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A Better Way to Perform Shoulder Exercises?

It’s pretty obvious that the shoulder is linked to the scapula, which is linked to the trunk.  So why do we so often perform isolated arm movement exercises without incorporating the trunk?  It’s a good question.  The body works as a kinetic chain that requires a precise interaction of joints and muscles throughout the body.

 

The Effect of Trunk Rotation During Shoulder Exercises

A recent study was published in the Journal of Shoulder and Elbow Surgery that examined the impact of adding trunk rotational movements to common shoulder exercises.

The authors chose overhead elevation, external rotation by the side, external rotation in the 90/90 position similar to throwing, and 3 positions of scapular retraction while lying prone (45 degrees, 90 degrees, and 145 degrees) that were similar to prone T’s and Y’s.  The essentially had subjects perform the exercise with and without rotating their trunk towards the moving arm.

A Better Way to Perform Shoulder Exercises?

EMG of the the upper trapezius, middle trapezius, lower trapezius, and serratus anterior were recorded, as well as 3D scapular biomechanics.

There were a few really interesting results.

  • Adding trunk rotation to arm elevation, external rotation at 0 degrees, and external rotation at 90 degrees significantly increased scapular external rotation and posterior tilt, and all 3 exercises increased LT activation
  • During overhead elevation, posterior tilt was 23% increased and lower trap EMG improve 67%, which in turn reduced the upper trap/lower trap ratio.
  • Adding rotation to the prone exercises reduced upper trapezius activity, and therefore enhanced the upper trap/lower trap ratio as well.

 

What Does This All Mean?

I would say these results are interesting.  While the EMG activity was fairly low throughout the study, the biggest implication is that involving the trunk during arm movements does have a significant impact on both muscle activity and scapular mechanics.  Past studies have shown that including hip movement with shoulder exercises also change muscle activity.

This makes sense.  If you think about it, traditional exercises like elevation and external rotation involve moving the shoulder on the trunk.  By adding trunk movement during the exercises you are also involving moving the trunk on the shoulder.

This is how the body works, anyway.  Most people don’t robotically just move their arm during activities, the move their entire body to position the arm in space to accomplish their goal.

It’s also been long speculated that injuries during sports like throwing and baseball pitching may be at least partially responsible for not positioning or stabilizing the scapula optimally.  I think this study supports this theory, showing that trunk movement alters shoulder function.

Isolated exercises like elevation and external rotation are always going to be important, especially when trying to enhance the strength of a weak or injured muscle.  However, adding tweaks like trunk rotation to these exercises as people advance may be advantageous when trying to work on using the body with specific scapular positions or ratio of trapezius muscle activity.

 

5 Tweaks to Make Shoulder Exercises Even More Effective

I’m a big fan of understanding how little tweaks can make a big difference on your exercise selection.  If you are interested in learning more, this month’s Inner Circle webinar will discuss 5 Tweaks to Make Shoulder Exercises Even More Effective.  The webinar will be Tuesday August 25th at 8:00 PM EST, but a recording will be up soon after.

 

 

 

Great Exercise to Enhance Posterior Shoulder Strength, Endurance, and Overhead Stability

I wanted to share an exercise I have been incorporating into my programs lately to develop posterior shoulder strength, endurance, and overhead stability.  I call it the ER Press as it combines shoulder external rotation in an abducted position with an overhead press.  When performed with exercise tubing, it provides an anterior force that the posterior musculature must resist during the movement.  The key is to resist the pull of the band while you press overhead.

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I use this drill a lot with my baseball players and overhead athletes.  I think it’s a great drill that hits many of the areas that I focus on when training a strong posterior chain of the trunk and arm.

It’s also becoming a favorite of my Crossfit and olympic lifting athletes, who are reporting that they feel more comfortable overhead and have more stability with their snatches and overhead squats.

There are numerous progressions that can be performed by simply changing the position the athlete is in, including tall kneeling, half kneel, and split squat stances.  You can also perform some rhythmic stabilizations at the top range of motion once to increase the challenge.

