For those familiar with my blog, you know I like to post research updates and exercises that prevent injury and maximize performance. In my setting, I get to work with a very active population ranging in ages from 10-50 in most cases, including elite and professional athletes. I am pointing this out simply because I have an opportunity to test and measure unique and challenging exercises every day with fit, athletic clients.
As part of my world, I am often faced with restoring shoulder, core and hip stability. As clients progress through rehab and conditioning, I am always seeking advanced training options that are feasible and functional. One training tool I like to employ, especially in upper body, core and hip training is the BOSU Balance Trainer.
Emphasizing co-contraction and scapulothoracic and glenohumeral stability is essential for optimal shoulder function. But more importantly, addressing kinetic chain function in the shoulder, torso and hips is a must if we are to soundly address energy leaks and reduce injury risk. To that end, I like to incorporate unstable closed kinetic chain training when my athletes are ready. The video below demonstrates two upper body step-up progressions (forward and side-to-side) on the BOSU Balance Trainer that I utilize for higher level clientele.
Upper Body Step-ups
Regression - in place stepping (this can be used to prepare clients for the step-ups)
This regression can also be a very effective training tool especially if the client lacks sufficient strength, endurance and form to execute the full step-up patterns. Pain and form should always guide exercise selection and progression.
Below are two links to my Functionally Fit columns describing the execution and application of these exercises:
I am big fan of lat pull downs and pull-ups. I think when done properly, this is a fantastic way to improve postural strength and safeguard the shoulder against injury. In April 2012, I wrote a column on lat pull downs addressing shoulder pain (click here to read that post).
I decided to add to that previous post and discuss a recent article published in the February NSCA Strength and Conditioning Journal. In the article, the authors present some research regarding how altering hand orientation and grip width affects muscle activity during the exercise.
Grip Width Summary
Lehman J Strength Cond Res 2005
Lusk et al. J Strength Cond Res 2010
Sperandei et al. J Strength Cond Res 2009
Hand Orientation Summary
Youdas et al.J Strength Cond Res 2010
Lusk et al. J Strength Cond Res 2005
For my CrossFit friends - optimal shoulder mobility, scapular stability and adequate thoracic spine extension and rotation is a must to minimize risk with kipping and less than perfect pulling form. I much prefer unweighting or assisting the body through pull downs, bands or partner assists to build pre-requesite strength initially until the client is better able to manage the movement under full body weight.
Quality movement ABSOLUTELY matters over hundreds and thousands of reps.
As far as research goes, I think we still need further studies on grip width and specifically how it may directly impact not only muscle activation but force on the glenohumeral joint itself. For me, I opt for pronated pull-ups and or pull-downs once per week with a moderate grip width in my own routine. I hope this information serves you well. Happy lat training!!
The company I am privileged to work for has officially entered into a partnership with Athletes’ Performance. We are joining forces with them to take our performance training to an even higher level. So, the Athletic Performance Center is now:
I am pumped as we will be able to offer the same elite level training and nutrition services that are offered at other locations in AZ, FL, TX, CA and MA. I will continue in my role as supervisor and sports physical therapist and look forward to all the great things to come. If you are not familiar with AP, check them out at www.athletesperformance.com.
Click here for a detailed press release from Raleigh Orthopaedic Clinic. I am confident this new venture will help me sharpen my saw and become an even better clinician and performance training expert.
As a therapist and fitness enthusiast, I always want to know the “why” and implications for exercises. I have posted on modified push-ups in the past, but I felt compelled to share some information that was published in the October 2012 Strength and Conditioning Journal. Bret Contreras et al. discuss the biomechanics of the push-up and provide an excellent overview of the different types of push-ups and what research has to say about them.
I was most interested by the parts on unstable push-ups as I tend to use the BOSU Balance Trainer and BOSU Ballast Ball in many of my programs. Here are some key points that the authors point out that are worth mentioning:
Other thoughts of mine:
Mastering form, alignment and strength with stable push-ups is common sense, right? So, do not advance to unstable push-ups without pre-requisite strength and satisfactory technique in a stable environment. Wrist mobility, shoulder stability, and core strength are just a few other key factors that should weigh in your decision to implement unstable push-ups.
Considering some isometric work with slightly bent elbows or even some small pulses can be effective in progressing toward these more advanced unstable push-ups. Clients need to understand the point of no return and I prefer to spot closely particularly when using a stability ball or BOSU Ballast Ball. Working with the BOSU (dome side down) is generally safer and allows for easier modification with the knees on the ground for those with less upper body strength or diminished control.
I also like to add a plus (scapular protraction at the top) to help counter the loss of serratus activity seen with BOSU push-ups. In the end, I really like using the unstable surface as the point of balance and have for some time. There are many ways to do push-ups, but considering some unstable work has a good return for those clients whoa ready for it.
Below is a picture of the BOSU Ballast Ball - I prefer it over the stability ball as it is less likely to slip out from underneath the client. It provides excellent shoulder and core stability work - my primary goals when electing to use it. Reps, sets, progression and recovery will be dictated by fatigue and form at all times.
I work with lots of patients and clients who consistently demonstrate inadequate hip and core stability. I see this show up routinely as asymmetrical 1’s for the trunk stability push-up, in-line lunge, hurdle step and rotary stability movements on the FMS. Unfortunately, this has been a recurring them in many of my females recovering from ACL reconstruction as well as runners with persistent pain/dysfunction in one lower extremity.
I am always looking for better ways to train the body in whole movement patterns as well as functional positions. One of my preferred positions is to test and challenge my clients in a split squat position. I begin with an isometric split squat cueing proper alignment and muscle activation. As clients master isometric postural control, I will allow them to add an isotonic movement by squatting in the position.
As they progress, I will add in perturbations to stimulate changes or challenges to their center of gravity. Often, you will see them struggle much more on the involved side. But to be honest, I find most people have an incredibly hard time maintaining proper alignment for long without cheating or falling forward or to the side. Allowing clients to lose form is okay provided they are cued to fix their alignment or they naturally self correct.
An additional wrinkle I throw in for this training is using the BOSU Balance Trainer. Below is a video that shows how I use this progressing from shin down to just the toes as a support on the trail leg. The second version will burn up your clients’ thighs and quickly become one of their least favorite exercises. The great thing is that you do not have to offer much resistance to create a significant perturbation.
For more detail on this exercise and application, click here to read my PFP column featuring it this week.