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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'low back'

This post is dedicated to improving mobility in two areas I commonly find restrictions in among my clients - the ankle and thoracic spine. Specifically, I often find limitations in dorsiflexion and thoracic spine rotation that create undue stress on other parts of the kinetic chain.

ankle-wall-mob-2

Standing wall touch

Recently, I wrote an article for the WeckMethod site on how to assess and improve ankle mobility.  As a clinician and coach, I see this issue in many runners and athletes I work with.  At times, it is joint restriction, while in other cases it is soft tissue limitations that impact mobility.

There are several potential reasons why one might possess less than optimal movement in the ankle.  The most common causes include: joint stiffness following injury and/or immobilization, soft tissue tightness in the gastroc/soleus complex, scar tissue from a prior injury, anterior ankle impingement, chronic ankle instability and adaptive shortening of the Achilles tendon.  Want to read more?

Click here to read my article on the WeckMethod site

Decreased mobility in the thoracic spine often creates dysfunction and stress on other parts of the kinetic chain, namely the shoulder and lumbar spine.  In many cases, clients will demonstrate asymmetry based on their sport, activity level and injury history.  In light of this, I often prescribe a simple, yet effective corrective exercise they can do at home to restore motion.  The exercise below is taken from my ‘Functionally Fit’ column I recently did for PFP Magazine.

Side lying t-spine roll

Side lying t-spine roll

In the full online column, I reveal two ways to do this and the applications for it.  This exercise also offers a way to assess your own range of motion, while teaching you a straightforward corrective exercise to improve mobility.

Click here to see the video of the side lying t-spine roll

Increasing shoulder, torso and hip strength and stability is a common training goal for athletes involved in sport.  Facilitating hip disassociation and kinetic chain linking with exercise is always a plus.  I like to use a diagonal mountain climber with hip extension to accomplish these objectives. More specifically, I utilize this exercise with my overhead athletes and anyone involved in cutting, pivoting and rotational sports.

Begin in a tall plank position.  The hands should be beneath the shoulders with the feet on the floor and shoulder width apart.  Slowly bring the left knee/hip under the body and toward the right elbow.  Pause at the end point prior to losing form or control.

Next, return the left leg toward the start position and up into full hip extension in one continuous movement.  Pause at the top end of available hip extension and repeat the cycle for 10 repetitions or time on the same leg.  Alternate legs and perform 2-3 sets on each side.

Sufficient upper body strength and core/hip stability in a 3 point position is necessary to perform the exercise correctly.  At no time should the foot of the moving leg touch the floor or be used to balance the body.  As far as a pace, I feel using a 1/1/1/1 cadence works best.

This exercise is an excellent way to promote shoulder, core and hip stability while facilitating hip disassociation as well.  Driving the hip back up into extension will activate the gluteals and simultaneously force the stable (fixed) hip to stabilize the pelvis and counterbalance the movement pattern. In addition, the client will have to effectively activate the hip and abdominal musculature throughout to avoid unwanted pelvic tilt/rotation during the movement.

Click here to view the full video of this exercise I did for my ‘Functionally Fit’ column for PFP Magazine.

We are consistently bombarded by screens in our daily life. Tablets, phones, laptops and our desire to be connected at all times encourages a froward head, rounded shoulders and a slumping posture. All of this spells too much flexion and mechanical overload on our posterior chain. Our bodies succumb to gravity. It is inevitable as we are naturally programmed to choose the path of least resistance.

I wanted to share an effective exercise to hit the cervical, thoracic and lumbar spine and improve overall postural strength and endurance. Begin lying face down over a stability ball as if you are diving into the pool (back will be rounded). Keep the feet about shoulder width apart. Next, retract the neck and lift the head and upper torso up as you simultaneously pull the elbows down and back as if you were pulling them into your back pockets. As you move into extension, squeeze the shoulder blades together at the top of the motion and pause for 1 second prior to returning to the start position. Perform 2 sets of 10-15 repetitions. The video below demonstrates how to execute the movement.

If you do not have a ball, the exercise can be done on the floor by placing 2-3 pillows beneath the hips in order to begin in a certain degree of flexion. As a general rule, avoid moving too far up into hyperextension. I prefer to have clients hold for a longer time at or slightly above neutral spine position to increase time under tension for a greater challenge.

