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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'balance'

Facilitating better lower leg stability is always a priority in my rehab and training programs. I have long been an advocate of single leg training to resolve asymmetry and reduce compensations and injury risk. Once a client masters form on the ground, adding in more proprioceptive challenges can take their training to a new level.

Today I wanted to share a previously unpublished video I shot for my ‘Functionally Fit’ column that demonstrates a single leg squat exercise on the BOSU Elite Trainer. It is a relatively new exercise tool that offers some tweaks on the original BOSU balance trainer.

This post is the third corrective exercise in a series I am doing for Personal Fitness Professional Magazine in my online column titled “Functionally Fit.”  To read more online exercise tips, visit www.fit-pro.com.

The hurdle step assessment (as part of the FMS) is designed to challenge the body’s proper stepping and stride mechanics as well as stability & control in single leg stance.  The step leg must perform ankle DF and hip/knee flexion while core stability must be present in single leg stance.

hurdle-step-2

Limited hip mobility and/or poor hip and core stability restricts natural movement and leads to compensatory motion often in the form of unwanted hip rotation, hip hiking, trunk sway in the frontal and sagittal plane.   A common corrective exercise prescribed to improve core stability is a standing march (single leg stance) with straight arm pulling to engage the core.

Execution: Begin standing with the feet together while holding the cable handles with the palms down.  Select a weight that provides ample enough resistance to maintain isometric shoulder extension for 30-60 seconds.  Be careful not to select too little or too much weight as this will disrupt the execution of the exercise.

Next, pull the arms down toward the side and hold in that position.  Maintaining an erect posture, slowly lift the left leg up (ankle dorsiflexion with knee and hip flexion) and pause for 2-3 seconds.  Move the unsupported leg back to the start position but keep the arms actively extended.  Repeat this sequence for 10 times on the left leg.  Rest for 30-60 seconds and then repeat on the other leg.  Perform 2 sets.

standing-hurdle-step-fms-corrective-cable-march

Additional notes: I tend to focus on unilateral consecutive repetitions (as described above) especially if there is a 2/1 asymmetry with the hurdle step.  As the asymmetry is resolving, I will progress to a reciprocal pattern as this is more natural in life/sport.  If a cable column is unavailable, alternate methods include using a suspension training apparatus or resistance tubing anchored high enough to accomplish the same upper body isometric pulling.

Application:  Poor hip stability and control in single leg stance is a common cause of overuse injuries in runners and contributes to increased risk for anterior knee pain and ACL injuries.  Keep in mind that poor performance on the hurdle step movement can be related to weak hip flexors on the stepping leg, tight hip flexors on the stance leg, diminished hip stability and poor balance.

It is critical to assess the whole movement prior to assuming that there is just one problem or weak link in the kinetic chain.  Restoring symmetric, optimal stepping patterns will promote proper hip disassociation, as well as training the body to synergistically activate core and hip musculature to demonstrate optimal single leg stability in unilateral stance.


I like to include exercises on this blog that are useful for rehab and fitness professionals as well as fitness enthusiasts who visit. This is a cool exercise that a colleague taught me.  I also recently shared this as part of my ‘Functionally Fit’ column for PFP Magazine.  It works great when doing partner workouts or if coaching a client.  We used it during our off season training for the Carolina Hurricanes and it is much harder than it looks on the surface.

Training clients to maintain core stiffness in athletic functional positions will improve performance and reduce injury risks for the spine and lower extremities. This exercise is an effective way to address postural stability, increase core strength and enhance kinetic chain proprioception

atlas-split-squats

Execution

Begin in a split squat position holding a stability ball overhead. The client maintains an isometric split squat while the coach/trainer provides directional perturbations in an attempt to disrupt balance and stability.

You may opt for several quick rhythmic perturbations or elect to use more sustained pushes (1-2 seconds in each direction) to challenge the client. Allow the client to reset to the desired position if he/she does lose balance in order to facilitate optimal motor patterning. Perform 30 seconds with the left leg forward, rest 30 seconds and then repeat with the right leg forward. Complete two sets on each side.

Be sure to observe asymmetries or deviations specific to either side as this will allow for better cuing and reveal energy leaks. Marking the desired distance between the front heel and rear foot toes with tape will ensure consistency for each trial side-to-side.

Application

This exercise is very effective in training kinetic chain stability and proprioception. Holding the ball overhead allows the trainer to challenge clients to resist movement in the sagittal, frontal and transverse planes through upper body driven loads and feedback. Additionally, the client must focus on maintaining an upright posture while the lower body musculature remains engaged.

Regression

For those with difficulty holding the ball overhead, consider holding the ball at shoulder height at first. Keep in mind the perturbations should be graded and not designed to push the client over or completely off balance.
One additional note to consider: you may opt to instruct the client to remain rigid throughout the drill or allow them to be relaxed and then respond with reactive rigidity when the perturbation comes.  Experiment with your clients and programs and see what you think!

Research has shown that strengthening the gluteus medius is clearly an essential way to reduce anterior knee pain and improve pelvic stability and function.  The exercise I am sharing today is useful for improving hip strength and pelvic stability in a closed chain fashion.

In the video below, I demonstrate a very effective way to strengthen the gluteus medius and improve hip stability.

For a full description of the exercise, check out my latest column, Functionally Fit, by clicking here.

Unearthing the cause of anterior knee pain and ridding our patients and clients of it is one of the never ending searches for the “Holy Grail” we participate in throughout training and rehab circles.  I honestly believe we will never find one right answer or simple solution.  However, I do think we continue to gain a better understanding of just how linked and complex the body really is when it comes to the manifestation of knee pain and movement compensations.

We used to say rehab and train the knee if the knee hurts.  It was simply strengthen the VMO and stretch the hamstrings, calves and IT Band.  Slowly, we began looking to the hip as well as the foot and ankle as culprits in the onset of anterior knee pain.  The idea of the ankle and hip joint needing more mobility to give the knee its desired level of stability has risen up and seems to have good traction these days.

Likewise, therapists and trainers have known for some time that weak hip abductors play into increased femoral internal rotation and adduction thereby exposing the knee to harmful valgus loading. So, clam shells, band exercises and leg raises have been implemented to programs across the board.

theraband-single-leg-hip-rotation-finish

Single Leg Resisted Hip External Rotation

As a former athlete who has tried his hand at running over the past 5 years, I have increasingly studied, practiced and analyzed the use and importance of single leg training and its impact on my performance and injuries.  As I dive deeper into this paradigm, I continue to believe and see the benefits of this training methodology for all of my athletes (not just runners).

As a therapist and strength coach, it is my job to assess movement, define asymmetries and correct faulty neuromuscular movement patterns.  To that end, I have developed my own assessments, taken the FMS course, and increasingly observed single leg strength, mobility, stability and power in the clients I serve. Invariably, I always find imbalances – some small and some large ones.

What are some of the most common issues I see?


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