How Pelvic Tilt Influences Hamstring and Spine Mobility

how pelvic tilt influences hamstring and spine mobilityHow many people come to you and complain that they have tight hamstrings?  It seems like an epidemic sometimes, right?  I know it’s pretty common for me, at least.  

Many people just tug away at their hamstrings and aggressively stretch, which may not only be barking up the wrong tree, but also disadvantageous.

I have really gotten away from blindly stretching the hamstrings without a proper assessment, as I feel that pelvic position is often the reason why people think they are tight.  This is pretty easy to miss.

In the video below, I want to explain and help you visualize the how pelvic tilt influences hamstring mobility and spine position.  Often times the hamstrings feel “tight” or “short” when in reality their pelvic position is just giving us this illusion.  I talk about this a lot with clients at Champion and often find myself making these drawings on our whiteboard.

Keep this in mind next time you think someone has tight hamstrings or has too much thoracic kyphosis.  Often times the key is in the hips!

 

How Pelvic Tilt Influences Hamstring and Spine Mobility

 

Strategies for Anterior Pelvic Tilt

If you are interested in learning more, I have a couple of great webinars for my Inner Circle members that you may find helpful:

Hip Variations and Why My Squat Isn’t Your Squat

Today’s article is an AMAZING guest post from my friend Dean Somerset.  I’ve been talking a lot lately about how hip anatomy should change your mechanics and why exercises like squats should be individualized based on each person, but Dean blows this topic out of the water with this article.  If you love this stuff as much as I, check out the link at the bottom for Dean and Tony Gentilcore’s new program, The Complete Shoulder & Hip Blueprint.  This is just the tip of the iceberg of what is covered in the program.

 

Hip Variations and Why My Squat Isn’t Your Squat

In a recent workshop, I had a group of 50 fit and active fitness professionals and asked them all to do their best bodyweight squat with a position that felt good, didn’t produce pain, and was as deep as they could manage. As you can imagine, looking around the room produced 50 different squats. Some were wide, narrow, deep, high, turned out feet or some variation all of the above.

Did these differences mean there was a standard everyone should aim for, and those who weren’t there had to try to improve their mobility or strength or balance in that position? Maybe, but there’s probably a bunch of other reasons as to why 50 people have 50 different squats.

A standard requirement for powerlifting is to squat to a depth that involves having the crease of the hips below the vertical position of the knee. That’s probably the only known requirement for squat depth out there. The universal recommendation of “ass to grass” depth being the best thing since sliced bread may sound nice on paper (or in Instagram videos or Youtube segments), but it might be something that’s relatively difficult for some people to achieve, and for others it could be downright impossible, regardless of how much mobility work or soft tissue attacks they go through. The benefits of a deep squat seem to only be reserved for those who have the ability to express those benefits by accessing that range of motion without some other compensatory issue.

Let’s just consider simple stuff like anthropometric differences between individuals. Someone who is taller will have a bigger range of motion to go through to hit a parallel position than someone who is shorter, and someone with longer femurs in relation to their torso length will have a harder time maintaining balance over their base of support compared to someone who has shorter femurs. A long femur could be any femur that comprises more than 26% of an individual’s’ total height. So someone who is tall and long femured will have trouble getting down to or below parallel due to simply having the limb lengths to allow the bar to stay over the base of support during the squat motion without losing balance one way or the other.

Not as commonly known is the degree of retroversion or anteversion the femoral necks can make. The shaft of the femur doesn’t just always go straight up and insert into the pelvis with a solid 90 degree alignment. On occasion the neck can be angled forward (femoral head is anterior to the shaft) in a position known as anteversion, or angled backward (femoral head is posterior to the shaft) in a position known as retroversion. Zalawadia et al (2010) showed the variances in femoral neck angles could be as much as 24 degrees between samples, which can be a huge difference when it comes to the ability to move a joint through a range of motion.

hip variations squat

The acetabulum could itself be in a position of anteversion or retroversion, and this difference itself could be more than 30 degrees. This means the same shaped acetabulum would give someone who has the most anteverted acetabulum 30 extra degrees of flexion than someone who had the most retroverted acetabulum, but would give them 30 degrees more extension than the anteverted hips.

There’s also the differences in centre-edge angles, or the angle made from the center of the femoral head through the vertical axis and the outer edge of the lateral acetabulum. Laborie et al (2012) measured this angle in 2038 19 year old Norwegians, and found that it ranged from 20.8 degrees to 45.0 degrees with a mean of 32 in males and 31 in females.

hip anatomy squat

Now to throw even another monkey wrench into the problem, there’s the simple fact that your left and right hips can be at different angles from each other! Zalawadia (same guy as before) showed that the angle of anteversion or retroversion of the femur could be significantly different from left to right, sometimes more than 20 degrees worth of difference.

squat anatomy

All of this can have a direct effect on their available range of motion. You can’t easily mobilize bone into bone and create a new range from that interaction, so if one person has hips where the bony alignment and shape doesn’t causes earlier contact in a specific direction compared to someone else who has a different shaped and aligned hip structure, it’s going to show in their overall mobility.

