load
• Tight calves or ankle stiffness
• Discomfort near the outside of the knee (fibular head)

Why Most Treatments Fail
If you only treat the knee:
• Symptoms may temporarily improve
• The root cause (foot mechanics) remains
• Pain often returns
Real recovery requires a full kinetic chain approach.
How to Fix Overpronation and Reduce Knee Pain

Effective rehab focuses on:
1. Foot Stability
• Short foot exercises
• Arch control training
• Toe coordination (intrinsics)- opposition toes ( yoga toes)
2. Tibial Control
• Managing internal rotation
• Strengthening lateral lower leg (fibularis muscles)
3. Knee Alignment
• Training the knee to track over the foot
• Reducing valgus collapse ( strengthen gluteus medius)
4. Full Movement Integration
• Squats, lunges, and single-leg control ( make sure foot/ankle doesn't collapse in and ensure glutes are engaged)
• Return to running and sport safely

When to Get Help
If your knee pain isn’t improving, or keeps coming back, it’s time to assess the root cause.
A proper movement assessment can identify:
• Foot instability
• Tibial rotation issues
• Knee tracking dysfunction

04/15/2026

Forward Head Posture, Elevated First Rib & Shoulder Pain: The Hidden Cause of Neck and Shoulder Dysfunction (And how to fix It)

Why This Matters:
If you're dealing with chronic shoulder pain, neck tightness, or poor posture, the root cause may not actually be your shoulder. A common but overlooked issue involves forward head posture, tight anterior scalenes, and an elevated first rib- a combination that disrupts normal movement and leads to persistent discomfort.

The Connection Between Posture, First Rib Dysfunction, and Shoulder Pain

1. Forward Head Posture (FHP)

Forward head posture is one of the most common postural imbalances today: often caused by:
• Prolonged sitting
• Computer and phone use
• Poor ergonomic setup

When the head shifts forward:
• Neck muscles become overactive
• Deep neck stabilizers weaken
• Stress increases on the shoulders and upper back

2. Tight Anterior Scalenes and Neck Muscle Dysfunction:

The anterior scalene muscles play a key role in both neck movement and breathing. When they become tight:
• They elevate the first rib
• Contribute to shallow chest breathing
• Can compress nerves (leading to tingling or numbness)

3. Elevated First Rib: A Hidden Driver of Shoulder Pain:

An elevated first rib can significantly affect shoulder mechanics:
• Restricts the proper movement of the clavicle and scapula
• Alters shoulder blade positioning
• Leads to impingement-like symptoms

4. Shoulder Pain Isn’t Always a Shoulder Problem

Many cases of chronic shoulder pain are caused by:
• Poor rib cage positioning
• Neck Dysfunction
• Altered breathing patterns

Common Symptoms of First Rib and Scalene Dysfunction:

• Pain in the front or top of the shoulder
• Tightness along the side of the neck
• Pain with overhead movements
• Tingling and numbness in the arm
• Difficulty taking a deep breath

How to fix Forward Head Posture, Elevated Rib, and Shoulder Pain

1. Restore First Rib Position
• First Rib mobilization exercises
• Scalene muscle release techniques
• Manual therapy or self-release work

2. Improve Breathing Mechanics:
• 90/90 breathing exercises
• Slow controlled exhales
• Rib cage positioning drills

3 Correct Posture and Strengthen Key Muscles:
• Chin tucks (deep neck flexors)
• Serratus anterior strengthening
• Lower Trapezius strength exercises

What not to do:
• Don’t just stretch your upper traps repeatedly
• Don’t ignore breathing mechanics
• Don’ t treat the shoulder without addressing the neck and ribcage

Daily Routine to Relieve Neck and Shoulder Pain (5-10 mins)
• Breathing reset (2-3 mins)
• Scalene and 1st Rib release (1-2 mins per side)
• Chin Tucks (10-15 reps
• Wall slides with reach (10 reps
Videos:

https://youtu.be/SCQexBR34Ig?si=lAhhELTR3fvvO1-Y
https://youtu.be/0Tt5Pu9yoUs?si=PWW6JhmdNH40L09_
https://youtu.be/iKQ_eWs6rr4?si=VqqEHyWpUonhIyse

04/08/2026

Thoracic Spine Mobility: Fix Poor Posture, Relieve Back Pain & Move Better

The thoracic spine (T-spine) is the middle portion of your spine, located between your neck and lower back. It plays a critical role in rotation, breathing, posture and overall movement efficiency.

Despite its importance, T-spine mobility is often overlooked- leading to back pain, poor posture, and shoulder dysfunction.

Key Functions of the Thoracic Spine:

1. Thoracic Spine Mobility and Rotation:
a. The thoracic spine is designed for rotational movement, which is essential for everyday activities like walking, reaching, as well as sports such as golf, hockey, and baseball.
b. When thoracic mobility is limited, the body compensates by overusing the lower back, increasing the risk of injury.

2. Reducing Lower Back Pain:
a. One of the most important roles of the thoracic spine is to protect the lumbar spine.
b. Poor thoracic mobility can lead to:
i. Chronic lower back pain
ii. Disc injuries
iii. Muscle strains

3. Improving Posture:
a. A stiff thoracic spine often results in:
i. Rounded shoulders
ii. Forward head posture
iii. Increased neck tension

4. Enhancing Shoulder Function:
a. The thoracic spine directly affects shoulder mobility and stability
b. Limited T-spine movement can cause:
i. Shoulder impingement
ii. Rotator Cuff Injuries
iii. Restricted overhead movement

5. Supporting Proper Breathing:
a. The ribs attach to the thoracic spine, making it essential for efficient breathing mechanics.
b. A stiff thoracic spine can:
i. Limit rib expansion
ii. Reduce lung capacity
iii. Lead to shallow breathing patterns

6. Boosting Athletic Performance:
a. The thoracic spines acts as a bridge between the upper and lower body, allowing for effective force transfer.
b. Important for:
i. Lifting
ii. Throwing
iii. Running

What are some signs of Poor Thoracic Spine Mobility:
• Persistent neck or shoulder pain
• Chronic lower back tightness
• Poor Posture (rounded upper back)
• Limited rotation or stiffness
• Difficulty reaching overhead

Exercises to Improve Thoracic Spine Mobility
• Thoracic Extensions over a foam roller
• Open book rotation
• Cat-Cow stretches
• Wall Rotations

Try these exercises:

youtube.com/watch?v=R0UwVZdqgTs&time_continue=4&source_ve_path=NzY3NTg&embeds_referring_euri=https%3A%2F%2Fprecisionst.ca%2F

Andrea Dowd at Precision Sports Therapy INC

09/03/2026

06/25/2026

06/05/2026

05/21/2026

05/06/2026

04/15/2026

04/08/2026

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Tuesday	8am - 8pm
Wednesday	8am - 8pm
Thursday	8am - 8pm
Friday	8am - 8pm