Brian Schiff’s Blog

Core training is common terminology thrown around in fitness circles today.  However, not much research has specifically addressed more advanced stability ball exercises and muscle activation until now.

A recent article released in the May 2010 Journal of Orthopedic & Sports Physical Therapy looked at 8 stability ball exercises and maximal voluntary isometric contraction (MVIC) versus traditional bent knee curl ups and crunches.

The 8 stability ball exercises studied with EMG were:

1. Roll out
2. Pike
3. Knee up
4. Skier
5. Prone hip extension left
6. Prone hip extension right
7. Decline push-up
8. Seated march right

Pike (end position)

All exercises were performed with a cadence of 1/1/1.  A metronome was used to ensure uniform repetitions and holds.  Researchers concluded that the pike and roll-out were the most effective exercises based on EMG activation.  However, keep in mind that these also require the greatest effort and pose a high degree of difficulty.

Why is this stuff important?  Research done by Cholecki and VanVliet concluded that no single core muscle can be identified as the most important for spinal stability.  Additionally, they believe that the relative importance of the muscle varies based on the direction and magnitude of the load imposed on the spine.

We have known for years the spine is least stable and most vulnerable in trunk flexion (as in the knee bent curl up), and that no one muscle contributes more than 30% to overall spine stability.  Choosing more demanding core exercises also typically increases spinal compressive forces as well.  This may be contraindicated in some populations.

Therefore knowing your client and condition is essential.  For example, flexion is often contraindicated with active disk pathology, whereas it may be indicated in those with facet arthropathy or spondylolisthesis.  Over the past decade or so, much attention has been placed on the transversus abdominus muscle. 

The prevalent thinking has been that it is a major contributor to spinal stability, although this is somewhat controversial and has not been unequivocally validated with science.  Another flaw here is that isolated contractions of it have not been demonstrated in higher level activities (e.g. sports). 

So, where is the functional tie in here?  The transeversus abdominus has shown similar activation patterns (within 15%) to the internal obliques with exercises similar to those in this study.  The highest activity from internal obliques was during the pike, roll-out, knee up, skier and hip extension left exercise.  This may indicate that transveresus abdominus activation is also high, but further research will need to be done.

The last critical piece of data involves looking at hip flexor activation as the psoas generates remarkable spinal compression and anterior shear forces at L5-S1.  This can be especially troubling for individuals struggling with lumbar disk pathology.  The exercise in this stud that demonstrated moderate hip flexor activation were:

• Bent knee sit-up
• Pike
• Seated march
• Hip extension exercises

So, if you or your client has a weak rectus abdominus and/or obliques or lumbar instability, these exercises may be contraindicated.  In the end, know that the stability ball provides much greater muscle activation compared to traditional bent knee sit-ups and crunches on the floor.  The caveat is identifying which ones are appropriate and most efficient in your case.

As a general rule, I suggest that you avoid long lever arm action with the legs in the presence of active disk pathology and instability.  You may opt for stability based exercises in a neutral spine position like planks as there is minimal shear and compressive loading here until clients develop more stability and strength.  With healthy and mroe advanced clientele, many of the stability ball exercises studied would be good alternatives to traditional crunch work to build muscle strength for the core.

I just recently returned from speaking at the AFPA Fitness Conference in Ocean City, MD.  I gave four different talks but invariably I always end up educating fitness pros on exercise selection, modification, and progression based upon individual client response.

It is so easy in the health and fitness industry to use set protocols or schemes we are comfortable with across the board even when we know clients are unique.  I have seen enough pathologic knees, shoulders, etc. over the years to know that everyone’s body reacts in its own unique way to exercise.

The primary tool we need to use to understand where a person’s body is in terms of inflammation and healing is pain.  We need to educate our clients to be forthright about ongoing pain before, during and after sessions.  So, what causes pain?  Often it stems from inflammation.

