In my first installment, Knee Pain with Lunges, I discussed how soft tissue quality and mobility can play a significant role in how we feel and move during the lunge. In today's post we will discuss how stability will play a role in the performance of the lunge.
First off, strength and stability are not the same thing.
Think of a sling shot.
photo credit: helmerslaw.com
The arm that pulls the elastic band back is considered strength. Stability is the arm that has to hold the slingshot steady and prevent it from moving as you pull with the other arm.
Another way to think of stability, as coined by Charlie Weingroff, "is control in the presence of change." We need both mobility AND stability in order to move well. If we have too much of one and not enough of the other, we will have problems at some point.
Back to the lunge. If all of the segments in the kinetic chain that we covered in the previous post meet the prerequisites for mobility, then we know we can move on to see if stability is a factor.
Per the Selective Functional Movement Assessment (SFMA), mobility limitations must be remedied before stability limitations are addressed. For example, if someone lacks full hip extension mobility, then we should not be attempting to bring a stability fix to a mobility problem.
So, how do we know if someone has a stability concern with the lunge movement? Well, let's watch them move.
In the video above, the hip, knee ankle are oriented one on top of the other in the saggital plane. There is no:
If we were to see lateral trunk sway or the aforementioned technique flaws (femoral IR, knee valgus, foot pronation), we would want to remedy that.
Here is a video of some of those flaws:
Now, just because someone may have the movement of the knee medially or a lateral trunk sway DOES NOT mean they are weak!
Too many times we assume that since we see knee valgus or lateral trunk flexion side to side, the person is weak. Here are two quick fixes to help remedy this.
First, try something called Reactive Neuromuscular Training, or RNT. What this technique does is try to reinforce the error in the movement. In this case, we are going to place a band around the knee and try to reinforce the femoral internal rotation/knee valgus.
Now you may ask why we want to REINFORCE the error in the movement. Well, by reinforcing the error, it causes the person performing the movement to have to consciously think of keeping their lower leg in proper alignment.
Here is a video below of using RNT to improve lunge technique:
If knee valgus isn't an issue with lunging, but the trunk sway is, try this:
By activating the core and trunk musculature by pulling on the band, it allows the core to remain stable and provide a stable base for the lower body to move upon during the lunging movement.
If the person's lunging form still is suspect and could be improved, you can start by performing the lunge in the bottom position and performing the concentric portion vs the entire lunging movement.
Or try holding onto a TRX or other type of suspension trainer to help groove the lunging movement if body-weight is still too difficult and/or lacking in technique.
By adding in the RNT band around the knee or using the band for core activation, these various techniques mentioned above can help to clean up a lunge.
Some people aren't ready to start performing a body-weight variation and may need to use the TRX for assistance or start from the bottom position. Time and time again, especially post-operatively, I will have clients use the TRX to help transition them to eventually performing a full body-weight lunge. You can progress the TRX assisted lunge from 2-hand hold to 1-hand hold and then to body weight.
In the next installment, we will discuss how technique plays a role in the lunge and how poor technique can cause issues with performing the lunge.
Spread the word and stay tuned for Part III!
photo credit: dccomics.com
The shoulders are a common area of the body that receive a lot of trauma, whether it be macro-traumatic like being hit in football, or micro-traumatic and continuously reaching overhead for years for poor shoulder stability and irritating various structures.
If you haven't checked out Part I, read that first! In part I, I displayed various techniques and exercises to help improve dynamic shoulder stability. In part II, we will discuss more advanced exercises to progress to once the ones in part I have become easier and you can perform them with proper technique.
*Disclaimer* I am not a kettlebell enthusiast and all I use in rehab and performance is kettlebells. They are a great implement to add an aspect of instability into training when performed in the "bottoms-up position."
In Part I, we had left off with Kettlebell Sidelying Arm Bar to Press. From there, we would progress into a Baby Get-Up.
If you cannot tell, the Baby Get-Up is a shortened version of the full Turkish Get-Up (TGU). I prefer to progress to the Baby Get-Up because it is an easier version as compared to the TGU. Easier in the fact that there are fewer steps involved and you don't have to go from the ground to standing, which can be a challenging position for some people with the TGU.