Elson and Aspinal (2008) showed that there can be a massive variation in both passive and active movements of the hip across age ranges and gender differences. They showed a true hip flexion range of between 80-140 degrees (mean of 25)with no lumbar rounding, a strict active straight leg raise with no lumbar rounding range of 30-90 degrees (mean of 70), and active leg raise with lumbar rounding of 50-90 degrees (mean of 86). This means someone in their sample managed to get 60 degrees more hip flexion than someone else in the sample. There was also a range of between 5-40 degrees of hip extension too, and across an age range from 19-89 years old, that’s a notable difference, especially if you work in general populations where everyone walks into the gym and over to the squat rack.

D’Lima et al (2000) found that hip flexion ROM could be as low as 75 degrees with 0 degrees of both acetabular anteversion or femoral anteversion, but as high as 155 degrees, with 30 degrees of both acetabular anteversion or femoral anteversion. An increase in femoral neck diameter of as little as 2mm was able to reduce hip flexion range by 1.5 – 8.5 degrees, depending on the direction of motion.

So essentially, your ability to achieve a specific range of motion is as much up to your unique articular geometry as it is to your strength and mobility. In many cases, it’s entirely independent of your strength and mobility, and no amount of stretching, mashing, crushing, or stripping will improve it. In many cases, trying to achieve that range of motion that’s outside of your joints ability to achieve will cause less desirable results, like bone to bone contact and irritation (potentially leading to things like femoroacetabular impingement), or compensatory movement from other joints like the SI joint or lumbar spine.

So with as much involved with the structure as I’ve presented here, and how impactful it can be to the end result of total motion of the hips during exercises, how can you determine whether it’s a limiting factor or not? If you happen to have X-ray vision you can do a good job of this, but you’d likely be charging a heck of a lot more money than you are right now for your services.

What we have available is a detailed assessment that focuses on a combination of features.

Involving a passive assessment to assume a theoretically available range of motion and shape of movement capability, an active assessment to see how they can use that range and whether there’s a difference between the two, and then determining strength or motor pattern aptitudes for the movements can be the best tools we have at our disposal, and then coaching the movement until their face sweats blood.

By using multiple approaches to assessing available and usable range of motion, you can get multiple views into a room that can paint a broader picture of what’s available. If the person has the ability to easily let their knee drop to their chest on your treatment table and squat to the floor, there’s obviously no restriction to their range of motion. If they have trouble breaking 90 degrees, even if they move wider through abduction and external rotation, their active range is limited through multiple tests, and their ability to show you a squat shows a lumbar flexion at around 90 degrees of hip flexion as well, the odds of you mobilizing that tissue to produce a significantly bigger range may be limited.

 

Passive Assessment of Hip Structure

 

Active Hip Flexion Capability Against Gravity

 

Active Rockback for Hip Flexion without Gravity Influence

 

Supported Squat Assessment


If all of these tests show a specific limitation to the range of motion consistently across all situations, it could be assumed that there would be a structural limitation versus passive insufficiency, weakness or other considerations. If active testing is limited but passive or supported assessments are fine, there could be a strength or motor pattern limitation holding the movement back.

Now sure, there’s a lot of brakes that could be restricting that range, from things like scar tissue to guarding and some soft tissue restrictions. Doing some work to help reduce that can help improve overall range of motion, but in some cases will be limited to just minimal gains. In some situations, trainers or therapists may work on improving range of motion for weeks or months and see no improvement, and in many cases the deck would be stacked against them seeing any improvement at all.

customized squat pattern

As mentioned earlier, there could also be an asymmetric structural element at play, which may necessitate an asymmetric setup for the movement where one foot is either turned out more, held slightly forward or back, or even turned into something like a one-heel elevated squat. The difference between this and a lunge is merely how far back that elevated foot is relative to the other foot, but again it’s taking advantage of potential asymmetries in structure and allowing an asymmetric set up to be more congruent with the individual.

Another way to think of it is if we have a potentially asymmetric structure yet force a symmetric set up on it, we may be creating an imbalance or compensative element in our training versus preventing it.

The Complete Hip and Shoulder Blueprint

complere shoulder and hip blueprintThese and many more elements are discussed in Complete Shoulder & Hip Blueprint, a new continuing education resource from Tony Gentilcore and Dean Somerset. This digital video product is 11 hours of lecture and hands on where they break down pertinent anatomy, considerations for program design, and delve into assessments, corrective options, and training considerations for these 2 highly involved complex structures.

The series is currently on a launch sale pricing, and the entire package is available for only $137 versus the regular pricing of $177. The sale is on from November 1 through 5, so act quickly to get your copy.  Click below to learn more or check out the below preview video!

