The Supine Groin Stretch is Egoscue's secret weapon. Pete Egoscue stumbled upon the power of it more than 40 years ago and it has not lost its effectiveness yet. As a Postural Alignment Specialist the Supine Groin Stretch is a favorite posture exercise in my Egoscue therapy for everyone from professional athletes to the elderly, those suffering from carpel tunnel to arthritic joints, those with twisted spines to tilted hips. 

If you have read any of Pete Egoscue's books (The Egoscue Method of Health Through Motion, Pain Free, Pain Free for Women, Pain Free at Your PC, Pain Free Living), worked with an Egoscue therapist, or worked with an Egoscue University certified Postural Alignment Therapist or Advanced Exercise Therapist you have heard of the Egoscue Supine Groin e-cise or one of its versions: Supine Groin Stretch, Supine Groin Stretch w/ Towels, Supine Groin Progressive in Tower, Supine Groin Regressive, Supine Groin Progressive on Towels, Supine Groin Progressive w/ Deep Hip Flexion, or its related cousins the Double Pedal Progressive, Double Pedal Regressive, Double Pedal Lying Supine, or Double Pedal Lying Supine on Towels. 

The Supine Groin in all its forms, helps restore the proper length and tension to your hip flexor muscles on the inside of your thigh. The Supine Groin relaxes and/or engages your hip flexors while your foot, ankle, knee, hip, spine, shoulder and head are aligned properly which creates a chain reaction up and down your entire body.

The Supine Groin Stretch posture exercise returns your pelvis to a neutral position and helps the muscles around your pelvis learn to hold it there. This directly impacts pain around the hips and lower back associated with hip bursitis, hip arthritis, degenerative hip, herniated disc, spinal stenosis, scoliosis, muscle spasms, spondylolisthesis, and sciatica, although what you do before and after the Supine Groin are just as important and your Advanced Exercise Therapist can help you figure out the right Egoscue e-cises to do.

All versions of the Supine Groin Stretch are made more effective when using the Egoscue Multi-positioning Tower because it holds the foot and ankle in the perfect position for the posture exercise. The  tower and foot pedal limit pronation and supination of the foot/ankle and foot abduction and adduction, which is very important for effective joint realignment up the entire body. This also helps maintain proper muscle length and tension throughout the leg and hip. 

The tower and foot pedal also hold the ankle at about a 90 degree angle which creates a slight lengthening pull on the triceps surea (or two major calf muscles - the soleus and gastrocnemius) via the achilles tendon. The gastrocnemius has two heads which attach to the lateral and medial femoral condyles and when lengthened in the Supine Groin Stretch via the Tower helps rotate your femur into a more neutral alignment and decreases tibial torsion.  

Realigning the foot, ankle, lower and upper leg with the rest of the body will help eliminate pain associated with bunions, sprained ankles, plantar fasciosis, arthritic knee, chondromalacia patella, iliotibial band pain syndrome, patellar tracking disorder, ligament tears, meniscus tear, and metatarsalgia.

All the different forms and variations of the Supine Groin Stretch have their own unique purpose and are used for specific reasons by your Postural Alignment Specialist and we will go through some of the differences between many of the versions. 

The Supine Groin Progressive in Tower takes the leg slowly from hip flexion to hip extension allowing time for the powerful and often tight hip flexors to relax and lengthen. You will spend 5 minutes or more per level waiting until your low back and pelvis settle flat on the floor before moving down to the next lower level. Repeat this process on every level on both legs. This posture exercise is a staple for people with Condition 1 posture imbalances, most notably an anterior pelvic tilt. Learn more about the Supine Groin Progressive in Tower.

Supine Groin Stretch with Towels is another Egoscue menu staple. During this e-cise you will spend 15 minutes or more per leg resting in the bottom level of the Tower while having rolls under your lumbar and cervical spine to support the S-curve in your back. Typically we will have clients use the "thigh test" to know when it is time to switch legs. To perform the thigh test, squeeze the thigh (quads) of the straight leg while keeping your glutes and stomach relaxed. Hold the contraction for several seconds and notice where you feel the tightest part of the contraction. Often clients feel it close to the knee or on the lateral quad when they first get in the position. Relax and wait 5 minutes and then retest. At this point your should feel the contraction being more centered in your quad. Take note of where you feel it and then relax for another 5 minutes. Retest the thigh again and you will usually notice it high up the quad. The goal is to stay in the Supine Groin Stretch on one leg until you feel the quad contraction toward the top of the thigh by your hip and centered. This means you are ready to switch legs. Repeat the process with your other leg. 