Courtesy of Tony Gentilcore
1-arm Bottoms Up Carry
Box Bottoms-Up Carries
If you have gone through Part I and are looking for more of a challenge, then give these a try and let me know what you think.
You can't walk into a gym nowadays and not see someone doing a plank or some variation thereof. They are a great way to train the anti-extension moment of the lumbar spine. They have quite a bit of carryover to other movements such as the squat, deadlift, and also to everyday tasks in our everyday lives.
One thing I see time and time again is people attempting to hold the plank for a certain period of time. I remember hearing about contests to see how long someone could hold a plank for and people would be posting on social media about it and their friends would be attempting to beat their friend's time.
I am definitely not against a little competition, but when people are attempting to hold planks 5+ minutes, that's when things get a little crazy.
Why is holding a plank for a long period of time a "bad thing"?
Well, besides holding a plank for a long period of time, when else would you be maintaining this plank position for during other gym-related activities or during everyday life?
Exactly! Never. During squats and deadlifts, maintaining a neutral spine position is only for a few moments. Definitely not as long as some of these multi-minute planks.
Second, with any type of exercise or movement, technique eventually begins to falter. Some people are better than others and can maintain proper form for a longer period of time. When performing a plank, we ideally want to see a nice, neutral spine position as shown in the picture below.
In the majority of people performing this type of movement, you can't tell me that they are maintaining pristine form during the entire time their are holding the plank position. What eventually is happens is one of two things:
One, they lose that nice, neutral spine position, gravity wins and their hips drop down towards the ground and they go into lumbar extension as shown above.
The problem with continuing to hold the "plank" in this position is that the abdominals are no longer the primary muscle group being "worked." The focus is now on either other muscles/areas such as:
Second, they lose that neutral spine position and instead of going into an extended position, they will hike their hips to the sky as shown below.
This is still not ideal because the spine isn't being trained to maintain a neutral spine. In order to improve spinal stability, especially under load when lifting or exercising, we must train the spine to maintain a neutral position while outside forces (ie. gravity) are trying to de-stabilize it and bring it into flexion or extension.
So, instead of trying to hold a plank for as long as you can and eventually defaulting into one of the examples shown above, try this INSTEAD!
Prone Plank with Breath
This variation is much HARDER. When incorporating the breath into this, you cannot rely on holding your breathe for increased spine stability. Now, we can get into a debate on whether holding your breath is good or bad during exercising.
If you are performing a max effort lift, ie. squat, deadlift, etc. and you need maximal spine stability, then holding your breath during a part of the movement may not be a bad thing. I would take a breath hold over not holding it and losing spine stability.
By performing a full expiration of air during this, you are forcing the abdominal musculature to have to force itself to stabilize vs using the Valsalva Maneuver and holding your breath to maintain spine stability. You don't want to consistently train by compensating and holding your breath to gain/increase stability.
You can start off by trying for a 1-2 breath duration and then increase to 4-5 breaths. Holding a plank or any other variation for days on end is more for "show" than it is for true application to lifting and/or daily life.
Give this variation a try and let me know what you think.
Most clients and patients that come into my office and many other offices or gyms throughout the world lack thoracic mobility. Some of them may sit at a desk for hours upon hours at a computer in the typical desk jockey posture.
photo credit: http://hawaiianlibertarian.blogspot.com/2014/01/cubicle-farming-desk-jockeys.html
We all know the negative side effects of prolonged sitting on not only orthopedic health but also on other bodily systems. There is nothing wrong with working on trying to improve a client or patient's thoracic mobility. Improved thoracic mobility can help in various areas of the body including:
As I have eluded to before, one area of the body can improve a completely different region of the body due to the concept of "Regional Interdependence."
Regional Interdependence, according to the Journal of Orthopedic and Sports Physical Therapy (JOSPT), is "the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint."
This is also related to the Joint by Joint Approach by Mike Boyle and Gray Cook.
photo credit: nicktuminello.com
So back to the discussion of thoracic spine mobility. First off, we need to assess thoracic spine mobility. There are a few ways that it can be assessed.
The discrepancy with measuring it in sitting is that there is the effect of gravity and having to sit in an upright position to move throughout the excursion of the ROM.
Second, it is easy for people to attempt to "cheat" this test by rotating through their lumbar spine or by moving their lower body in an attempt to increase rotation.