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Shoulder Impingement – 3 Keys to Assessment and Treatment

Shoulder impingement really is a pretty broad term that most of us likely take for granted.  It has become such a junk term, such as “patellofemoral pain,” especially with physicians.  It seems as if any pain originated from around the shoulder could be labeled as “shoulder impingement” for some reason, as if that diagnosis is helpful to determine the treatment process.

Unfortunately, There is no magical “shoulder impingement protocol” that you can pull out of your notebook and apply to a specific person. [Click to Tweet]

I wish it were the simple.

A thorough examination is still needed.  Each person will likely present differently, which will require a variations on how you approach their rehabilitation.

But the real challenge when working with someone with shoulder impingement isn’t figuring out they have shoulder pain, that’s fairly obviously.  It’s figuring out why they have shoulder pain.

 

 

Shoulder Impingement: 3 Keys to Assessment and Treatment

To make the treatment process a little more simple, there are three things that I typically consider to classify and differentiate shoulder impingement.

  1. Location of impingement
  2. Structures involved
  3. Cause of impingement

Each of these can significantly vary the treatment approach and how successful you are helping each person.

 

Location of Impingement

The first thing to consider when evaluating someone with shoulder impingement is the location of impingement.  This is generally in reference to the side of the rotator cuff that the impingement is located, either the bursal side or articular side.

shoulder impingement assessment and treatment

See the photo of a shoulder MRI above.  The bursal side is the outside of the rotator cuff, shown with the red arrow.  This is probably your “standard” subacromial impingement that everyone refers to when simply stating “shoulder impingement.”  The green arrow shows the inside, or articular surface, of the rotator cuff.  Impingement on this side is termed “internal impingement.”

The two are different in terms of cause, evaluation, and treatment, so this first distinction is important.  More about these later when we get into the evaluation and treatment treatment.

 

Impinging Structures

To me, this is more for the bursal sided, or subacromial, impingement and refers to what structure the rotator cuff is impinging against.  As you can see in the pictures below (both side views), your subacromial space is pretty small without a lot if room for error.  In fact, there really isn’t a “space”, there are many structures running in this area including your rotator cuff and subacromial bursa.

Shoulder impingement

You actually “impinge” every time you move your arm.  Impingement itself is normal and happens in all of us, it is when it becomes excessive or abnormal that pathology occurs.

I try to differentiate between acromial and coracoacromial arch impingement, which can happen in combination or isolation.  There are fairly similar in regard to assessment and treatment, but I would make a couple of mild modifications for coracoacromial impingement, which we will discuss below.

 

Cause of Impingement

The next thing to look at is the actual reason why the person is experiencing shoulder impingement.  There are two main classifications of causes, that I refer to as “primary” or “secondary”shoulder  impingement.

Primary impingement means that the impingement is the main problem with the person.  A good example of this is someone that has impingement due to anatomical considerations, with a hooked tip of the acromion like this in the picture below.  Many acromions are flat or curved, but some have a hook or even a spur attached to the tip (drawn in red):

shoulder impingement

 

Secondary impingement means that something is causing impingement, perhaps their activities, posture, lack of dynamic stability, or muscle imbalances are causing the humeral head to shift in it’s center of rotation and cause impingement.  The most simply example of this is weakness of the rotator cuff.

The rotator cuff and larger muscle groups, like the deltoid, work together to move your arm in space.  The rotator cuff works to steer the ship by keeping the humeral head centered within the glenoid.  The deltoid and larger muscles power the ship and move the arm.

Both muscles groups need to work together.  If rotator cuff weakness is present, the cuff may lose it’s ability to keep the humeral head centered.  In this scenario, the deltoid will overpower the cuff and cause the humeral head to migrate superiorly, thus impinging the cuff between the humeral head and the acromion:

evaluation and treatment of shoulder impingement

 

Other common reasons for secondary impingement include mobility restrictions of the shoulder, scapula, and even thoracic spine.  We see this a lot at Champion.  In the person below, you can see that they do not have full overhead mobility, yet they are trying to overhead press and other activities in the gym, flaring up their shoulder.

shoulder impingement mobility

If all we did with this person was treat the location of the pain in his anterior shoulder, our success will be limited.  He’ll return to gym and start the process all over if we don’t restore this mobility restriction.

The funny thing about this is that people are almost never aware that they even have this limitation until you show them.

 

 

Differentiating Between the Types of Shoulder Impingement

In my online program on the Evidence Based Evaluation and Treatment of the Shoulder, I talk about different ways to assess shoulder impingement that may impact your rehab or training.  There are specific tests to assess each type of impingement we discussed above.

The two most popular tests for shoulder impingement are the Neer test and the Hawkins test.  In the Neer test (below left), the examiner stabilizes the scapula while passively elevating the shoulder, in effect jamming the humeral head into the acromion.  In the Hawkins test (below right) the examiner elevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, grinding the cuff under the subacromial arch.