I readily admit I have had an aversion to abdominal exercises that involve straight leg lowering since my days in pee wee football where we were forced to do lifts and holds a few inches above the ground.  Some will relate to a modern day version of this exercise known as “six inches.”

As someone with tight hip flexors and who has personally suffered from sciatica in the past, I am NOT a fan of abdominal training that exposes the lumbar spine to large loads and undue risk related to exercises that involve long levers (e.g. throw downs, scissors, etc) and place high shear force on the spine.

I was reminded of why I feel this way in a fitness class this past week.  I take a cycle/core class at my local gym and have done a traditional spinning class twice per week for 3 years.  After 45 minutes of cycle, we move to a fitness room for core.  I have done this new format for three weeks. This week we were asked to do a series of exercises which included “banana rolls.” If you are unfamiliar with this move, check out You Tube for some video demos.

While this exercise may be effective for core strengthening, I can honestly say as one who has never done the move before that trying to execute it as part of a continuous sequence of movements without rest between the moves was very hard to do with proper form.   The fatigued state encouraged using momentum and straining to simply get the movement done (not to mention the fact my greater trochanter was sore from the rolling on the hard aerobic floor).

The next day I woke up with low back pain.  My back has not hurt like that in years.  In light of the role the iliopsoas plays by virtue of its attachment on the lumbar spine, we must consider the impact of reverse muscle action and how it creates shear on the lumbar spine during movements that rely on stabilization with the legs extended against gravity.  Additionally, for those clients like me with muscle tightness, increased lumbar lordosis and a history of low back disorders, health and fitness professionals must consistently evaluate safety and efficacy as well as trying to challenge clientele in a workout session.

For all of these reasons, I increasingly rely on neutral spine anti-extension and anti-rotation training exercises in my programming for athletes and clients of all ages and abilities.  That is not to say I never do rotational or active movements.  They are appropriate given the right order, progression and demands of the respective individual. I just think we must consider form and risk versus reward in exercise programming.

The exercise video below illustrates how to use sliders in a tall plank position to accomplish great core activation and hip/shoulder stability without stressing the lumbar spine with long lever movements. Keep in mind that quality should override quantity in terms of deciding repetition schemes. Do not let the desire to fatigue clients cause form to suffer as this may increase injury risk.

For more specifics on the execution and progression/regression of this particular exercise, click the link below to read my most recent exercise column for PFP Magazine.

Tall plank shoulder circles

Suffice it to say I will not be doing banana rolls again. While I am not completely discarding the exercise, I do think it should be done in a non-fatigued state and taught incrementally if done at all. Most importantly, we as fitness professionals must always remember to program exercises based on fatigue and skill level, while carefully weighing risk versus reward in group or individual sessions.

There seems to be consistent questions, debate and studies done with respect to stretching.  As the thought of more closely analyzing the quality of movement (FMS, Y-Balance testing, SFMA for example) moves to the forefront in the PT and fitness world, many search for the right mix of exercise to maximize mobility.

I count myself as a supporter and follower of the work of Gray Cook and Stuart McGill.  While I may not agree 100% with all of their ideas, I generally consider them to be brilliant minds and ahead of the curve.  I have been using the FMS in my practice for some time now and have also begun to incorporate Y-Balance testing as well (see pic below courtesy of the IJSPT)

le-y-balance-test

The Y-Balance test may not have significant relevance to hip mobility as much as it does limb symmetry, but I included it here to illustrate my point in observing kinetic chain movement to help determine where the weak link or faulty movement pattern may be.  It gives us valuable information with respect to strength, balance and mobility.

With the revelation that FAI is more prevalent than we knew (click here for my post on FAI), I am always interested in hip mobility and how to increase movement in the hip joint.  Limitations in hip mobility can spell serious trouble for the lumbosacral region as well as the knee.

I currently use foam rolling, manual techniques, dynamic warm-up maneuvers, bodyweight single leg and hip/core disassociation exercises and static stretching to increase hip mobility.  However, I am often faced with the question of what works best?  Is less more?  How can I make the greatest change without adding extra work and unnecessary steps?

Well, Stuart McGill and Janice Moreside just published a study in the May 2012 Journal of Strength & Conditioning Research that sought to examine three different interventions and how they improve hip joint range of motion.  Previous work has been focused on the hip joint alone, and they wanted to see how other interventions impacted the mobility of the hip.  Click here for the abstract


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