Lateral Stabilizers and Transverse Plane Exercise

01/27/2012 By Leave a Comment
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).

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Honey Badger Exercise: Part 2

12/16/2011 By 4 Comments

Don’t exercise like a honey badger.

Proper training is performed within the functional range and with appropriate load.  Any professional ignoring or failing to appreciate these concepts is irresponsible.  To paraphrase Charlie Weingroff, DPT in Rehab=Training Train=Rehab, “if someone is paying you, you’re an expert and the least you owe them is not to hurt them”.

I can’t tell you how simple and perfect Charlie’s statement is. For those struggling to grasp this concept, let’s compare it to something we all know. Should training be like food service…. you don’t need to be serving 5 star cuisine. It’s fine to be a commercial chain, local family restaurant, diner, or fast food joint. (Although I’d much rather eat somewhere that takes pride in their menu.) Regardless of what style of restaurant you choose, the bottom line is you can’t be making the customers ill. We have standards for this in food service (and other industries), but sadly no such acceptable standard exists with the training community.

For those of us with a professional license and oath, we understand the prima facie duty of non-maleficence or primum non nocere, “First do no harm”. It is essential and overdue that this concept begin to be integrated into training and fitness as well.

Previous honey badger exercise post.

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Cross-Fit’s Mascot: The Honey Badger

11/21/2011 By 5 Comments

I recently had two unrelated experiences that after reflection (and viewing a funny video while talking about the second experience with some colleagues) seem to have some commonality.

Experience 1:  In August my wife and I visited Namibia to attend a friends wedding.  Our first trip to Africa was filled with unique and wonderful experiences and a few unexpected introductions.  While in Etosha National Park, we met a honey badger on his morning hunt.  At first this seemed unimpressive.  We were on an early morning safari tour and as the sun rose we were expecting so see giraffes, lions, leopards, elephants, wildebeest, zebras and other big, exotic creatures.  Instead we were using an infrared flashlight to view a honey badger searching in a field.  The fact that this was important to our guide should have been a clue about how impressive a honey badger was, but the significance didn’t set in until about an hour later.  As we were stopped now viewing two adult male lions, someone remarked how fearsome the lions looked.  Our guide, Wilson, explained that he was not afraid of the lions (they are often lazy and poor hunters, although good killers of the wounded or careless prey). He went on to say that he most fears the leopard and cape buffalo, but that the honey badger was the ‘toughest’ animal in the entire park.  Seeing the size and complete lack of intimidating appearance of the honey badger his statement struck me as odd.  Learning more about the honey badger you see that they are extremely driven, tough, and goal-oriented, but reckless in their pursuits.  Thankfully honey badgers are as resilient as they are reckless.

Do you exercise like a honey badger?  The honey badger don’t care. (see video below)

Experience 2:  I was introduced to Cross-Fit recently, a new exercise fad with all the buzzwords that you would hope to hear from a high quality program.  They welcome all abilities and think everyone is an athlete; they perform ‘functional’ exercises; they train ‘form’ before load; and they focus on core stability.  I went to view a Cross Fit session and realized that while the buzzwords were there, they were not applied effectively.  Functional exercises were performed, but not within the ‘functional range’ of the participant.  People of varying abilities and experiences were given the same program and encouraged to do what they could without being offered a peel-back exercise, which encourages the less able to try and perform up to the level of the more able participants.  It was clear that exercise was intended to be ‘tough’ and that you should ‘really feel it’ afterward.  The session ended with an abdominal exercise in which a half round support was placed under the lordosis (curve) in the lumbar spine (low back), and then the athlete performed a full sit up over the half round support into lumbar flexion.  (This is after other exercises performed with poor control caused repeated loading in lumbar flexion.)  [For those unaware repeated loading in flexion is the #1 cause of non-traumatic back pain, so this is a dangerous combination.] As the session ended I left wondering how a system developed with such great intent had declined to the reckless pursuit of movement that I witnessed.

‘Functional Range’ defined: “The functional range is the painless range which is appropriate for the task at hand”, Dennis Morgan PT, DC.  A range of movement within in an exercise that does not increase symptoms and is performed with adequate control and stability.

The parallel:  In talking with other healthcare providers this past weekend (Zak, Phil, et al.)  I realized that many others see the same significant flaws in Cross Fit (as well as some well known programs and exercise DVDs) that I do.  [This is not to say these programs are inherently bad, just often poorly applied.]  It was also confirmed that many have seen athletes become patients from these programs.  The common perception was that these injured people had the best intent to be healthier, but they were encouraged to pursue health with reckless abandon and emphasis on movement and muscle activity over control and coordination.  This is much like the honey badgers endless efforts to gather food which frequently ends in being stung by swarms of bees, fighting with buffalo, and venomous paralyzing snake bites.  The difference is that the honey badger is remarkably resilient and recovers in a short period of time.  Humans and human tissues often do not possess this same resiliency and injuries can take weeks (or longer) to be addressed.  We need to stop exercising like honey badgers.