The Supine Groin Stretch with Towels can be a great posture exercise for clients with Condition 3 posture imbalances especially a posterior pelvic tilt, thoracic kyphosis, and forward head posture because it will help restore the natural S-curve to their spine. 

Supine Groin Progressive on Towels is a posture exercise that allows us to progressively lengthen the hip flexors while maintaining the S-curve in your back. The thigh test is used to determine how long to spend at each level progressing from the top level down to the bottom level. 

The Supine Groin Progressive Deep Hip Flexion allows us to change the demand on the leg not in the Tower by putting that hip into deep hip flexion. This changes the position of the pelvis and spine and we will usually use the thigh test to determine when to lower the leg down to the next lower level in the Tower during this posture exercise.

During the Supine Groin Regressive in Tower posture exercise we move from the bottom position of the Tower to the top level of the Tower to take the leg from hip extension into hip flexion. 

The Double Pedal Progressive in Tower posture exercise allows us to do both legs in the Tower at once and progressively lower the legs down the Tower. The double pedal is needed to perform this e-cise and the following e-cises.

Double Pedal Lying Supine utilizes the Tower to hold the feet and ankles in the correct position as we allow the body to react to the full supine position of this posture exercise.

During the Double Pedal Lying Supine on Towels we utilize the towels under the lumbar and cervical spine to maintain the S-curve in the spine while the body reacts to a fully supine position. The Tower stabilizes the foot and ankle in a neutral position allowing changes up and down the load joints.

When doing the Double Pedal Regressive posture exercise we have the client start at the bottom level of the Tower and every couple minutes have them move up one level in the Tower. We move up the levels of the Tower until they are in the top position. This allows up to take the leg from hip extension into hip flexion slowly. 

You can see and purchase your Egoscue equipment including the Egoscue Multi-Positioning Tower, Egoscue Single Foot Pedal, Egoscue Double Foot Pedal, Egoscue Rolls, and Egoscue Large Block online from Crooked Human or in person at Oregon Exercise Therapy. 

If you have any questions about the Supine Groin Stretch or any of its variations or the equipment used to perform the posture exercises contact me today by email, phone, or Skype/FaceTime and I'd be happy to help you or even set up a time you can come into the clinic and I can walk you through how to use these powerful e-cises first hand. 

You wouldn't build a house on a crooked foundation would you? 

The same principle can be used when looking at strength training and weight lifting. Before doing any strength training or weight lifting, it would be a good idea to make sure your foundation is balanced and level. The human body's foundation is its posture and load joint (ankles, knees, hips, shoulders) position:

Most athletes and people working out at the gym do not have balanced posture. This means that every time they workout or lift weights they are strengthening their imbalances. This will lead to injury, pain, and decreased performance. They think they are getting stronger, but without a balanced foundation the whole structure will crumble (their body will break down). 

It is extremely important for serious and professional athletes to keep their body balanced and posture aligned because they are pushing their bodies to the max and postural imbalances will make them injury prone. This is seen daily in all professional sports and the high rates of injury and short careers of many professional athletes. Athletes who focus on balancing their bodies and keeping their posture aligned will prevent many injuries and extend their careers. We have worked with athletes from the NBA, MLB, NHL, WNBA, NFL, MLS, NCAA, and Olympic teams. 

Maintaining postural alignment or a level foundation is also very important to anyone who wants to stay active as they age. People who want to run, hike, bike, golf, or play tennis into their 50s, 60s, 70s and beyond should pay close attention to their posture and body alignment. Our clients who live the principle "straighten before you strengthen" are as active or more active in retirement than ever and doing it all pain free. 

If you would like a free foundation inspection (postural evaluation) contact me at Oregon Exercise Therapy today and we'd be happy to meet with you. 

I love this testimonial I received from one of my clients because she is a great example of someone who really "gets it". "Getting it" is the key to clients getting better and staying better. "Getting it" involves:

• Discovering that no one else is responsible for your current state of health but you and taking full responsibility for your current and future health. 
• Recognizing that your body is not broken and believing that you can get better.
• Understanding that we can all learn something new and that the common beliefs about pain might not be the whole story and experts might not know it all.
• Realizing that Egoscue or Postural Alignment Therapy is not a treatment you receive but an education in how your body works.
• Realizing that pain is not an event but a process and it will take time to correct your body alignment and posture.
• Enjoying the process and having fun!