 

Exercise Selection for Rehabilitation Programs

Today’s guest post is written by Dennis Treubig, PT, DPT, CSCS.  Dennis has some great thoughts and I couldn’t agree more with his motivation to push himself.   This is a concept I talk about all the time.  I love the first line below!   Thanks for sharing, I think this information and the “progress” Dennis has made is a great example of thinking outside the box, while justifying your thoughts with scientific rationale.  Good work Dennis, thanks!

Exercise Selection for Rehabilitation Programs

selecting rehabilitation exercisesI believe that from time to time any physical therapist should ask themselves, “Professionally, what do I do differently now than 5 years ago?”  If your answer to that is nothing, you are doing a disservice to yourself and your patients (and most likely aren’t reading websites like this).  If you answer that question with a lengthy discussion, then I commend you.  When I asked myself that question recently, I realized that one of the major areas I have changed is in exercise selection for my patients.  After thinking about it more and more, I feel that this is one area that separates the run-of-the-mill PT from the “advanced” PT – and that is why I decided to elaborate on my thoughts.

I think there are many physical therapists out there that bombard their patients with a slew of exercises thinking that more is better.  These PT’s will add new exercises without taking out old ones, they will prescribe “3 sets of 10” for each exercise, and rarely progress the weight/resistance.  These types of PT’s will also see a new, “cool” exercise somewhere and then, without proper discretion, try it with all of their patients.  While this is not necessarily a “bad” treatment, I believe that we, as PT’s, should be better than this.

When I came out of PT school, I was eager to jump right in and try all these new & exciting manual techniques and exercises (for the purpose of this article I will obviously focus on the exercise aspect).  While my patients were getting better, I found my treatment plans were loaded with exercises, making it difficult to know what was beneficial, which ones may have been causing soreness, and which ones weren’t even necessary.  In addition, it was also making each patient’s treatment rather lengthy, which is not ideal when you practice in Long Island, NY where most of my patients are “limited on time.”

So, I went back to the research, followed some new professional blogs, and read books from different fields (physical therapy, strength & conditioning, business success, etc.) to see how I could better serve my patients.  Here are some of the key points that resonated with me:

Selecting Reps and Sets

If the leading strength & conditioning specialists have their healthy clients doing only 3-5 main exercises (not including a little assistive work) when strength training, why would we put our injured patient through 7, 8, 9… exercises for “3 sets of 10?”

Since an injured patient is not going to be able to tolerate the volume of a healthy strength-training individual, we should be implementing volume less than that (and increasing it as necessary).  And since when did 3 sets of 10 become the only way to exercise in a PT clinic.  If strength & conditioning specialists constantly change the reps/sets to fit the needs of their client, why aren’t we?  We should be altering the sets, repetitions, and resistance of the exercises to fit within that desired volume.

The Pareto Principle (80/20 rule)

In case you are not familiar with this principle, it states that, for most events, approximately 80% of the effects come from 20% of the causes.  I believe this is applicable to rehab exercises – 80% of our results probably come from 20% of the exercises we give to patients (or should come from 20% of the exercises).  This means that if you focus on the appropriate 3-4 exercises and cut out the rest, you will get similar results.  And, I believe, better satisfaction from your patients.

Integrating Recent Research

Research articles that studied EMG analysis of therapeutic exercises have provided us with better information regarding muscle activity during each exercise.

Among others, articles by Reinold et al, Ekstrom et al, & Ayotte (references at end of article) have shed light on common exercises we prescribe.  This allows us to re-evaluate the exercises we use and pick the ones that elicit the most desired muscle activity.  And just because these articles looked at numerous exercises, it does not mean that we should pick every “good” exercise they looked at – be selective and choose the most worthwhile exercises.

