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ReVITALize Rehab Club

Physical Therapy Clinic | CA | ReVITALize Rehab Club

Author: Danh Ngo

  • Early flexion in pitching and arm pain.

    12 key characteristics are described by OnbaseU that can impact a pitcher’s consistency, promote overload problems like tendinitis, and potential loss of playing time. The one pitching characteristics that this article will talk about is called Early Flexion.  

    Before we go into what Early Flexion is and the possible consequences of Early Flexion from a medical standpoint, let us establish how to best use this article. Pitching characteristics are not correlated with pitching problems or faults. You can find numerous pitchers with early flexion pattern and still excel to the level of being a Cy Young pitcher. We can strongly demonstrate that the need to show early flexion is due to compensation for a physical-mechanical or physical performance issue. The compensation will be decided necessary or unnecessary from a collection of tests, movement screen, and clinical collaboration with the team and the pitcher.

    Problem is considered a problem when it matters. What this statement implies is that if you cannot bring results, then the characteristic needs to be evaluated by your team of baseball professional providers: medical, pitching coach, and performance fitness.  

    So, what is early flexion? 

    When you take a look at a side view of a pitcher in action and freeze-frame at the Maximal External Rotation position, you will notice the spine is not in a neutral or extended spinal position. If you draw a line from the tailbone to the scapular landmark, an early flexion pattern is demonstrated as not having any open space in front of this line. The lower half of the spine is rounded while the pitcher is in the maximal shoulder external rotation position.

    Why does this matter from a medical standpoint?

    Your shoulder is naturally a joint that moves too much. The triple actions of torquing the arm into layback external rotation and subsequent act in throwing the arm fast and forward to decelerating control of the arm places the shoulder in high stress. When you calculate 1000’s of pitches over months and years, the shoulder myotendinous unit starts going into failure strain territory. Basically, your rotator cuff muscles and others cannot perform at a high level to protect your shoulder.

    The early flexion characteristics put more strain on the shoulder and elbow ligaments and passive stabilizers. Your labrum starts to tugged and strained. When you raise your arm overhead, your thoracic spine needs to naturally couple the motion with extension and rotation to the same side of the throwing arm. The combined shoulder and thoracic spine arthokinematics occur to allow efficient contraction of your rotator cuff muscles and open clearance of humerus bone on subacromial joint space. When your spine is positioned in the inefficient early flexed position, your shoulder starts to become hypermobile in the front aspect and under-recovered to the back aspect of the shoulder.

    An upright and efficiently postured hip, pelvis, and lower spine usually dictate how hard you will have to work to have a well-distributed upper body posture.  

    As a Sports Medicine Physical Therapist, we can focus on rebuilding the rotator cuff muscles and shoulder complex, but it will likely continue to fatigue from the strain of pitching. This idea goes to the elbow complex, especially the ulnar collateral ligament (UCL). The key to sustained success is to identify the reasons for the early flexion characteristics.

    What are the common mechanical faults?

    1. Lower spine dysfunction.  You lack the mobility or awareness to isolate extension to your lumbar spine, thoracolumbar junction, or lower thoracic spine and rib cage. You choose to go into early flexion because that is your only physical option.  Treatment includes getting manual therapy directed to your spine, and most importantly, upgrade your movement habit to allow non-early flexion pattern.
    2. Pelvis.  Your sacroiliac joint helps to transfer load from your legs to your spine. Your ability to bring one leg forward and one leg to trail behind requires a coordinated movement sequence conducted by the sacroiliac joint. You can have a stiff pelvis and/or uncoordinated sacroiliac region.  Treatment includes strengthening your pelvic stabilizers such as your Gluteus Maximus, Gluteus Medius, Hamstrings, Iliopsoas, and deep pelvic muscles. You may benefit from manual therapy to your sacroiliac region to allow better exercise tolerance.
    3. Hip Joint.  When your front hip cannot flex, then your pelvis and/or spine will have to make up for the hip limitations. This is commonly under-detected since the pitching characteristic is looking at the spine.  Treatment includes stretching and self-soft tissue exercises to regain hip flexion while the spine is stabilized.  

    There are other possible sources and getting a baseball pitching screen, and if there is pain involved, a follow-up Selective Functional Movement Assessment (SFMA) screen will give you a comprehensive plan of action.

    If you need an expertise to evaluate any stubborn muscle or joint tension or pain, click the orange button to get your free phone consultation or telehealth consultation with Dr Ngo. You will get a sense of what is holding you back and general guidance on what is your next best step to recovery.

    We specialize in recurrent muscle tightness and the pain the comes with it. Get your expertise second opinion with a click of the orange button below.