The take home:

  • Honey Badgers are incredible, fearless, and resilient creatures (with funny and inappropriate youtube videos [view with caution due to language]).
  • Exercise programs such as Cross Fit, kettle bells, and home exercise DVDs can be wonderful components to a healthy lifestyle, but are all too often performed with recklessness (poor form, repeated spine loads, boom-bust mentality, failure to prescreen for injury risk, failure to recognize and respect the ‘functional range’, and an emphasis quantity over quality).
  • Exercise should be ‘challenging’ but does not need to be so ‘tough’ or ‘hard’ that it is likely injurious.
  • If you have worked with a healthcare professional who understands movement patterns and joint loading, see what they think of your program and goals before it’s too late. (most often parts of the program are great, and a few parts are problematic, with help to identify those you can continue, while limiting your risk). [if you haven't, use the clinical rehab society to find one]
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How do you lift your weights???

11/10/2011 By Leave a Comment

While attending a seminar hosted at Peak Performance in NYC, I was impressed by the high level of training offered by Joe Dowdell and his staff.  [visit Peak Performance on facebook] Even as Joe and his staff joined us in the Functional Assessment seminar, workouts continued in the gym with excellent instruction.  The hallmark of quality training is making an exercise ‘challenging’ while maintaining good form, simply making an exercise ‘hard’ (adding weight, doing it faster, performing more reps or sets) is easy to do, but doesn’t produce quality results.  The ‘hard’ way is the hallmark of lesser trainers.  I was impressed by high caliber and ‘challenging’ exercises I saw while at Peak, and I think the contrast with what I saw next is what made it so apparent.

After watching an exceptional set of plank rolls, the athlete stood up, his trainer went to prepare the next exercise, and I watched the athlete bend into complete lumbar flexion with no hip hinge to pick up his water bottle.  Great form and core control in exercise should translate to the same in everyday activities, it clearly did not here.

I saw a similar episode after watching some well done box jumps.  The exercise was performed with quickness, balance, control of a neutral spine, and stability at the hip evident by no medial collapse at the knee or trendelenburg’s sign at the hip.  Upon completing the set, the trainer began to put the box away and the athlete bent over to retie her shoes.  Something like this:

Note extreme lumbar flexion, failure to hinge at the hip. This is not a spine sparing or load sharing strategy.

I was surprised both times this happened. It was clear to me that the athlete understood proper form from the way they performed the exercise. It was clear the trainer understood quality ‘challenging’ exercise from the standard they set for the athlete.  However, there was no translation into activities of daily living.

After thinking about this, I realized that this happens in my office as well.  I spend time training patients in the hip-hinge, proper lunge mechanics, and other spine-sparing strategies so they can continue functioning without aggravating their condition.  In addition to teaching this I explain disc loading (see chart below) and try to follow the teachings of manual medicine pioneer Karl Lewit, MD, “The first treatment is to teach the patient to avoid what harms them.”  However, on occasion that same patient at the end of their visit reaches down to put on their shoes, pick up there purse, or collect their wallet and cell phone and performs the exact movement we just trained with improper form.  I take the opportunity to remind them, they often have a surprised expression, and together we work to repeat the activity with a more spine sparing strategy.

Are you loading your back unnecessarily?

The challenge for the clinicians and the trainers out there… first recognizing improper movement strategies and training good form; second getting good form incorporated into activities of daily living, work duties, and recreational activities through functional training and repetition.  We need our patients and athletes to understand this connection and then we need to work on repetition to myelinate these quality pathways. That which we wish to do with ease, we must first do with frequency.

  1. Teach correct movement patterns. (choose spine sparing, painless, dysfunctional patterns to correct)
  2. Repeat and groove these patterns.
  3. Make movement patterns more complex and add functional challenges.
  4. Add stability.
  5. Build endurance.
  6. Add speed, power, or stability training.

The common thread here is that it is not what we can do it’s what we actually do that determines injury risk.  Much like Professor Stuart McGill’s critique of FMS or similar screens. A simple but brilliant comment. A great analogy is diet and nutrition.  If someone can demonstrate that they can make a healthy, balance, nutritious meal, but they instead choose to eat fried fast food, what is their health risk?

To be truly effective, an athlete or patient’s ability to perform quality movement in the office and/or gym must translate into proper movements during daily activity.

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Hate sit ups??? Perfect, stop doing them….

07/23/2011 By 3 Comments

We’ve been doing sit-ups for decades to strengthen the abs and protect the back. While there is truth to the fact that core strength (and endurance) is protective for the low back, the best way to train this is still debated (or at least not widely adopted).  It is not uncommon to see people in many gyms or even elite athletes doing sit ups and leg lifts.  But commonality does not mean it is correct.  Professor Stuart McGill of the University of Waterloo has taken the effort to quantify the load placed on the lumbar spine and disc during many of these common exercises.  It has become very clear that sit-ups, crunches, leg lifts, and many other common ‘abdominal/core’ exercises have unsafe back loads and are likely more harmful and injurious than they are protective.  We need to move beyond the idea of training the abdominals to simply look good at the beach or pool and start doing better core training.

This is discussed in a NY Times article on Core Myths.  Please read the short article.

The obvious question then becomes what exercises should I be doing, if sit ups and crunches aren’t ideal.  McGill has popularized his Big 3 and has research to support their effectiveness in activating the core as well as showing lower spinal loads during the activity.  The Big 3 include:

  1. Side Bridge
  2. Bird Dog
  3. Curl Up

As with all exercise proper form is essential.  Without proper form the exercise is not as effective and more likely harmful.  If you have questions consult a competent health care or exercise professional.  [Looking for one?  Try searching the ISCRS website]  To view these exercises, and another challenging core stability exercise called ‘Stir the Pot’ view this 3 minute video. McGill- Core Values.

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