The Jam Experiment

rehabilitation exercisesIf you are unfamiliar with this experiment, here is a brief synopsis (officially titled, “When Choice is Demotivating: Can One Desire Too Much of a Good Thing?”).  Shoppers at a grocery store were presented with two different displays of jam – one had 6 flavors and the other had 24 flavors.  The results showed that 30% of people who visited the display with 6 jams actually purchased jam, while only 3% made a purchase after visiting the display that offered 24 jams.  (Photo by @joefoodie)

So, you’re probably asking, “How does this relate to rehab programs?”  Here is where I first noticed this idea – anecdotally, when providing patients with a home exercise program, the more you give them, the less likely they are to perform it.  Soon thereafter, I also became aware of it with regards to the exercise programs my patients went through.  The more exercises they did, the less likely they were to remember how to do them correctly and the less intense they did them.

“Perfection is not when there is no more to add, but no more to take away.”

One day, I came across this quote from Antoine de Saint-Exupery and it definitely left an impression on me (personally and professionally).  All too often, I see new, more complex exercises being added to patients’ programs without taking the basic exercise out.  This becomes redundant, increases the volume, and lengthens the treatment time.  For example, if your patient is doing wall squats, sit-to-stands, and leg press for 3 sets of 10, cut out the more basic sit-to-stands and wall squats and focus on the leg press.  Do the leg press for 4-5 work sets and bump up the intensity.  I bet you’ll get similar results with less work.  This will free up time for important mobility/corrective exercises and more manual techniques.  And by no means do I think that my treatment plans are perfect, but this quote makes you think about things in a different way.

After taking all this into account, I began to “trim the fat” and re-designed my rehab programs.  I wanted my programs to be direct, efficient, easily understood, and reproducible (for after discharge).  So, I started giving my patients 3-4 exercises, frequently altered the reps/sets/weights as necessary (usually in the 4-5 work set range and 4-8 rep range), educated my patients on the reasoning/technique/progression of the exercises and…  TADA… the results were better than I had before.

Not only were the patients’ results better, but it also became easier for me to manage any problems that may arise.  And when fewer exercises were implemented, my patients were retaining the information and able to make decisions on their own.  Now, it’s not uncommon for me to tell my patient what exercise is next and after 5 minutes they’ll come up to me and tell me, “I warmed-up for 8 reps on 80 lbs, then did 2 sets of 8 at 100 lbs, 2 sets of 6 at 110 lbs and was only able to do 4 reps at 120 lbs.”  When your patients are making decisions (and the right decisions) without your help, you know you have done your job right.

I hope this article makes you think about how you design your treatment programs and sparks some discussion in your clinic.

 

References

  • Ayotte NW, Stetts DM, Keenan G, Greenway EH.  Electromyographic Analysis of Selected Lower Extremity Muscles During 5 Unilateral Weight-Bearing Exercises.  J Orthop Sports Phys,  2007;37:48-55.
  • Ekstrom RA, Donatelli RA, Carp KC.  Electromyographic Analysis of Core Trunk, Hip, & Thigh Muscles During 9 Rehabilitation Exercises.  J Orthop  Sports Phys,  2007;37:754-762.
  • Ekstrom RA, Donatelli RA, Soderberg GL.  Surface Electromyographic Analysis of Exercises for the Trapezius & Serratus Anterior Muscles.  J Orthop Sports Phys, 2003;33:247-258.
  • Ekstrom RA, Osborn RW, Hauer PL.  Surface Electromyographic Analysis of the Low Back Muscles During Rehabilitation Exercises.  J Orthop Sports Phys,  2008;38:736-745.
  • Ferriss, Timothy.  The 4-Hour Workweek: Escape the 9-5, Live Anywhere, and Join the New Rich.  Crown Publishing Group, 2007.
  • Iyengar SS, Lepper M.  When Choice is Demotivating: Can One Desire Too Much of a Good Thing?  Journal of Personality and Social Psychology, 2000;79:995-1006
  • Reinold MM, Wilk KE, Fleisig GS, et al.  Electromyographic Analysis of the Rotator Cuff & Deltoid Musculature During Common Shoulder External Rotation Exercises.  J Orthop Sports Phys, 2004;34:385-394.