    CLICK HERE FOR FREE CONSULTATION WITH A SPORTS MEDICINE AND ORTHOPEDIC SPECIALIST

    One LOVE,

    Danh Ngo PT, DPT, OCS, SCS

    Doctor of Physical Therapy

    Board Certified Specialist in Orthopedic and Sports Medicine

    Onbase University Certified Pitching Specialist

    Certified Advanced Movement Specialist – RockTape

    Certified Mobility Specialist – Rocktape

    Mind Body Health Results Coach

    pulled a groin muscle

  • Lungs biomechanics and its impact on strength, posture, and stability based on Postural Restoration Institute philosophy.

    We have a special treat for you readers in this article. It comes from the passionate and generous teachings of Ron Hruska, the founder of Postural Restoration Institute. Their teachings and clinical practices can be seen in many Sports Medicine and Performance Specialist clinics and gyms. They are becoming the cutting edge of integrating sound holistic biomechanics into performance. Due to the COVID-19 pandemic, Ron Hruska is educating on the lung’s impact on posture and strength. He picks his favorite go-to exercises based on the week’s topic.

    Logo with a silhouette of a baseball player and 'OBU Certified' text.

    You will get a sense of how simple movement can have a profound impact from a kinetic movement chain and physiologic-movement perspective. We found it exciting to learn how each week’s webinar builds on top of each other to round out to one big concept. The lungs are the root of many peoples problems!

    This article is our interpretation and summary of Postural Restoration Institute’s concepts. If you are interested we highly suggest you click on this link HERE to watch and learn first hand.

    Introduction Topic on Compliance (click to watch the video)

    This video brings on the difference of compliance and pressure. Compliance implies the ability to conform and be manipulated. Pressure is the resultant force that comes with movement. The two need to be understood and applied in different ratios so you can be control of the environment and situation for optimal health.

    Compliance helps us to not get injured! The more we can absorb and release tension because our tissues are elastic and pliable, our tissues are not holding tension over a prolonged time. We need to relax and this takes energy when we are more on the “pressure” side of the equation.

    If you need to be produce maximal strength, you need pressure and less compliance. You do not want a pliable lower back and hips, as much as you need control force to move heavy object. If you can harness focused pressure while keeping compliance, you have the winning edge.

    This can be seen in Michael Jordan’s ability to manipulate a basketball and dominate his foes.

    Compliance and pressure needs to cycle to bring a rhythmic and necessary compression and decompression pumping effect. Numerous systems in our body is regulated through a pumping cycle, such as a heart beat or a gut motility cycle. Our ability to move requires a systemic and holistic cycle of compliance and pressure, which is maintained by two factors listed below.

    • Respiration efficiency of inhalation and exhalation.
    • The visceral organ ability to move independently of the musculoskeletal encasement during movement such as the cycle of locomotion.

    The more our visceral organs move independent of each other and the neighboring tissues, the less pressure is needed to move our bodies. There was a fascinating reference to an article on how a liver transplant can be kept healthy and viable for 2-3 more hours when compliance is maintained. The liver tissue becomes less “pressured”.

    There is another reference to an article on how laying on your stomach can bring more compliance cycle to COVID-19 patients. There is more perfusion and ventilation to the lungs as laying on your stomach will replace the pressure that your body will need to produce. Your diaphragm will have to work harder to bring rhythm back. Your body can relax and be compliant again. Again, the more compliant you are the more you can ride a virus load.

    As you read the rest of the article, be mindful of compliance and pressure regulation to improve movement and ease pain.

    Week 1 – Pleura, Lung & Chest Wall Relationships to Physiological and Physical Mechanics (click to watch the entire video)

    The first week starts with a quick overview of the lung anatomy and the nuances that impact each of the individual lungs. The main point is that ventilation (air exchange) and perfusion (fluid exchange within the capillaries) of the lungs need to be in contact. If that is disrupted, then the gas exchange will be changed. This is will tie into Week 4’s webinar. The lung is a very efficient machine that runs on minimal energy because it is the gas exchange and airflow that causes the lung to function. The lung is pumped by the diaphragm muscle that is underneath the lungs.

    The lung is surrounded by the rib cage (chest wall) and its associated pleura. The lung is encased by the visceral pleura. The inner chest wall is surrounded by the parietal pleura. In between the two pleurae is fluid that helps allow it to move, slide, and glide independent of each other. This is important as local lesions can cause ketchup-like fluid consistency that will impact your breathing and rib mechanics.

