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.
It has been a while since my last post. To be honest, I have been busy with preparing/presenting my live seminar last week and webinars, as well as fulfilling my writing obligations and clinical role. So, I have been taking a “break” from blogging and recharging the battery so to speak.
Now I am getting back to it. The great thing about presenting though is that I am consistently reading and reviewing the latest research on topics related to my presentations and closely examine my rehab and exercise philosophy. In my clinic, I treat many runners for knee pain.
The average profile is an experienced runner b/w the ages of 25 and 50 who logs 20 – 35 miles per week and routinely competes in half marathons or some sort of triathlons.
Common injuries include IT band problems versus lateral meniscus tears versus patellofemoral pain. Often, I uncover the following things related to kinetic chain deficiencies:
I wanted to make everyone aware of two courses that I am presenting in the next 2 weeks in conjunction with Allied Health Education:
The first is a (2) hour webinar on Current Concepts in the Recognition and Treatment of Femoroacetabular Impingement tonight, August 23 from 8-10 PM. The course is intended for PT’s, PTA’s and ATC’s looking for an in-depth presentation on the condition and its management. Click here for more information.
In addition, I am scheduled to present two (1) day seminars on “Fit Knees” in Greensboro, NC on Sept. 7 and Richmond, VA on Sept. 8. This lecture/workshop event will feature my evidence based approach to injury prevention and rehabilitation for knee osteoarthritis, running injuries and ACL injuries.
The material presented in this seminar is intended to help identify knee dysfunction and implement safe and effective rehab, corrective exercise and training strategies tailored to meet the needs of each client. Attendees will learn how the presenter utilizes the FMS, Y-Balance test and other screening tools to determine limb asymmetry and imbalances. Additionally, participants will learn how to use assessment and current research to create effective training programs, facilitate the rehab process and guide post-rehab decision making. Click here for more information.
If you have further questions, feel free to post them on the blog.
While I treat a vast number of knee ailments in my practice, the focus of my training and rehab is often more proximally directed at the hip. Understanding the role of hip muscles and how the hips and pelvis work together to impact knee alignment and closed chain function is critical in resolving knee pain and dysfunction.
Below is a “go to exercise” exercise I use for gluteus medius activation and core/pelvic stability training. Using a mini-band provides an adduction force cueing the client to abduct and activate their external rotators to maintain proper alignment. Additionally, they need to avoid a drop on one side of the pelvis (look at the ASIS).
Click here to read my entire column dedicated to this exercise in PFP’s online magazine. I hope you find this exercise and information useful for you and/or your clients.
Let me start off by saying I have the privilege to assess and treat many avid runners on a weekly basis. Some of them are triathletes and others just dedicated runners. While the age and experience level varies, I see more female runners in all.
Recently, a woman in her mid thirties came in for PT after being referred by a physician’s assistant (PA) with a working diagnosis of hip flexor tendinitis. She had developed pain running in the past few weeks. It was now at a level preventing her from running despite using NSAIDS to reduce inflammation.
Specifically, she complained of increased pain with figure 4 sitting, difficulty and pain getting up from a chair, and increased pain with running. Her pain level at the eval was 2/10 but went as high as 9/10 with running. Lots of things can cause pain in the hip joint.
Summary of clinical findings:
Poor single leg stance on the involved hip with mild pain
No leg length discrepancy
Subtle antalgic gait
AROM for hip and L-spine are within normal limits
No pain with quad or hip flexor stretching
Manual muscle testing reveals 5/5 strength for hip flexion (SLR and seated), abduction and adduction
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