 

About the Author

Exercise Selection for Rehabilitation ProgramsDennis Treubig, PT, DPT, CSCS.  Dennis received his Doctorate of Physical Therapy from the University of Delaware in 2005 and has been practicing at ProHealth Physical Therapy in Lake Success, NY for the past 6 years.  He is also a Certified Strength & Conditioning Specialist by the NSCA and a Clinical Instructor for the Hofstra University Athletic Training Program.

 

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Fitness Gadget Review – Fitbit, Jawbone Up, Nike Fuel Band

I’m going to take a different approach to this week’s Stuff You Should Read and provide some Fitness Gadget Gift Ideas and review the Fitbit, Jawbone Up, and Nike Fuel Band.  ‘Tis the season.  If you know me, you know it takes me an hour to pick out cough medicine at CVS because I have to nitpick and compare every aspect (it’s a curse…).  Well, I just recently did a similar thing to the fitness tracking gadgets that are on the market now.  Since I did all the deliberating in my head, I hope you benefit from my OCD personality.

 

Inner Circle and RehabWebinars.com Update

I hope everyone had a great holiday and downtime last week.  My next live Inner Circle webinar will be tomorrow morning at 10:00 AM EST.  I will be discussing the system I use to stay current with new thoughts and research, and how you can build your own system too.  You’ll learn how you can quickly and easily build a system online to stay current.  Even if you put just a couple of these techniques into action, you’ll be able to enhance your skills.  Inner Circle members can sign up for the live webinar at the Inner Circle dashboard.  As always, I’ll get a recorded version up to the site sometime next week.  Click here to learn more about my Inner Circle.

For December, I know we all have a crazy month ahead of us.  I am going to talk more in depth about a couple of articles I from this site recently on the qualities we need to succeed and then do a live Q&A sessions via webinar.  I’ll do two live Q&A’s, one during the day and then try my best to do another in the evening during the week.  Come with your questions in hand and we’ll do a nice chat session online in a webinar.  If you have a specific case study or difficult patient you want to discuss, contact me and send me an email describing it and perhaps we’ll discuss.  I’ll let everyone know when these will be scheduled.

RehabWebinars.com actually featured a webinar of mine this month, discussing the Scientific and Clinical Rationale Behind Shoulder Exercises.  For those that know me, you know I enjoy this topic.  I discuss some of the latest research on selecting shoulder exercises.  Learn more about RehabWebinars.com.

 

Fitness Gadget Gift Ideas

For those looking for gift ideas for the fitness enthusiast in your life (or wondering what to ask for yourself!), here are three gifts ideas you may want to checkout.  Fitness trackers are hugely popular right now, with the three big names being Fitbit One, Nike Fuel Band, and the new Jawbone Up.

Fitbit One

Fitbit One Fitness Gadget Gift IdeasThe Fitbit brand has a few options, but the newest model, the Fitbit One is worth considering.  The Fitbit One tracks your steps, distance, calories, and stairs climbed in a pedometer that clips to your belt or shoe.  In addition, it has one of the better features to me, the ability to monitor your sleep cycles and wake you up silently using a smart alarm.  What this means is that when you tell it you want to wake up at 7:00 AM, it may notice that you are in a light state of sleep at 6:50 and will vibrate to wake you up before you drift back off into deep sleep, preventing you from waking up groggy.  While the smart alarm is cool, I like tracking my sleep quality just as much.  I have used this to monitor my training and stress levels.  It syncs wirelessly through Bluetooth, works with a bunch of great apps, and has a pretty nice app of it’s own.  Click here to learn more about the Fitbit One, it’s the #1 selling pedometer on Amazon.

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Nike Fuel Band

Nike Fuel Band Fitness Gadget Gift IdeasNike brings a similar product to the market in the form of a wrist band.  The Nike Fuel Band looks pretty cool (if you are into the whole wristband thing, I like it better than clipping on a Fitbit) and has a nice colorful display that looks cool (and doubles as a watch if you want).  The Nike Fuel app is OK, though Fitbit’s is better in my opinion.  It does sync wirelessly, but most disappointing to me is that it does not monitor your sleep or offer a smart alarm.  This is the biggest negative to me.  I would love to have all these features in one.  I should also note, the clip on wristband has a couple of drawbacks, I can’t tell you how many times I’ve pinched my wrist when putting it on, and I have also had it open up on me while wearing several times.  Nike has also tried to quantify fitness with what they call Nike Fuel.  They don’t tell you how they calculate it, but I have to admit it backfired for me.  I noticed what my Nike Fuel level was on days I didn’t work out and saw that I was still way above average, which encouraged me to take the day off from training.  I guess I’m pretty active at work…  Click here to learn more about the Nike Fuel Band.