The wonderful thing is anyone who "gets it" will also get better and be able to live, play and be pain free. If you'd like to talk about your current pain situation contact me for a free consultation and postural and functional evaluation. 

Humans spend their whole lives seeking pleasure and avoiding pain. Why is it then, that pain is the number one reason why people visit their doctor? Why is it that 1 in 4 doctor visits are for pain? Why is it that 80% of people will have low back pain some time during their life and 42% of Americans experience pain daily? I think part of the problem rests in our beliefs. Many great teachers have taught us to examine our beliefs and if they are not serving us to change them. Culturally, we have convinced ourselves and have come to believe three things about pain that warrant re-examining: (1) pain is giving us the message of limitation or that something is broken, (2) we are healthy if we do not have pain, and (3) the solution to our problem rests outside of ourselves. These beliefs stop us from doing what needs to be done to be pain-free for life. 

Current belief: Pain is giving us the message of limitation, or that something is broken.

Our entire acute care system is set up around this belief. This misconception creates a treatment system that does not work. The most common treatments for musculoskeletal pain are drugs, surgery, and manipulation. All these treatments are aimed at relieving the symptom, but do nothing about the reason why the symptom appeared. When we assume that something is “broken,” then there is something that has to be “fixed.” This leads to the use of surgery to fix the herniated disc, shoulder impingement, or bunion. And then we assume since we “fixed” the broken piece, we are healthy again. This is not true however. The reason why the herniated disc, shoulder impingement, or bunion showed up in the first place was never addressed. This can lead to the symptom reappearing later.

New belief: Pain is telling us that something is not happening that should be happening.

Our back hurts because our posture is compromised. Our backs have lost their S-curve, flexibility, and proper support from the pelvis. When we restore our posture our pain will go away and our intrinsic healing power will take over and heal our herniated disc. Surgery to fix something is no longer needed and even if we do have surgery, we still need to correct the faulty posture that caused the problem in the first place.

Current belief: We are healthy if we do not have pain.

Our societal belief that we are healthy if we do not have pain, leads to treatment focused solely on symptom relief. As in the previous examples, surgery does not make us healthy again; it only “fixed” what was falsely considered “broken.” Pain killer drugs are a multimillion dollar industry based on our misconception of what it means to be “healthy.” None of us believe that we have an Oxycodone deficiency when we take Oxycodone. And we all know that taking pain medication is doing nothing about why the pain is there.  The medication only masks our pain, allowing us to ignore the real problem.

New belief: We are healthy when we are free of pain AND limitations.

Before pain comes limitation, which is usually attributed to aging.  We frequently hear people say: “I used to run, but now I walk” or “I used to climb the stairs, but now I take the elevator” or “I used to play with the grandkids on the floor, but now I can’t.  But, that’s ok because I’m 50, 60, 70 years old.”  These limitations are not normal and are not age related.  Learning to recognize these limitations allow us to take our focus back to the cause: our posture. When we correct our posture we are at the same time restoring optimum function to the body and we are preventing future problems from occurring.

Current belief: The solution to our problem rests outside of ourselves.

In many cases, we believe that something external to us caused our pain – our bad genes, our computer, improper footwear, a car accident, past injury, or previous surgery. This allows us to pass all the responsibility for becoming well onto someone else. This is why we use so many external fixes: massage, manipulation, ultrasound, surgery, braces, drugs etc.

New belief: We must take personal responsibility for our health.

Responsibility means we have the ability to respond. Total health and wellness is not possible until we take responsibility for our own health. When we take responsibility for our health and take action we become empowered and allow our bodies to do what they do best – thrive. We have a tremendous capacity for healing and renewal if we allow it. Reminding our bodies of correct posture and function will take stress off the affected areas and allow our intrinsic healing power to take over. You can see and feel the physical changes that take place as a result of your efforts. Associated with this is an increased feeling of confidence that accompanies the improved health you are responsible for.

Shoulder pain is no fun. It can get in the way of golf, tennis, gardening, carrying groceries and even washing your hair. Shoulder pain can vary from mild soreness to excruciating pain and may be diagnosed as a torn rotator cuff, bursitis, tendonitis/tendonosis, frozen shoulder, labral tear, arthritis, thoracic outlet syndrome, or a nerve impingement. All these different symptoms must have many different causes and specific treatments that address these causes right? Maybe not. 

Most shoulder problems and pain are caused by the same thing: thoracic flexion which causes forward rounded shoulders. 