Shoulder impingement tests

You can alter these tests slightly to see if they elicit different symptoms that would be more indicative to the coracoacromial arch type of subacromial impingement.  This would involve the cuff impingement more anteriorly so the tests below attempt to simulate this area of vulnerability.

The Hawkins test (below left) can be modified and performed in a more horizontally adducted position.  Another shoulder impingement test (below right) can be performed by asking the patient to grasp their opposite shoulder and to actively elevate the shoulder.

how to assess shoulder impingement

There is a good chance that many patients with subacromial impingement may be symptomatic with all of the above tests, but you may be able to detect the location of subacromial impingement (acromial versus coracoacromial arch) by watching for subtle changes in symptoms with the above four tests.

Internal impingement is a different beast.

This type of impingement, which is most commonly seen in overhead athletes, is typically the result of some hyperlaxity in the anterior direction.  As the athlete comes into full external rotation, such as the position of baseball pitch, tennis serve, etc., the humeral head slides anterior slightly causing the undersurface of the cuff to impingement on the inside against the posterior-superior glenoid rim and labrum.  This is what you hear of when baseball players have “partial thickness rotator cuff tears” the majority of time.

shoulder internal impingement

 

 

The test for this is simple and is exactly the same as an anterior apprehension test.  The examiner externally rotates the arm at 90 degrees abduction and watches for symptoms.  Unlike the shoulder instability patient, someone with internal impingement will not feel apprehension or anterior symptoms.  Rather, they will have a very specific point of tenderness in the posterosuperior aspect of the shoulder (below left).  Ween the examiner relocates the shoulder by giving a slight posterior glide of the humeral head, the posterosuperior pain diminishes (below right).

how to assess shoulder internal impingement

 

3 Keys to Treating Shoulder Impingement – How Does Treatment Vary?

There are three main keys from the above information that you can use to alter your treatment and training programs based on the type of impingement exhibited:

Subacromial Impingement Treatment

To properly treat, you should differentiate between acromial and coracoacromial impingement.  Treatment is essentially the same between these two types of subacromial impingement, however, with coracoacromial arch impingement, you need to be cautious with horizontal adduction movements and stretching.  This is unfortunate as the posterior soft tissue typically needs to be stretched in these patients, but you can not work through a pinch with impingement!

A “pinch” is impingement of an inflamed structure!

Also, I would avoid elevation in the sagittal plane or horizontal adduction exercises.

 

Primary Versus Secondary Shoulder Impingement

This is an important one and often a source of frustration in young clinicians.  If you are dealing with secondary impingement, you can treat the persons symptoms all you want, but they will come back if you do not address the route of the pathology!

I do treat their symptoms, that is why they have come to see me.  I want to reduce inflammation.  However, this should not be the primary focus if you want longer term success.

This is where a more global look at the patient, their posture, muscle imbalances, and movement dysfunction all come into play.  Break through and see patients in this light and you will see much better outcomes.

A good discussion of the activities that are causing their symptoms may also shed some light on why they are having shoulder pain.  Again, using the example above, if you don’t have full mobility and try to force the shoulder through this tightness you are going to likely cause some issues.  This is especially true if you add speed, loading, and repetition to elevation, such as during many exercises.

 

Internal Impingement

One thing to realize with internal impingement is that this is pretty much a secondary issue.  It is going to occur with any cuff weakness, fatigue, or loss of the ability to dynamically stabilize.   The athlete will show some hyperlaxity in this athletic “lay back” shoulder position.  Treat the cuff weakness and it’s ability to dynamically stabilize to relieve the impingement.  How to treat internal impingement is a huge topic that I cover in a webinar for my Inner Circle members.

 

Learn Exactly How I Evaluate and Treat the Shoulder

If you are interested in mastering your understanding of the shoulder, I have my acclaiming online program teaching you exactly how I evaluate and treat the shoulder at ShoulderSeminar.com!

The online program at takes you through an online 8-week program with new content added every week.  You can learn at your own pace in the comfort of your own home.  You’ll learn exactly how I approach:

  • shoulder seminarThe evaluation of the shoulder
  • Selecting exercises for the shoulder
  • Manual resistance and dynamic stabilization drills for the shoulder
  • Nonoperative and postoperative rehabilitation
  • Rotator cuff injuries
  • Shoulder instability
  • SLAP lesions
  • The stiff shoulder
  • Manual therapy for the shoulder

The program offers 21 CEU hours for the NATA and APTA of MA and 20 CEU hours through the NSCA.

Click below to learn more!

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Should Everyone Deadlift?

Many people have called the deadlift, “the king of all exercises.”  And rightfully so, as there may not be a bigger bang-for-your-buck exercise out there.