A better way to assess true thoracic rotation is in quadruped. First, have the patient or client go on a table or on the ground. Instruct them to bring their feet and knees together and sit back on their heels. Once their are on their heels, place one forearm at mid-line on the ground and the other arm behind their back, as shown below.
Once the person is in this position, you are going to instruct them to twist as far as they can while maintaining their arm and lower body on the table/floor. By being in quadruped position, it forces the lumbar spine to be "locked" and therefore the rotation cannot come from anywhere but the thoracic spine.
One cue or trick, that I got from Miguel Aragoncillo, who got it from a SFMA course, is to tell the person, who is performing the movement, to imagine that they are in a tunnel and that one wall of the tunnel is right next to their hip and the other wall is next to their opposite shoulder and hip. Tell the client not to bump into the walls when twisting.
What this cue does is that it helps to limit any type of compensation by side-bending through the lumbar or thoracic spines, etc.
So once you have the person all set, ask them to twist as far as they can. Normal values for thoracic rotation are 50 degrees. Instead of trying to eye-ball it, use the Clinometer App on the Iphone or Android to assist in measuring.
Place the base of your phone at T2-T4 on your thoracic spine.
So, now that you have measured the client's thoracic rotation, how does it look?
If it is 50 degrees or above side to side, then we are good to go. If they are a rotational sport athlete (baseball, lacrosse, softball, volleyball, etc.), upwards of 70 degrees is usually ideal.
What if they have less than 50 degrees of rotation bilaterally or to one side?
Then we must have to have them foam roll their thoracic spine, have some type of thoracic manipulation done by a chiropractor or physical therapist, or perform some type of thoracic mobility drill!
Not so fast!
Just because someone lacks normal or full Active Range of Motion (AROM) in thoracic rotation does NOT mean they need to improve their thoracic spine mobility.
We need to assess it PASSIVELY!
Key Points for Assessment:
If someone still has less than 50 degrees for general population/70 degrees for rotational sport athlete, then they may need to have some type of manual therapy done by a physical therapist, sports chiropractor, or massage therapist. If you are a coach, then use some type of thoracic mobility drill.
Mobility drills can include:
But...what if the client or patient has FULL or NORMAL passive thoracic rotation as shown in the video above???
Do we still want to mobilize their thoracic spine?
Do we still want to do mobility drills?
The answer is no.
This particular client or patient does NOT lack mobility. They lack STABILITY. They lack the ability to access the ranges of motion that they have.
Imagine you have a car. The car drives really well when the E-brake is off. The car doesn't run so well when the E-brake is on.
photo credit: http://auto.howstuffworks.com/auto-parts/brakes/brake-types/emergency-brakes.htm
Well, imagine when you have the normal amounts of mobility, but you can't access those ranges of motion. Your body is putting the E-brake on.
The timing, sequencing, and motor control of the muscles surrounding the spine and inner core (diaphragm, multifidi, TA, and pelvic floor) are not firing properly. In turn, the big prime movers (Paraspinals) are trying to stabilize as well as be prime movers. This is causing a decrease in active ROM versus exhibiting normal passive ROM.
So, what do we do to fix this?
Thoracic Spine Stability Exercises
Stability for the thoracic spine can come in various forms. Here are a few examples below:
Quadruped Assisted Thoracic Rotation
Tall Kneeling Kettlebell Trunk Rotations with Breathing
Courtesy of FunctionalMovement.com
Bird Dog Arms/Legs
The Bird Dog Assisted Arms/Legs is known as a core exercise, but it is great for improving the stability and motor control of the arms, legs, and trunk. By improving stability at the trunk, it can allow the thoracic spine to move better.
Bird Dog Resisted Arms/Legs
Two people may present with poor thoracic spine stability aka poor active thoracic rotation. One person may respond better to a Quadruped variation and another may respond better to the Tall or Half Kneeling variation. Perform the corrective that elicits an improvement in their active thoracic rotation. Make sure to test before and after a corrective to see if it actually improved.
Give these a try if your thoracic spine ACTIVE mobility is limited!
Here I will be writing and posting about topics ranging from physical therapy, injury prevention/reduction, and strength and conditioning.