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Jawbone Up

The Jawbone Up could be the perfect blend between the Fitbit and Nike Fuel Band.  Originally launched last the year, the wristband was pulled from the market as the product was not quite as water resistant as the advertised!  I see that as a positive, they’ve spent months redesigning and have just re-released the product.  I would imagine they wouldn’t risk another disaster (right???)!  The Jawbone Up is another wristband, though it doesn’t snap on the the Nike Fuel Band, which is probably a good thing.  It does monitor your sleep, have a smart alarm, and a cool app.  It also has the ability to track what you eat and your mood, making it a pretty complete package.  However, it does not sync wirelessly.  I personally don’t care about this feature the most.  Unfortunately, you can’t get the Jawbone Up on Amazon yet.  I think you can get it online from Jawbone or at the Apple Store, with Best Buy getting it soon.  Click here to learn more about the Jawbone Up.

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Here are few key points of each to help you decide.  The Fitbit probably makes sense for the greatest majority of people, the Nike Fuel Band is potentially the coolest, and the Jawbone Up has the best features if your like the wristband thing.  I would go with the Fitbit, but I think I like the wristband better, so I am going Jawbone Up.

  • Fitbit One – Sleep monitor, wireless, clips onto belt, works with a bunch of other apps
  • Nike Fuel Band – Has clock, wireless, wristband – does not have sleep monitor
  • Jawbone Up – Sleep monitor, wristband – does not wirelessly sync

 

These all seem like quick and easy gift ideas for a wide variety of people.  I’m a fan of these new fitness tracking gadgets so thought this was all worth sharing.  Which one are you getting???  Happy shopping, hope these fitness gadget gift ideas come in handy!

 

 

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Quality Over Quantity

Quality Over Quantity

Quality over quantity – It is a phrase that we have heard countless times before, though probably could apply it more.  This simple concept has been one of the most recurring themes in my teachings as well as my core philosophies throughout my career.  But, this took me some time to fully understand the true power of “quality over quantity.”   (Photo by David Gallagher)

This is how I learned that lesson.

 

My Experience

I started my career off in an outpatient setting that thrived off quantity.  Our clinic was huge and always packed.  We could churn out some patient care, that is for sure.  Call it what you want, but it was a high volume machine.  Was it an awesome experience?  Absolutely.  Was it an invaluable learning experience?  Absolutely.  You can learn so much by seeing so many different patients in such a short amount of time.

At the time, that was the culture.  Mass market rehab centers were popular and spreading, and why not, I am sure they made a killing in profit.  Funny thing was, I had no idea why the turn over rate of therapists was so rapid, usually coming and going within a 1-2 year span.

Then one day I figured it out.  I am sad to say that I have treated 40 patients in one eight hour work day with no assistance.  I remember that day clearly.  My assistant had an illness in the family and I had a full schedule.  As I plunged my way through the day, I remember clearly thinking to myself

[box size=”large” icon=”none”]“I am not giving my patients quality care today.”[/box]

I remember that feeling clearly and it was awful, I bet many of you have felt that too.  I marched in my clinic director’s office at the end of the day and said to him (and really myself) that I would never do that again, sacrifice quality because of quantity.

 

Quality Over Quantity in Our Practices

My experience above is probably not that uncommon and a major reason why so many therapist are willing to take the risk of moving into private practice.  The changes in healthcare and insurance reimbursement is creating a huge challenge for physical therapy clinics that are seeing their per-patient reimbursements shrink.