I told the trainers this past weekend that cryotherapy will do wonders for many conditions.  In fact, I see many discontinue ice after the first 2-3 days.  This is a BIG mistake in my opinion.  Who ever said ice will not help sub-acute or even chronic inflammation for that matter?  I am adamant that clients ice in the presence of pain.

Pain is a marker and evaluative tool we need to embrace to better tweak rehab and exercise progressions.  Cryotherapy is crucial in reducing persistent inflammation.  I particularly like to use it immediately following workouts to reduce any new post-exercise soreness and inflammation that may creep up with higher volumes and intensities in the session.

Today, I wanted to share two of my favorite cryotherapy resources with you.  You see, I want my clients to be proactive and vigilant with their own personal rehab and wellness programming.  That often necessitates that they purchase tools to use at home.  This way they are ready when unexpected pain or inflammation strikes.

My preferred solutions are:

• Biofreeze– a topical ointment or spray that helps reduce pain from aches/strains and joint pain.   My personal massage therapist uses it and I find relief in my neck with it after each session.  I carry this in my OpenSky store because it is effective.  You can see more by clicking on the image below:

• Custom fit cold compression wrapsfrom Cold One – I personally own the shoulder, low back and knee wraps.  These conform to your body and velcro down so you don’t have to hold them on or worry about them not hitting the right area.  Click the image below for more info.  You can even save 10% right now using the promo code BSCHIFF10.

I think you will find these resources useful in the recovery of musculo-skeletal pain and inflammation.  While heat may be used and feels good, I prefer cold therapy to reduce pain and inflammation.

According to research, more than 70% of people in the US will experience at least one episode of low back pain (LBP) in their life.  What is known about LBP and jogging?  Keep in mind running is an extension activity in the spine.  It also involves obvious repetitive compression/loading with ground impact.

A recent study in the Journal of Athletic Training (Sept./Oct. 2009) looked at the impact of lumbar paraspinal muscle fatigue and postural adjustments seen in running.  Poor lumbar extension endurance has been linked to increased risk for developing LBP.  In this study, researches looked at 25 recreationally active participants with a history of recurrent episodes of LBP and 25 healthy controls.

The testing process included:

1. 5 minute warm-up on the treadmill
2. 60 seconds of treadmill jogging at self selected pace
3. 1 set of fatiguing isometric lumbar extension exercise
4. Another 60 second treadmill jog at the same speed

For your reference, the fatiguing lumbar exercise consisted of repeated cycles of 10 second, gravity resisted isometric contractions followed by a 10 second rest on a lumber hyper extension chair.  So, what did the results show?

In a nutshell, those with a history of recurrent LBP showed much less postural adjustment with the muscle fatigue compared to their healthy counterparts.  The healthy subjects tended to exhibit a more forward trunk lean (1.1 degrees or less lumbar lordosis) and increase lateral bend during jogging gait.

On the flip side, those with recurrent LBP, they tended to stay more upright (0.2 degrees of additional lean on average).  The authors feel this may indicate a coping mechanism due to core instability and a way to effectively stabilize the spine.    Increased trunk lean would increase forces on the spine and intervertebral disc.  The lack of change in the population with LBP may help explain excessive fatigue in the muscles that support the spine, pelvis and hips.

So what does this mean for those who have LBP?  The postural change, or rather lack thereof, may be an Aha moment in regard to the need for improved core training for runners and athletes.  It should also indicate that long term running or athletic competitions may increase the risk for more frequent LBP or a greater back injury. 

There are three big takeaway messages here:

1. Include low back extension endurance training in your workouts
2. Integrate appropriate core exercises (planks, side planks, 3 dimensional exercise) to improve strength and stability of the hips, pelvis and spine
3. Get professional evaluation and training from a knowledgeable fitness pro if you have LBP

Many people suffer from general low back pain and sciatica.  Do you realize most of this pain is brought on by poor posture, too much sitting (slouched) and lack of mobility in the spine.  In today’s video, I discuss this issue and show you two simple exercises to do daily to prevent disc problems as well as eliminate back aches related to daily mechanical strain.