The image above shows thoracic kyphosis and the forward head and shoulder posture that follows. When the shoulder joint is forward like this the joint surfaces, muscular stability and strength, and shoulder range of motion are all compromised. 

A research group wanted to look at how different sitting postures affected shoulder range of motion. They studied 30 healthy young men, 18-35, with no recent history of shoulder problems and measured their shoulder range of motion in 3 different sitting postures. 

Their analysis "demonstrated significant differences in all comparisons (p < 0.001)."

They concluded:

• "Changes in sitting posture affect shoulder ROMs in all directions tested"
  
• "Greater changes in shoulder ROMs were associated with greater increase in thoracic kyphosis" 
  
• "Even subtle changes in thoracic kyphosis need to be considered during shoulder evaluation". 
  

Thoracic kyphosis or thoracic flexion causes a decrease in range of motion of the shoulder, but how does that cause tendonitis or impingement or a rotator cuff tear? 

The shoulder is a complex junction of bones, muscles, tendons, ligaments, nerves, blood vessels, and connective tissues that are all affected by slight changes in bone/joint position and movement patterns. 

Individuals with thoracic kyphosis exhibit less than normal and ideal thoracic mobility especially thoracic extension. Thoracic extension is needed for any overhead arm movement (throwing a ball, pull-ups, overhead presses, changing a light bulb, reaching top shelf in kitchen/closet) and without proper thoracic extension, scapular positioning and rotation is compromised creating nerve, blood vessel, tendon and ligament impingement and compression along with muscular strain. 

No matter whether you are dealing with supraspinatus tendon impingement in the subacromial space, bicipital tendinopathy, or peripheral nerve entrapment in the shoulder, these can all be resolved by restoring proper thoracic, scapular, clavicular, and humeral position and mobility and stability. 

It is important to look at the underlying reason for the shoulder pain and dysfunction and address all related imbalances and not solely focus on the shoulder and associated muscles. The underlying reason for the faulty shoulder biomechanics can be pelvic position and lack of function which causes changes in thoracic extension and scapular positioning and movement. Without looking at and treating the entire posture and biomechanics of the body, we are simply treating symptoms and those same symptoms or related symptoms will return later. The client/patient might temporarily feel better but this false sense of confidence will lead to future injury and pain - often much worse than the original injury and pain. 

Runner's World published a great article called "5 Things Runners Should Know About Knees: Starting with "whether running with ruin your knees". It begins by saying:

I couldn't agree more. Even though many people and well meaning experts believe that running will ruin your knees, there are many reasons to believe this is untrue. 

The more you use your brakes on your car the faster they wear out. People often think the same rule applies to our bodies, but it doesn't work the same way. Cars are inanimate objects and our bodies are amazing living organisms. Our bodies actually get stronger the more we use them - cartilage included! Runners don't get arthritis more often but actually get stronger and more resilient knees. 

Stimulus response organism. That's what humans are. Our bodies keep responding to activity (i.e. getting stronger) no matter how old we are. There are some amazing examples of older runners and athletes doing things that are very inspiring. How about a 104 year old sprinter or a 100 year old marathon runner or a 82 year old nun who finished an Ironman triathlon. Here's a list of ten more amazing athletes over 60 years old. 

I think it is interesting we are always searching for the magical supplement or pill that will regrow our cartilage (the latest is stem cell injections) without first asking 'why is my cartilage wearing away in the first place?' If we can prevent the degeneration of the cartilage we might not have to worry about regrowing it later. 

Very true. You can say the same about any musculoskeletal pain: the site of the pain is not the source of the pain. Neck pain can be caused by a pelvic imbalance. Foot pain can be eliminated by changing your shoulder position.  Iliotibial band (IT band) pain or patellofemoral pain syndrome is very related to hip muscle imbalances. We must remember that the body is a unit and in order to eliminate pain for good we must look at the entire body and treat the underlying cause of the pain not just the symptom. 

While I agree that getting stronger is a good idea, I like to remind people that it's important to make sure that your posture is aligned before you start doing strength training because otherwise you'll be strengthening your imbalances which can lead to injury. I like the phrase: get straight then strengthen. For a free posture evaluation that can be done in-person, over Skype, or through email contact Matt at Oregon Exercise Therapy today and I'll let you know what you need to do to prevent injuries and protect your knees. 

Read the article: Runner's World: 5 Things Runners Should Know About Knees

Related articles: 
Knee joint osteoarthritis
Why runners don't get knee arthritis
Cartilage regeneration
Patellofemoral pain and your posture
Meniscus surgery ineffective 
Preventing ACL injuries