To me, the solution is obvious – we have to move to include more of a cash-based practice.  But we as a profession just aren’t there yet, people routinely pay for chiropractic, massage, acupuncture, fitness, and other services out of pocket, yet balk at a $20 co-pay for physical therapy.

[box size=”large” icon=”none”]But can you blame the consumer?[/box]

Think about it.  What do they get from the above mentioned providers?  They get quality.  They get individualized care.  They get one-on-one attention.  These are all things that we sometimes miss in physical therapy as we schedule overlapping patients.  What would you think if you went to the dentist and they cleaned two teeth, then went to help someone else, came back to clean a few more teeth, then moved on to someone else, and so on?

Unfortunately cash-based practices aren’t always possible, especially in more rural areas.  (As a side note, Jarod Carter has a whole website dedicated to starting a cash-based practice that is worth checking out if this interests you).  And seeing multiple people at once isn’t always bad.

In the past, I wrote articles about what we can all learn from a barbershop and what we can all learn from Steve Jobs.  If you haven’t read them, this would be a time to go back and take a peek.  The message on both is the same – people come to you for an experience.

[box size=”large” icon=”none”]Don’t be content provided mediocre care.  We are better than that.  [/box]

For the young clinicians, get better at using your hands and less machines.  People come to you for manual therapy.  If you aren’t comfortable yet with your manual therapy skills, keep working on them and attend seminars to continue with your development.  It is well worth your investment.

 

Quality of Quantity in Our Programs

While the principles above apply more specifically to the broad sense of our business, the “quality over quantity” concept also is important in our programs.  In both the rehabilitation and fitness settings, I have seen many people get locked into a program that they wrote without:

  1. Individualizing the program
  2. Adjusting the program based on the person’s response
  3. Paying attention to the detail

Many times we get caught up in the fight to get from point A to point B that we forget that sometimes the journey is the greatest part.

Rushing through an exercise just to say you finished it without assuring movement quality is just as bad as selecting poor exercises.  You essentially are strengthening the person’s compensatory pattern and fostering poor movement quality.  This is probably what led to their tissue breakdown and into your clinic or facility!

I have talked about this quite a bit as it comes to core training.  This is an underlying theme in my Functional Stability Training of the Core program, quality over quantity.  This serves as a good model for discussion but it really goes well beyond the “core.”  As an example, the internet is filled with aggressive and advanced core exercises that realistically are not appropriate for many people.  Forcing these on your patients and clients just to seem cutting edge will only hurt them in the long run.  The body will find a way to accomplish a task, sort of like the path of least resistance.

While there are a million bad examples on the internet, I’ll use an example of myself showing poor technique during a plank:

Poor Plank Technique

 

This is a great way for me to perform a plank poorly, using too much of my right side wall and right hip flexor.  This avoids my deficiency with my left side wall and kicks in the psoas for lumbar stability.  In long run, doing this will feed into my poor motor patterns and cause more harm.

Remember motor control is one of the bigger issues we should all be addressing, not just stretching what is tight and strengthening what is weak.  Remember that next time some is performing an exercise with poor technique right in front of you…  correct them!   This is again another example of “quality over quantity.”  Help people move better and help them feel better.

Think about this next time you are working with someone.  Be a stickler for technique.  We have to do this to truly enhance performance, wether it is athletic performance or just simply human performance.

 

Sorry, I rarely take advantage of my audience and use this forum to “rant.”  I much prefer teaching!  However, I can’t tell you how many people ask me where to get started when trying to improve their own skill set.  Quality is a good place to start!  What are some of your experiences as you have learned the concept of quality of quantity?

 

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Functional Stability Training of the Core – Live Seminar with Eric Cressey and Myself

It is with great pleasure that Eric Cressey and I are announcing a new live seminar that we are conducting this November.  We will be speaking on a new collaborative system that we are putting together for rehabilitation and performance training, called Functional Stability Training, and how to apply it specifically to the core.  I have been alluding to this over the past year or so in many of my articles and the system is a concept I have been thinking about for a long time.