    The fluid and space (intrapleural pressure) result in a negative pressure of 756 mm Hg (-4 mm Hg difference) that keeps the lungs inflated. This produces a suction pressure between the rib cage and the lungs. Flow moves from high to low. The lung pressure, or atmospheric pressure and intra-alveolar pressure, is higher at 760 mm Hg. Remember that flow goes from high to low. 

    If the atmospheric pressure is lower because of altitude or your alveolar pressure increases above normal 760 mm Hg, you will have a hard time getting air into your lungs. The same goes for the opposite pattern. Airflow into the lung when the alveolar pressure is lower than atmospheric pressure. The respiratory muscles will contract to open up the lungs. When you get air into your lungs, the flow of gas opens up the lungs with the pleural cavity suctioning the lungs to open too. When you get a description of this pressure gradient, the loss of suction will result in a collapsed lung.

    Exhale can be said of the opposite pattern happening. The intercostals muscle contracts to shift the alveolar and atmospheric pressure gradient.

    The right lung has three lobes, which makes is larger, wider, and shorter. The right lung is divided into horizontal and oblique fissures. Your right 4th and 5th ribs is a good area to find the horizontal fissure. Your oblique fissure comes off of the horizontal fissure to orient diagonally from your right shoulder to your left hip.

    The left side rib cage is more crowded with the heart and esophagus, so the left lung is smaller, longer, and narrower with 2 lobes. Many are familiar with the need for the lungs to deflate and inflate, but the lungs and rib cage help to absorb shock, provide leverage for stable movement, and moves in recoil and coil-like manner.

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  • Rotator Cuff Tendinitis 101: How to improve mobility, strength, and possibly, avoid surgery.

    Everyone has an opinion on the management of shoulder pain. Whether it is a family member, co-worker, or neighbor, you are bound to find someone that tried to rid of their shoulder pain conservatively or surgically. You will hear both sides of people’s experiences when it comes to having shoulder surgery. Some will say that it helped and they would recommend it. Others will say that it was a horrible and painful experience. This article will focus on providing you some basic shoulder exercises that will support a rotator cuff tendinitis or torn tendon diagnosis, and possibly avoid rotator cuff surgery.

    Since we specialize in athletes’ shoulders, we will provide our spin for the more complex rotational athlete’s shoulder. This article is still very useful for the everyday shoulder. The difference between the athletes’ shoulders, such as baseball pitcher, swimmer, volleyball or tennis overhand serve, and an everyday person’s shoulder is that the athletes’ shoulder needs a continual obsession about maintaining the foundational basics that this article talks about. This is an article of the basics of rotator cuff function and performance, so you can resolve your tendinitis or torn rotator cuff myotendinous unit.  

    A muscle and tendon work together, so we are going to establish that they will be both called a contractile unit. All muscle and tendon, both help you to contract a muscle and move your arm. Your Sports Medicine Physical Therapist or Orthopedist Surgeon will decide that you have rotator tendinitis if you have “sharp” pin-point pain to the tip of your shoulder or “dull and achy” broad pain to the general region of your shoulder. It will hurt to raise your arm overhead. You may or may not have a limited range of motion. If you have fallen on your shoulder or had suffered a direct blow to your shoulder, they might suspect a tear over tendinitis. There is research that shows age is a contributing factor of one having a rotator cuff tendinitis or tear.

    If you are wondering how your Orthopedist or doctor concluded your rotator cuff tendinitis after looking at your shoulder for 5 minutes, only to tell you to take painkillers, apply ice, and seek a Physical Therapist, it is because of the general guidelines listed above. It does not take long to tell your age. He hears your story for 1-3 minutes. Trauma? Occupation? He or she can see there is shoulder pain when you raise your arm. Touching your arm does not tell much more, so if the doctor is in a rush, he may or may not touch your arm. This might disgust and frustrate you even more.  

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  • How does a perfect baseball pitch or hit look like?

    Who is your favorite baseball player? Pitcher? Hitter? Did you learn how to pitch or hit based on your baseball idols? When I was growing up, Nomar Garciaparra from the Los Angeles Dodgers and Boston Red Sox had a batting ritual that gave him the success he had as a Major League batter. Do you pitch like Dontrelle Willis or a Nolan Ryan? This article will dive into the core principle of perfect pitch or hit based on OnBASE University’s founding philosophy.

    Logo with a silhouette of a baseball player and 'OBU Certified' text.
    Click here to know more about OnBASE University.

    As a certified OnBASE University coach, the philosophy has resonated with the ideals of ReVITALize Rehab Club. We take everyone’s unique talent and try to get the most out of their body’s capabilities. Everyone has billions of factors that dictate their movement and health, such as DNA, structural anatomy, beliefs, sensory awareness, developmental movement, and emotional iQ, or fear-based thoughts. As there are infinite ways to play throw and hit, there is a common factor that impacts the ability to produce the best pitching and/or swinging sequence.