In my opinion, the deadlift is the most underutilized exercise in rehabilitation.  Perhaps the move is intimidating?  Perhaps people are afraid of barbells?  Perhaps people are worried patients may hurt their backs?  Perhaps rehab professionals don’t know enough about strength and conditioning?

I always say that I am a much better physical therapist because I am also a strength coach, and always keep learning from many great strength coaches.

As the gap between rehab and performance continues to narrow, the deadlift may be the final exercise to cross the chasm.  We shouldn’t be afraid of the deadlift, however, we also need to understand the the conventional deadlift is not for everyone.

 

Why Everyone Should Deadlift

should everyone deadliftOne of the most important trends in rehabilitation and strength and conditioning over the last decade or two has been the move away from muscle-based exercises and shift towards movement-based exercises.  Rather than work on quad strength, work on squatting, for example.  (Photo credit by the man, the myth, and the deadlift legend Tony Gentilcore)

The deadlift is essentially a hip hinge pattern, which is extremely functional and equally elusive for many people.

Put simply, people can’t hinge anymore!  It’s amazing.

As our society changes and relies more on poor posture patterns, prolonged seated periods, and things like excessive use of smartphones, I’m amazed how it seems even kids can’t touch their toes anymore.

Working on a poor hip hinge pattern is extremely helpful for so many different issues that I see every day.  From back pain, to knee pain, to even poor sport performance.

We have become so anterior chain dominant.  Luckily, the deadlift hits the entire posterior chain in one big lift.  

So the the deadlift really helps with the hip hinge pattern, but there are so many other benefits including working on better posture, glute development, lower extremity power development, a stronger core, stronger lats, and even enhanced grip strength.  

You can see why it’s such a big bang-for-your-buck exercise.

 

Why Everyone Shouldn’t Deadlift

Wait a minute…

I just spent the first half talking about how beneficial the deadlift is for so many people.  Why shouldn’t everyone perform a deadlift?

Let me clarify – I’m talking about the conventional barbell deadlift.

Take a step back and remember that we are more concerned about movements, than muscles, right?  So luckily there are many variations of hinging, and even deadlifts, that can be utilized to achieve all the above great goals.

Perhaps the deadlift is so underutilized in the rehab setting because everyone just looks at the conventional barbell deadlift.  That’s like going straight to the top, saying that there is no way you can perform that exercise, then just scrapping all forms of deadlifts and hip hinge exercises.

Most people that walk into the door at Champion have no chance at being successful at a conventional barbell deadlift.  Among other things, you need:

  • Good mobility
  • An understanding of the hinge pattern neuromuscular pattern
  • The ability to load, essentially lift a weight with intent

Most people don’t have at least 2-3 of these qualities.

We’ll try to get them there with the right blend of mobility drills, corrective exercises, and manual therapy, but that doesn’t mean we have to wait to start deadlifting.  We just need to start at a more regressed level.

So, don’t immediately scrap the deadlift, find a way to incorporate it.  Work within your mobility and limited range, try a variation using a kettlebell or sumo stance, and use submaximal loads until you can groove a proper hip hinge pattern.

deadlift variations

One of my favorite resources on deadlift technique and variations is this excellent article by Mike Robertson.

As you improve, you can incorporate more advanced forms of the deadlift, but don’t simply scrap the deadlift until then, modify!

 

3 Ways to Modify a Deadlift so Anyone Can Perform

If you want to learn more, I have an Inner Circle webinar on 3 Ways to Modify the Deadlift so Anyone Can Perform.  In this presentation, I break down the 3 most common reasons why people often don’t perform a deadlift, the inability to load, poor hinge patterns, and altered hip anatomy.  Deadlifts are great, and really underutilized in rehab, but with these 3 modifications, anyone should be able to perform them.

To access this webinar:

3 Ways to Modify the Deadlift so Anyone Can Perform

The latest Inner Circle webinar recording on 3 Ways to Modify the Deadlift so Anyone Can Perform is now available.

 

 3 Ways to Modify the Deadlift so Anyone Can Perform

3 ways to modify the deadlift so anyone can performThis month’s Inner Circle webinar is on 3 Ways to Modify the Deadlift so Anyone Can Perform.  In this presentation, I break down the 3 most common reasons why people often don’t perform a deadlift: the inability to load, poor hinge patterns, and altered hip anatomy.  Deadlifts are great, and especially underutilized in rehab, but with these 3 modifications, anyone should be able to perform.


This webinar will cover:

  • Why deadlifts are so important
  • The 3 most common reasons why people can’t deadlift
  • How to regress and vary the movement
  • How to include at any stage of the rehab and performance spectrum


To access this webinar:

 

Working Core Training in 360 Degrees

The notion of core training has been around for years and years.  As far back as I can remember, people have been doing crunches, sit-ups, weighted side bends, and more.  You could walk into any gym in the world and probably see someone doing some sort of “core” exercise.

core training sit ups

Photo credit

Even today, there are still people performing sit-ups or some other variation in their training program.  But as we continue to learn more about the spine, these traditional core exercises may actually be disadvantageous.  According to Dr. Stuart McGill, a noted spine biomechanist from the University of Waterloo:

“The spine may be more prone to injury when they are in a fully flexed posture.”