 

Functional Stability Training

In order to function properly our joints need to be mobile, but control of this mobility is often less than optimal.  Unfortunately, this stabilization is often overlooked in the design or rehabilitation and performance programs.  Traditional program design relies too much on stretching what is tight and strengthening what is weak.  We are missing the boat on stabilization.

Basically, Functional Stability Training is how I approach building my rehabilitation programs for injured people and how Eric and I build corrective exercise progressions for performance training.  It is the integration of physical therapy and performance enhancement training, the integration of exercises and manual techniques, and the integration between mobility, strengthening, and dynamic stabilization.

If you have taken my course at ShoulderSeminar.com or watched Eric and I’s Optimal Shoulder Performance DVD, then you know a little but about the basics of Functional Stability Training as it applies to the shoulder.  We are going to expand on that even more.

 

Functional Stability Training for the Core

This seminar will specifically discuss Functional Stability Training for the Core.  This isn’t the standard exercise progression for the core with sit ups, infomercial gimmicks and medicine ball tosses.  Rather, this is training the core to work the way it was intended to work – to provide stabilization of the trunk while simultaneously moving the extremities during functional activities.

Once you have trained the core to function properly on it’s own, functional exercise positions and progressions can occur.  Far too often we are all guilty of skipping steps or not mastering the basics before moving to advanced progressions.  This will only assure the reinforcement of poor movement patterns and lead to future muscle imbalances.

The progressions discussed are applicable to rehabilitation, injury prevention, and performance enhancement programs.  For the rehabilitation specialist, the information will help you get away from traditional passive treatments and low back rehab exercise.  For the fitness and performance specialists, the information will help you achieve new progress with your clients to maximize functional and athletic potential.

There are a lot of “core training” programs out there.  Functional Stability Training of the Core is not intended to swamp you with the basics like non-functional anatomy of the spine.  Rather, this program quickly gets into technique and will show you a simplified approach to think about the core based on the TRUE FUNCTION of the core.  Simple, yet highly effective.

The seminar will be held at Cressey Performance in Hudson, MA (not too far outside Boston) on Sunday November 20, 2011.

Here is our current agenda:

  • Functional Stability Training – An integrated approach to rehabilitation and performance training – Reinold
  • Recent Advances in Core Performance – Understand the concept of Functional Stability Training for the Core, true function of the spine, and how this impacts injuries, rehab, and training – Reinold
  • Maintaining a Training Effect in Spite of Common Lumbar Spine and Lower Extremity Injuries – Outlines the causes and symptoms of several common injuries encountered in the lower extremity, and how to train around these issues to keep clients/athletes fit during rehabilitation – Cressey
  • Understanding and Controlling Extension in Athletes – Looks into the causes of and problems with excessive lumbar extension, anterior pelvic tilt, and rib flairs in athletes – Cressey
  • LAB – Assessing Core Movement Quality:  Understanding where to begin with Functional Stability Training exercises for the core – Reinold
  • LAB – A Dynamic Progression of Core Performance Exercises  – Progression from simple core control to advanced rehab and training techniques – Reinold
  • LAB Understanding and Controlling Extension in Athletes – Progresses on the previous lecture with specific technique and coaching cues for exercises aimed toward those with these common issues – Cressey
  • LAB Advanced Stability: Training Power Outside the Sagittal Plane – Traditional power training programs are predominantly focused on the sagittal plane, but in most athletic endeavors – especially rotational sports – power must be displayed in other planes of motion – Cressey

 

Register Now

You can view more information and register for the seminar at FunctionalStability.com:

 

WARNING:  There are only 50 spots available for this live seminar.  Last seminar that Eric and I conducted, Optimal Shoulder Performance, sold out in just a week.  We fully expect this course to sell out in days.

A Simple Modification To Maximize Your Bridge Exercise for Hip Extension

Bridge ExerciseThe bridge exercise is a simple and effective exercise to begin working on hip extension and turning on your glutes.  This in itself is so important to restoring muscle imbalances of the lower extremity and core.  Common postural adaptations include excessive anterior tilting, which in turns makes it difficult to extend the hip and really activate your glutes, specifically your gluteus maximus.