    Here is OnBASE University’s philosophy.  “We don’t believe there is one way to pitch; we believe there is an infinite number of ways to pitch. But we do believe that there is one efficient way for everyone to pitch and it is based on what they can physically do.” 

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  • Our promise to understand.

    We would like to start with us saying that “I promise to understand”.

    We cannot say that we understand what some are feeling, because to truly understand, you have to be able to relate. BUT we know there are many people of all race, color, sex, and such are feeling hurt, pain, and deathly afraid.


    The death of George Floyd did take our breath away for a brief moment but at least it was briefly. Someone lost a life. A son. A friend. A person.


    Going back to our promise…


    We have not lived your life and felt the joys and suffering of your life and this is why we can only try to learn more about you. We can try to understand you deeper, past your skin, social media posts, clothes, house, and the car that you drive.


    We can agree that you are a human being with desires, goals, thoughts, and dreams. You need oxygen, warmth, food, water, and shelter to live. Some of you do not have the basics and we see that you have the strength to survive.

    If you have been following us, we say that there is ONE key thing that is more important than wealth, health, and such. That one thing is to feel important and heard.

    Everyone has their own experiences that influence their beliefs and thoughts. This turns into decisions and then actions.

    Changing beliefs takes years and even generations. Due to this idea, we know it is important to allow conversations to happen that revolves around you.

    This is why we promise to provide a space for you to talk without judgment.
    We became a medical professional to “do no” harm and we know bias can impact care. This is why we promise to understand.

    Research shows that when people are oppressed and not given a medium to express their thoughts and feelings, they have more pain. Pain that is deep within that pills won’t fix.

    At ReVITALize Rehab Club, we can promise to give you our world so you can be 1% more at ease to share.

    The ability to talk and communicate as a person ist the true essence of being a human. This is what makes people feel important. It is what allows s to shift towards recovery and regenerative state of healing.

    We give you the most valuable thing in life. We give you our time. We hope that he many people we helped can support his one statement. Either way, we promise to understand you.

    If you are suffering from pain or unwanted stiffness, do not wake up hoping that it will go away. If you feel like no medical professional is hearing you, we promise to give you the time to feel heard.

    Allow your healing to start with a free consultation from us. Our gift so you can start doing what matters to you!

    Click HERE for a FREE consult

    One LOVE,

    Danh Ngo PT, DPT, OCS, SCS

    Doctor of Physical Therapy

    Board Certified Specialist in Orthopedic and Sports Medicine

    Certified Advanced Movement Specialist – RockTape

    Mind Body Health Results Coach

    Smiling young man wearing glasses and a striped sweater over a white shirt.

  • The FOUR foundations that a player needs when using a weighted baseball throwing program.

    This article was birth out of a parent asking me to develop a program that incorporated weighted baseball. This is a tricky and hot topic currently in the baseball community. The touted benefit is the increase in throwing velocity, while the downside perception is the increased injury rate to the shoulder and elbow region. There is no debate that Tommy John surgery or surgery to the ulnar collateral ligament is on the rise. The shocking truth is that modern orthopedic medicine is full of great inventions such as othrobiologics or more accurate and better materials used during shoulder and elbow surgeries.

    As a Sports Medicine Physical Therapist with a high interest in baseball rehabilitation, I was excited and felt a higher level of responsibility to make sure I produce results without sacrificing his health. I wanted to incorporate my holistic approach that combined physical tactics with the knowledge of Functional Medicine. There are some key principles that this article will talk about that. It was what was conveyed to both the parent and client of mine.

    Before I started everything, I did not want to assume that my background was enough to ensure his physical safety. I dug to the researched and looked at the perspectives of a few of the leading baseball performance groups, such as DriveLine, OnBaseU, Cressey Performance, and a landmark research article written by my colleague Physio, Mike Reinold. There are overlapping themes that I agree with and will present in this article. 

    The overall answer with the weighted ball is that it is necessary for a player’s development.

    That being said, you need certain fundamentals before starting, and once you start, all players need to have a system that allows them to adapt and evolve due to the use of a weighted ball throwing program.

    This article is not about me telling you how many repetitions and sets you need for your weighted ball program. This article explains my logic in dosing and the holistic physical preparation that this player will need to throw successfully. I hope to show that there needs to be a sense of purpose and thought behind every exercise and baseball-related activities.  

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  • 3 reasons to not stretch your tight hip flexors pain.

