Archives for January 2012

Lateral Stabilizers and Transverse Plane Exercise

Quadratus Lumborum

Can you see the stabilizing, connecting architecture.

We know that no muscle works in isolation and the brain thinks in terms of movement, not muscles.  So I think the title of these videos (and articles) may be misleading for those who are not familiar with the paradigm and principles that support it.  Despite calling it QL training, you will notice very quickly that Dr. Liebenson & Chad Waterbury are training patterns and functional whole body exercises, not working to isolate an individual muscle.  Keep in mind our common movement patterns as you review this and realize how neglected that lateral direction or transverse plane can be.  So far today I’ve spent 95+% of my time moving forward on level surfaces.  My activation of the lateral stabilizers has been minimal.  Our modern society and common training exercises necessitate evaluation of this plane and likely incorporation of these exercises into most routines.

A great introduction, now see how it’s done.

Some addition reading: on Dr. Liebenson’s blog  & Chad Waterbury’s blog.
Also a previous post by Dr. Cubos on Gluteus Medius activation which includes the role of the QL.

We must assess all planes and all movements.  Treatment is the applied to the worst, pain-free pattern (treat the abnormal motor control that improves the mechanical sensitivity).

How To Stop Screwing Yourself Over

20 Minutes that are worth spending… TedX video entitled “F*@# Y__ Stop Screwing Yourself Over” with Mel Robbins.
How activation energy, auto pilot, the need for exploration, and ability to FORCE yourself impact your happiness, success, and getting everything you want out of life.
If this doesn’t motivate you to make changes….

  • in your activity level
  • in your career
  • in your sport/training
  • in your relationships

… perhaps you didn’t watch closely enough?
This is SIMPLE but not EASY.  Just like so many treatments for my patients.  Simple, but not easy, exercises.  Simple, but not easy, changes in diet.  Simple, but not easy, changes in perspective and lifestyle.  Best luck to everyone to FORCE themselves to make the simple decisions.

I first viewed this on: SB Coaches College

Quantity vs Quality – Past & Present

The age of electricity began in 1882 and fueled the second Industrial Revolution.  The ability to produce more goods faster, shaped the outcomes of major world events such as World War I & II.  Consider that only England, Germany, France and the U.S. has completed the industrial revolution at this time. Our ability to produce mass quantities of weapons, uniforms, supplies, and food was significant in this era.  History buffs know there are many examples of how German technology was superior to US/British technology at this time, however we all know the outcome. In short, during this period quantity trumped quality.

As this has carried forward we see widespread  examples of how this concept of quantity over quality has gone wrong.  Quantity over quality  has corrupted society.  We are saturated in low quality abundance.

  • Calories over nutritional content.
  • White bread everywhere vs. whole grains.
  • American cheese food vs. actual cheese.
  • Processed, packaged foods full of preservatives.
  • ALL LEAD TO: Obesity & disease


  • Exercise fads, the quick easy, this is for everyone approach.
  • 3 sets of 10 mentality.dysfunctional hypertrophy in bodybuilding
  • Lift more weight.
  • Add balance challenges to anything.
  • No pain, no gain mantra.
  • LEADS TO:  hypertrophy, compensatory pattern, accumulation of stress/strain, failure to meet goals, frustration, injury,…… inactivity.  (Stronger, but no healthier.)


We now know that quality of exercise is more important than quantity.  The same holds true in nutrition, quality foods (whole foods, organic foods) are more valuable than quantity.
Systems have been developed to access quality of movement.  Functional assessment or evaluation of movement quality have been around for some time and were championed by Vladamir Janda.

  • Janda & Prague School teachings including Dynamic Neuromuscular Stability.
  • Liebenson’s Mag 7

These methods are not always used as we rely on traditional orthopedic testing (which has it’s place in examination, but also has it’s limitations) and diagnostic imaging.  Imaging such as x-ray, MRI, CT also has it’s utility, but is frequently over utilized and often muddles the clinical picture as it does not show function or pain.  Evaluation of structural change has poor correlation to pain and function, it can be misleading.  To combine the concepts, below are some examples of imaging (flouroscopy) during poor quality and then high quality movement patterns.  After watching them which is more important, the # of repetitions you do, or the quality of the repetitions?  Would you prefer 3 sets of 10 with bad form? Or one set of 4 with good form?

Abduction of the shoulder, first with a shrugged, decentrated, elevated scapula; then repeated with proper packing/stabilization.

original posting @

Which shoulder exercise would you like to see in your patients?  In your own exercise?

The days of quantity have passed.  The emphasis needs to return to QUALITY.   Once we achieve quality, quantities of quality exercise can be used to increase capacity.

Triathlete Imaging- Supporting active care.

To view the original, well referenced blog post look here, from Toronto physiotherapist Laura McIntyre.

So is active care and exercise important?  (Yes, this is rhetorical.)

  • Compared to the top image… which do you like the looks of better?
  • Image 2: Sedentarism?
  • Image 3: Active lifestyle?

You will see the active triathlete with significantly more muscle mass, less fatty (adipose) tissue, and denser bones.  More muscle, less fat, & stronger bones. Sound like something you might want to be part of?

I once heard Craig Liebenson, DC say that we need patients to ‘fear inactivity, more than they fear activity’.  To add context this includes having someone knowledgeable helping them choose appropriate movements, exercises, and activity.

With this being said, there is another side.  Elite athletes and extreme performance are not exactly the best examples of healthy living.  While there are clear benefits to remaining active, at the extremes there is some negative consequence as well.  These feats of athleticism place a toll on the body as well.  This was very clear to me after completing my first marathon. I was convinced by personal experience that there is another extreme.  Another example is the shortened average lifespan of the NFL player.

To summarize:

  • What happens as you age is partially (& significantly) your choice? (see images).
  • There’s a middle road between the couch and ultra-marathons.  Maybe the focus should be on long term athletic participation.

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What do you know about FAI?

I found myself talking about this with patients and other providers a lot lately…. thought someone else may be interested.

Sometimes you must admit when you’re not the expert… this is it for me.  Still working at mastering this.  So here’s what a few others have to say.FAI Hip

As several of my patients had hockey related hip pain I asked a Canadian… here’s what Jeff Cubos, DC sent me:

From Kevin Neeld:

From Eric Cressey:

From Craig Liebenson, DC:

And below, 52 seconds to remind you that conservative measures should be attempted prior to performing surgery due to imaging findings of impingement.  (Please seek care and advise from a qualified health care professional to be sure you’re a candidate for conservative care and something more pressing is not going on.)  For appropriate conservative care, see above links.