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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: core exercise

Improving lateral chain strength is always a priority when training or rehabbing athletes. Improving anti-rotation stability is particularly important for injury prevention and dissipation of forces in the transverse plane. Whether working with a post-op ACL client or training an overhead athlete, I am always seeking ways to increase torso/pillar stability to increase efficiency of movement and reduce injury risk.

This video below from my Functionally Fit series for PFP Magazine will demonstrate a great exercise do accomplish these training goals.

Emphasis should always be placed on maintaining alignment. Do not progress the load too quickly, and be cautious if using the fully extended down arm position if clients have a history of shoulder instability or active shoulder pathology as this places more stress on the glenohumeral joint. Below are some progressions and regressions as well:

Regressions

1. Decrease the hold time as needed to maintain form and alignment
2. Allow the kettlebell to rest against the right dorsal wrist/forearm
3. Stack the top foot in front of the other foot as opposed to stacking them on top of one another to increase stability
4. Bend the knees to 90 degrees to reduce the body’s lever arm

Progressions

1. Increase the weight of the kettlebell and/or increase hold time
2. Lift the top leg away from the down leg
3. Add light perturbations to the top arm during the exercise to disrupt balance and challenge stability
4. Perform the exercise with the down arm fully extended

Well, it has been too long since my last post.  Between seeing patients and the onset of spring sports with my kids, I have not been writing as much as I would like.  I hope to get back to posting at least twice per month very soon.  In the meantime, I thought I would share two recent videos I did for PFP Magazine.  They include a half kneeling torso rotation and supine torso anti-rotation using the Surge.  Both are great ways to improve rotary stability.

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!

I utilize bridging as an assessment and exercise tool in my training and rehab programs.  Posterior chain/hip stability is poor in many clients.  The ability to maintain a neutral spine, engage the glutes and fight rotation is NOT an easy task by any means. So, coaching and cueing proper bridging is a great way to enhance pillar strength and reduce injury risk, while facilitating better movement patterns in sport.

I wrote a recent column for PFP magazine entitled iso bridge with alternate knee extension.  Click here to read the column and the application, regression and progression of the exercise.  In addition, I have included a short video below showing double leg and single leg bridge exercises that can be used to work on the hips and core.  The second exercise is the dynamic version of the iso alternate knee extension bridge I write about. I show you some of the single leg progressions that come after mastering the iso bridge as well.

I hope this video and article is useful to you.  I also want to take this opportunity to thank you for reading my blog and wish you a very Happy New Year!

It is widely accepted that decreased hip strength and stability leads to knee valgus. Excessive frontal plane motion and valgus torque increase the risk for non-contact ACL injuries. While we know that hip abductor weakness is more of an issue in females than males, the question remains to what degree other factors are involved.

knee-valgus-add-ir

Claiborne et al (1) noted that only 22% of knee variability could be linked solely to hip muscles surrounding the hip. In light of this we must look at the whole kinetic chain when assessing movement dysfunction and injury risk. In the most recent issue of the IJSPT, researchers sought to discover how activating the core during a single leg squat would impact the kinematics of 14 female college-age women. They excluded participants with current pain or injury to the lower extremities or torso, or if they had a history of any lower extremity injuries or surgeries in the past 12 months.

The participants were assessed for their capacity to recruit core stabilizer muscles using lower abdominal strength assessment as described by Sahrman (2). This testing model has 5 levels of increasing difficulty used to challenge participants to maintain a neutral spine. The draw back of this method is that it is done in supine versus the standing position of this study, but the author acknowledges this limitation. Out of a possible high score of 5, five of the participants scored a 1 or 2, while the other nine scored a zero.

For the study, a six inch step was used to assess 2 reps of a single leg squat. Each participant was asked to perform the test with the dominant leg to standardize conditions. They performed the reps under two conditions:

1. CORE - engaged abdominal muscles as they had been instructed to do so during the Sahrman test

2. NOCORE - no purposeful engagement of abdominal muscles

Results

  • The CORE condition resulted in smaller hip displacements in the frontal plane but had no effect on hip angular range of motion - essentially there was less medial/lateral movement
  • The CORE group did not exhibit any changes in knee displacement but did exhibit greater degree of knee flexion - this may suggest higher function assuming more knee flexion is desired during squat tasks in sports and functional activities
  • Those scoring the lowest on the core assessments had larger improvements in performance when they did in fact activate the core musculature

How do we use this information to affect our practice?  Well, in terms of rehab it seems straightforward and many of us may already encourage patients to activate their core during treatment.  However, I think the greater contribution may come in injury prevention programs (particularly ACL programs) where we are looking at all facets of neuromuscular control and appropriate muscle activation patterns.

With any prehab or rehab strategy, we as clinicians, trainers and strength coaches are essentially trying to reprogram the brain to summon and execute a better motor pattern or strategy - feedforward training.  We know that healthy individuals tend to have better transverse abdominus and multifidus muscle activation, so it only makes sense to consider activation of local stabilizers as we work on global muscles.  Improving core and pelvic stability should only help reduce unwanted frontal plane motion.

With that said, the authors of this study readily acknowledge more work needs to be done with larger clinical populations (including EMG work) to more clearly identify what magnitude the core musculature has on lower extremity motion and displacement.

Keep in mind the proper program will always stem from your ability to assess movement impairment and tissue dysfunction.  I suggest beginning with a FMS in the athletic population and incorporating parts of that or the SFMA to compliment your evaluation in the clinic.  This will generally reveal the priorities for the corrective exercises.  For now, we can use this information in this particular study to be more intentional with our patients and clients suffering knee and hip dysfunction by adding this one simple step to our programming.

References

1. Claiborne TL, Armstrong CW, Gandhi V, Princivero DM. Relationship between hip and knee strength and knee valgus during a single leg squat. Journal of applied biomechanics. 2006;22(1):41.

2. Faries MD, Greenwood M. Core training: stabilizing the confusion. Strength & Conditioning Journal. 2007 ;29(2):10.