    The saying to keep it simple silly holds, but when it comes to fixing tight hip flexors pain, you have to understand why you should not stretch something that feels tight. A tight muscle should only be stretched out when you had a prolonged event that required you to not use that muscle(s). A case where stretching of a tight muscle is appropriate is during the rehabilitation of a body part that has been cast or splinted.

    When muscles are have been cast or splinted, there is shortening the basic contractile unit of muscle fiber called sarcomeres. This effect impacts your ability to produce power and strength. The shorter the sarcomeres, the more difficult it will be to get good contraction of a muscle. When you perform static stretching of a muscle, you lengthened the sarcomeres.

    This article will point out the case that your tight hip flexors are not due to a sarcomere and muscle fiber issue. But before we dive into the 3 common reasons for having a tight hip flexor, we will point out what a tight hip flexor muscle can do to your body. A tight hip flexor muscle will result in a compensated pelvis to be rotated anteriorly, thus resulting in one side of the pelvis to be in an exaggerated lumbar lordosis, pubic bone to be positioned more forward and down, and tailbone (coccyx bone) to be tipped up and back. Imagine a teapot with the spout placed down (like the pubic bone) to serve tea. The handle is the position of the coccyx. Every bone and joints that are associated with this posture adapts and will be malpositioned, accordingly.

    The list of common local complaints is included below.

    • Lower back pain.
    • Feeling like you have one leg shorter than the other leg.
    • Sacroiliac joint pain or dysfunction.
    • Groin pain or femoral-acetabular impingement.
    • Sciatica nerve pain.
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  • 3 Running Styles and the Impact on Your Body.

    Running is a great exercise to help improve your heart, lung, and mental sanity. Did you know your running styles can tell us a lot about how well built your body is to run? There are numerous nuances and tendencies that we can write about to help improve on your run, but the article will be forever long.


    An example of a running variable that will impact the stress load on your legs and spine is cadence. Cadence is a factor that has been shown to alter the ground reaction force to your legs and spine. This article will dive into the overall movement pattern and the indications of how you are using your spine and legs. There still needs to be follow-up strength and mobility assessment after you analyze your running style. The movement analyzation will guide on what might be going on during a run, but the follow-up testing will help to validate the theory of what is going on. There is no ONE particular test that will tell you everything. In the clinical world, you need a cluster of tests that will give you a working foundation to start experimenting with.

    After you learn about the 3 common running styles, we have an exclusive offer for you. At the end of the article, there is an orange button that you can click on to get your FREE running assessment. We will respond to you and give you instructions on how you can send us your running video. The video will guide us to know which running style you are using. In the email response, we will tell you to perform 3-4 movement tests and report back to us. We will ask about your running goals and your past training history. All of these three major factors will allow us to give you feedback so you can improve and run with ease.

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  • 5 Ways to How to Improve Gut Health

    Contrary to popular belief, bacteria isn’t always bad. In fact, an ecosystem of trillions of bacteria called the ‘gut microbiome’ plays a vital role in our body’s overall health. As we’ve previously shared in our ‘Stool Testing 101 and How Your Gut Impacts How You Feel’ post, a healthy gut microbiome is important for our mood, our muscular system, and our cognitive functions. If you’re not quite sure how to maintain a healthy gut, here are some tips.

    1. Eat the Right Food.

    Eating the right diet is a key factor in keeping your gut healthy. Case in point: Consuming food that’s rich in fiber stimulates the growth of good bacteria in your gut — from fruits and vegetables, to legumes and grains. True enough, SELF Magazine notes that whole grains not only block the reabsorption of cholesterol in the gut, but they also supply it with prebiotics — which is essentially food for healthy gut bacteria. Also, foods that contain polyphenols such as nuts, soy products, and dark chocolate, help promote both diversity and the number of bacteria in your gut.

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  • 21st Century Health Care Solutions: The Functional Medicine Approach to Chronic Illness

    Chronic illness impacts over 125 million Americans.

    While so many people suffer from chronic illness, many don’t get the treatment they need. When it comes to chronic illness, too many people live with the aches, pains, and discomfort associated with it.

    The reason for this is that symptoms of chronic illness can often look like acute conditions that are able to be treated with medication. Well, functional medicine makes relief a possibility! 

    Functional medicine offers an approach that traditional medicine fails to offer patients.

    To learn about why functional medicine is the best option for coping with chronic illness, keep reading!

    What Is Functional Medicine?

    Where traditional medicine focuses on prescribing medication for chronic illness, functional medicine takes a more holistic approach.

    The goal of functional medicine is to identify the cause of chronic illness. To do this, a doctor specializing in functional medicine will take a look at all the symptoms you’re experiencing. Then, they will determine a possible cause.

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