However, another common finding with anterior pelvic tilting is tight hip flexors.  Early phases of rehabilitation and corrective exercise should attempt to improve hip flexor mobility, however this tightness also limits your ability to extend the hip and thus activate and train the gluteus maximus.

So what do we do?  Traditionalists will say that we need to restore mobility before working on strengthening.  I agree with this, but also think there are ways to work round your limitations to make progress with both hip flexor mobility and hip extensor activity simultaneously.

 

Modification for the Bridge Exercise to Maximize Hip Extension

There is a simple modification that we can do to the bridge exercise to maximize hip extension.  Rather than perform the exercise with our legs parallel in the sagittal plane, try putting your feet closer together and slightly separating your hips.  This puts your hips in slightly more external rotation and abduction, as seen in the below video.  Note that improvement in my ability to extend my hips:

YouTube Preview Image

 

 

Why this Improves Hip Extension and the Bridge Exercise

The reason why this modification allows us to extend the hips more is due to the action and orientation of the iliopsoas muscle group.

In addition to flexing the hip, the iliopsoas group also externally rotates the hip.  This is not discussed nearly as much as hip flexion, but something to consider.

Furthermore, if you look at the picture, you can see that the orientation of the iliopsoas group is not straight in the sagittal plane, but rather, slightly abducted (something to keep in mind when stretching as well).Iliopsoas

[box type=”info”]To shorten the iliopsoas group as much as possible you need to position the hip in slight external rotation and slight abduction.[/box]

In order to maximize our ability to contract the gluteus maximus and extend the hip, we need to put our body in a position that shortens the hip flexors as much as possible.

Try this simple modification for the bridge exercise and let me know if you can achieve more hip extension.

TRX Serratus Slide

serratus anteriorThe serratus anterior is an extremely important muscle that helps control normal shoulder and scapular function by protracting and upwardly rotating the scapula. In addition, the serratus assists in stabilizing the scapula against the rib cage, preventing scapular winging. These are all critical functions of the serratus that help prevent shoulder impingement.

Because the serratus is so important in functional arm movements, exercises to strengthen and enhance neuromuscular control of the serratus should be incorporate into many training and rehabilitation programs, especially in those with shoulder dysfunction.

While traditional protraction exercises have been effective in strengthening the serratus, recent research has identified that serratus activity is increased when combining both protraction and upward rotation of the scapula (Ekstrom et al JOSPT 2003). This movement helps train the serratus in a functional pattern that combines the muscle’s several important roles in scapular mobility.

Based on this research, I began using a dynamic jab exercise as baseline exercises for basic training and rehabilitation of the serratus (Reinold et al JOSPT 2009).  I discussed this and other techniques in training the serratus in my webinar that you receive free for signing up for my newsletter, so check that out if you haven’t already.

However, this exercise is quickly mastered and further challenge is often required. Incorporating a closed kinetic chain position and unstable surface training will require a greater degree of dynamic stability of the scapula and promote neuromuscular control. Thus, I began incorporating the TRX Suspension Trainer to further advance the exercise.

 

The TRX Serratus Slide

The TRX Suspension Trainer is an excellent method of performing the Serratus Slide movement that challenges both the strength and stabilizing functions of the serratus muscle. Furthermore, the amount of challenge can quickly be adjusted by modifying the angle of the exercise.

TRX Suspension Trainer Serratus Slide

This picture doesn’t do the exercise justice, it is really all about the movement.  TRX recently featured this exercise on their website with a video demonstration, so check it out at the below link:

[box type=”tick” style=”rounded” border=”full”]Click here to check out my TRX Serratus Slide video![/box]

I really have found a bunch of great uses for the TRX Suspension Trainer, and this is just one example.  I am going to keep sharing some of the exercises that I incorporate the TRX straps.

Also, I just recently got my hands on the new TRX Rip Trainer, this thing is pretty cool, I have started to use this a lot in my programs, specifically for some of the exercises in my Functional Stability Training system, they work great for enhancing core stability.