Last time I checked, when someone is performing a sit-up, they are in a great deal of flexion.  

Many other studies by McGill and other researchers have been published on the increased risk of high repetition and/or loaded lumbar spine motion.  Since this research has been published, there has been a pendulum swing towards performing more neutral spine movements such as planks.

core training plank

In another study by Cholewicki and McGill in Clinical Biomechanics:

“One important mechanical function of the lumbar spine is to support the upper body by transmitting compressive and shearing forces to the lower body during the performance of everyday activities. To enable the successful transmission of these forces, mechanical stability of the spinal system must be assured.”

By performing some type of plank or neutral spine exercise, this can potentially train the core to transmit force from the upper body to the lower body or vice versa without compromising the spine.

Performing plank variations is great, but as humans, we move in multiple planes of motion.  Therefore, we need to train the core to function in all planes of motion.

 

Core Musculature

360 degree core trainingThere are many muscles that contribute to the functioning of a stable core position.  These muscles include:

 

  • Rectus Abdominis
  • Internal Obliques
  • External Obliques
  • Transverse Abdominis
  • Multifidi
  • Quadratus Lumborum
  • Diaphragm
  • Pelvic Floor
  • Latissimus Dorsi

There have been studies performed over the years saying that transverse abdominis or multifidi are the main stabilizers of the lumbar spine.  Study after study, many by McGill, have refuted that 1 or 2 muscles are the primary stabilizers of the spine.  McGill et al. in the Journal of Electromyography and Kinesiology found that:

“The collection of works synthesized here point to the notion that stability results from highly coordinated muscle activation patterns involving many muscles, and that the recruitment patterns must continually change, depending on the task.”

Therefore, when we are training or treating our clients, we should not be attempting to isolate one muscle we performing lifting tasks.  Some muscles may be more active than others in one task as compared to another.  Instead, we should be working to maintain a neutral spine position and to resist motion through the lumbar spine.

The McGill Big 3

McGill came up with a series of 3 exercises, entitled “The Big 3” to help teach and re-educate patients or clients returning from a low back injury on how to properly stabilize their spine.

They include:

McGill Curl-Up

Key Points:

  • Place finger tips under low back.
  • Maintain a neutral spine position at low back and neck.
  • Slightly lift shoulders off ground while maintaining spine position.

Bird Dog

Key Points:

  • Maintain a neutral spine.
  • Imagine you have a drink on your low back. Don’t let it spill

Side Plank

Key Points:

  • Start on your side in a hip hinged position (hips slightly flexed).
  • Bring hips forward, not up.

These exercises are great implements to add into the beginning of a strength and conditioning program or during a rehab program for someone returning from a low back injury.  But, these exercises are a foundation for movement.  If we are going to build core stability throughout, thence need to have a solid foundation as well as solid “walls and a roof.”

 

Core Training Progression

There are typically two functions of the core:

  1. Transmit force from the lower body to the upper body or vice versa.  
  2. Resist motion.  

For example, if you are a baseball player and are throwing or swinging a bat, you want to have some motion through your lumbar spine, but predominantly through the hips and thoracic spine.  If we try to stop motion at the lumbar spine, your effectiveness as an athlete will be subpar.

Don’t forget…  the spine needs to move.  This is something Mike has covered in his article Are We Missing the Boat on Core Training?

Regarding the other aspect of resisting motion, if you are going to pick something heavy up off the ground, you want to maintain a neutral spine posture so that your core can transmit force from your legs and into your arms as you lift to the implement.

We need to appreciate these two different situations as we program for our clients.

The three planes of movement that the core musculature works in is the:

  • Sagittal Plane
  • Frontal Plane
  • Transverse Plane

The sagittal plane is lumbar spine flexion and extension. The frontal plane is lateral flexion or sidebending.  The transverse plane is rotation to the right or left.

The following progressions are a big part of Mike Reinold and Eric Cressey’s Functional Stability Training For the Core program.

 

Anti-Extension Core Training

Anti-extension core training consists of the body’s ability to resist movement into lumbar spine extension or to slow down motion from a flexed position to neutral, or from neutral to extension.

Exercises that focus on anti-extension stability are:

RKC Plank

Key Points:

  • Pull your elbows toward your toes.
  • Squeeze your glutes as hard as you can.
  • Maintain a neutral spine.

TRX Fallouts

Key Points:

  • Maintain a neutral spine.
  • Tuck tailbone/bring belt towards chin.
  • Slide arms out while keeping neutral spine.

Farmer’s Carries

Key Points:

  • Hold relatively heavy weight in each hand.
  • Ribs down/neutral spine.
  • Walk.  Don’t lose neutral spine posture as you walk.

Dead Bugs

Key Points:

  • Flatten low back to ground so that spine is neutral.
  • Bring right arm overhead and left leg out away from body.
  • Do not lose neutral spine position.  Return to starting position.
  • Repeat on other arm/leg.

Tall Kneeling Anti-Extension Press

Key Points:

  • Setup cable at head height when in tall kneeling.
  • Maintain a neutral spine and press cable overhead.
  • Cable will try to pull you into extension.  Don’t let it.
  • The only thing moving should be your arms.

Anti-Lateral Flexion Core Training

Anti-lateral flexion core training consists of the body’s ability to resist movement into lumbar spine lateral flexion to the right or left or to slow down motion from a flexed position to neutral, or from neutral to the opposite laterally flexed position.

Exercises that focus on anti-lateral flexion core stability are:

Suitcase Carries

Key Points:

  • Hold weight in one hand.
  • Do not let weight pull you out of a tall, neutral posture.
  • Don’t overcompensate to and flex to the opposite side.
  • Walk.

Side Planks

Key Points:

  • Start on your side in a neutral spine, slightly hips flexed position.
  • Maintain neutral spine and bring hips forward.
  • Maintain a straight line from your head, shoulders, spine, hips, knees, and ankles.

Racked Carries

Key Points:

  • Maintain a tall posture similar to the suitcase carries.
  • Walk.

Anti-Rotation Core Training

Anti-rotation core training consists of the body’s ability to resist movement into lumbar spine rotation to the right or left or to slow down motion from a rotated position to neutral, or from neutral to a rotated position.

Exercises that focus on anti-rotation core stability are:

Anti-Rotation Press

Key Points:

  • Start behind cable arm.
  • When you press your hands away, don’t let the machine rotate you.  Maintain a neutral spine.
  • Perform facing both directions.

1/2 Kneeling Chops

Key Points:

  • Leg closest to the machine should be up.
  • Bring arms down and across your body to you far side hip.
  • Only move head and arms.
  • Perform on both sides.

1/2 Kneeling Lifts

Key Points:

  • Leg closest to machine should be down.
  • Same cues as chops, but bring cable to far side shoulder.

TRX Anti-Rotation Press

Key Points:

  • Feet should be in tandem.
  • Maintain a neutral spine position.
  • Don’t let your body rotate or sidebend during press.
  • Perform on both sides.

 

Multi-Planar Movements and Rotational Sport Athletes

Once the body has mastered the basic core progressions and anti-movement-based drills, it is important to incorporate multi-planar and rotational movements.  These movements work on incorporating movement through the hips and thoracic spine versus some of the movements before where basically no movement was occurring.

As mentioned before, these exercises will help the athlete and client to control themselves going from one position to another.  As a rotational sport athlete, we don’t want to completely limit any spine motion.  We want the body to be able to control and decelerate the body using the musculature versus passive restraints (ie. bone, ligament, etc.) at end range.  These can also be used by non-rotational sport athletes as well.

Sledgehammer Hits

Key Points:

  • Bring the sledgehammer up over one shoulder.  Don’t let it bring you into lumbar extension.
  • Hit the tire while maintaining a neutral spine.
  • Alternate per side.

Medicine Ball Overhead Slams

Key Points:

  • Raise the medicine ball overhead.
  • Avoid going into lumbar extension.
  • Slam the ball to the ground while maintaining a neutral spine.

Medicine Ball Overhead Rotational Slams

Key Points:

  • Bring the ball up overhead.  Don’t let it bring you into lumbar extension.
  • Throw while maintaining a neutral spine.

Medicine Ball Scoop Toss

Key Points:

  • Load your back leg with your weight.
  • Transfer weight quickly from back to front leg.
  • Majority of the motion should be coming from the thoracic spine and hips.
  • Perform on both sides.

Medicine Ball Shotput Toss

Key Points:

  • Load medicine ball at shoulder height.
  • Load back hip/leg.
  • Quickly drive off back leg and twist through hips/thoracic spine.
  • Perform on both sides.

 

Breathing and Core Training

Implementing breathing with core training is very important.  If we are constantly holding our breath while performing core exercises, then we are compensating using the valsalva maneuver versus training the musculature to have to stabilize throughout the exercise.

Related Articles:

*Disclaimer*: if you have heavy weight in your hands or on your back in the cases of a deadlift or squat, then I am a proponent of using the breath to brace the core and spine.  When it comes to core exercises as mentioned above, remember to breath.  

With the said, here are a couple of exercises where implementing the breath adds another component to the movement.

Anti-Rotation Press with Full Exhale

Key Points:

  • Same as before with Anti-rotation Press.
  • Complete full exhale when hands are out in front of your body.
  • Maintain proper form during exhale and inhale.

Prone Plank with Full Exhale

Key Points:

  • Same as before with Plank.
  • Complete full inhale and exhale without losing form.

 

Strength Training and Core Stability

Lastly, we can’t go through an entire article and not discuss the use of core stability and strength training.  I am a firm believer that just performing squats and deadlifts are not enough to improve core and trunk stability.  Adding some of the movements mentioned above can add another component to create a well-rounded training program.

When it comes to performing squats, deadlifts, etc., maintaining a neutral spine during the lifts is extremely important.  Yes, there are some elite level lifters out there who can sway away from a neutral position in one direction or the other.   For the vast majority of people performing strength movements such as these, a neutral spine should be maintained.

There you have it.  By incorporating core stability exercises throughout all planes of motion, it will allow your clients and/or athletes to reduce their risk for injuries as well as improve their performance.

 

Learn More About Core Training

If you want to learn even more about functional core training, check out Mike Reinold and Eric Cressey’s Functional Stability Training for the Core.  The program goes over many of these progressions and a whole lot more to help you completely understand the true role of the core and how to incorporate functional core training into your rehab and strength training programs:

 

About the Author

andrew_millettAndrew Millett is a Boston-based physical therapist in the field of orthopedic and sports medicine physical therapy.  He helps to bridge the gap between physical therapy and strength and conditioning.  Visit his website at AndrewMillettPT.com.

 

 

 

 

Bridging the Gap From Rehab to Performance

I’m really excited to announce that the online version of the Champion Bridging the Gap From Rehab to Performance seminar that we had up in Boston last month is now available!

We see so many people at Champion that have rehabbed elsewhere for months and are still doing 3×10 of straight leg raises.  It’s no wonder that studies show persistent weakness after rotator cuff repair, ACL reconstruction, and other surgeries.  We aren’t bridging the gap!  

That’s why we wanted to put this together to show how we focus on acute rehab, but understand the process to transition them to performance-based activities.

On the flip side of the equation, the assessment process and program design for someone recovering from an injury that wants to transition to strength and conditioning is also different and important to understand.  

We’ll show how we integrate strength and conditioning concepts into our rehab programs, and how we assess and design strength and conditioning programs for people follow injury.

To me, this is the future our professions need to head towards.  We can’t just perform quad sets, straight leg raises and mini squats!

 

Bridging the Gap From Rehab to Performance

champion bridging the gap from rehab to performanceThe online version of the Champion Bridging the Gap From Rehab to Performance contains 7 modules and over 6 hours of content designed to help you build better rehab and post-injury training programs.  We’ll cover:

  • Applying Strength and Conditioning Principles into Acute Rehab – Lenny Macrina
  • Integrating Advanced Rehab and Early Strength and Conditioning – Dave Tilley
  • Integrating Performance Therapy to Optimize Performance – Mike Reinold
  • Live Q&A Session with the Rehab Team
  • Performance Training Post Injury: The Assessment Process – Rob Sutton
  • Performance Training Post Injury: Program Design – Kiefer Lammi
  • Live Q&A and Demonstration of the Assessment Process and Discussion on Program Design

Personal trainers and strength coaches will benefit from learning how we integrate rehabilitation concepts into our programs to properly assess, customize programs, and advanced people into strength and conditioning programs.  Likewise, rehabilitation specialists will benefit from learning how we integrate appropriate strength and conditioning concepts through the acute and advanced phases of rehabilitation.

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Integrating Performance Based Physical Therapy

The latest Inner Circle webinar recording on Integrating Performance Based Physical Therapy is now available.

 

Integrating Performance Based Physical Therapy

Integrating Performance Based Physical TherapyThis month’s Inner Circle webinar is on Integrating Performance Based Physical Therapy.  This presentation is actually my talk from the recent Champion Bridging the Gap From Rehab to Performance Seminar that we conducted in Boston last month.  

I wanted to share this with Inner Circle members as I feel the topic is important as performance based therapy is definitely the future of our professions.  Performance therapy is something that is performed to help people optimize themselves and improve performance, no matter what performance means to you.  You don’t need to be injured to benefit from performance therapy.  This is a lot of what we do at Champion and something that I really wanted to share.

We are actually going to be releasing an online version of the Champion Bridging the Gap From Rehab to Performance Seminar, which will include this presentation, plus others from Lenny Macrina, Dave Tilley, Rob Sutton, and Kiefer Lammi.  

Inner Circle members can access my talk now, and get early access to purchase the seminar.  Everyone else will have to wait until the official launch next week!  Plus, if you’d like to purchase the seminar, I also have a $10 off coupon just for Inner Circle members.  All the links will be in the Inner Circle Dashboard.

This webinar will cover:

  • What is “performance therapy”
  • The need for a paradigm shift in what we do
  • What I look for in my movement assessments
  • The components of manual therapy I perform
  • How to integrate and maximize your outcomes with corrective exercises

 

To access this webinar:

 

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