Basic Functional Activities – Rolling Part 2

As I mentioned at the end of my last post, the Turkish Get Up is the final step to rolling, moving from your back to your side, to sitting, and then transitioning up to 1/2 kneeling and finally standing.  Here is the whole thing, once again performed by the great Brett Jones and narrated by Gray Cook.  I definitely advise their DVD, Kettlebells from the Ground Up

I also love the neurodevelopmental patterns from the Prague School of Rehabilitation and Dynamic Neuromuscular Stabilization.  Here is a great example of using developmental patterns for your get up.

If you can master these movements, just about every other functional activity is much easier.

Basic Functional Activities – Rolling Part 1

2) roll from one lying position to another (simple rolling)

This activity is clearly one you want to be able to do, roll over in bed, or roll over on the ground.  Ideally, you should have pain free multi segmental rotation (from the SFMA), but if you perform a “hard roll,” you can do it without pain even if you don’t have pain free MSR.  I like this activity a lot because it is a great way to utilize your oblique slings (external oblique to contralateral internal oblique).

Here is an example of a contralateral hard roll.  I call it contralateral because you have the knee and contralateral (opposite) hand touching.

I also like to do an ipsilateral (same side) roll, where the hand touches the same side knee.  I also like to use a pilates ring to create the tension between the knee and the hand.  I like this exercise as a safe way to work on rotational core / lumbopelvic strength.

I also like the SFMA rolling or the “soft roll.”  I feel this really gets into the rotational chains from Thomas Myers’ work and becomes good preparation for a Turkish Get Up or Arm bar.

Here is the soft roll (UE supine to prone):

Here are all the patterns:

Kettlebell Armbar – one of my favorites:  Jump to about 1:30 or so.  I really like what he looks like around 1:54 – showing great shoulder mobility and stability:

Turkish Get Up:  Brett Jones performing, Gray Cook narrating.  This is from a great DVD, Kettlebells from the Ground Up.  This exercise is really the main part of the next post.

Keep Moving, Jason

recent research

http://journals.lww.com/nsca-jscr/Abstract/2014/07000/Does_an_In_Season_Detraining_Period_Affect_the.32.aspx

Swimmers: continue your dry land rotator cuff training throughout the entire season.

http://journals.lww.com/nsca-jscr/Abstract/2014/07000/Neutral_Spine_Control_Exercises_in_Rehabilitation.27.aspx

If you have a patient with a fusion, you can get some nice core muscle activation with neutral positioning and resisted limb movements.

http://journals.lww.com/nsca-jscr/Abstract/2014/07000/Effect_of_Supervised,_Periodized_Exercise_Training.25.aspx

For best exercise outcomes, hire a personal trainer.

http://journals.lww.com/nsca-jscr/Abstract/2014/07000/Responsiveness_of_the_Double_Limb_Lowering_Test.17.aspx

Not surprisingly, double leg lowering isn’t very responsive for testing abdominal strength.  But a lower abdominal progression is better.  But to improve this strength the most, general exercises are better than specific ones.

Basic Functional Activities

Physical Therapy is a goal based profession.  We write goals at our initial visit and then continue to reassess them and create new ones as appropriate as we go.  Fitness needs to have similar goals.  Here is a list of basic functional activities that I think could fall into either the physical therapy to fitness spectrum (Training = Rehab per Charlie Weingroff).

I like to think of these from a chronological perspective.  What is the first thing you need to be able to do in the day and then what other things are needed too.

1) lay down in any position: sidelying, supine, prone
2) roll from one lying position to another (simple rolling)
3) get up to sitting (more advanced rolling)
4) stand Up (squat)
5) walk
6) bend over (deadlift)
7) pick something up (deadlift)
8) reach up (press)
9) grab an object (press)
10) pull open a door (pull)
11) sit down (squat)
12) get down to the floor (lunge)
13) move on the floor (crawl)
14) push your self up from the floor (press, lunge)
15) push something (press)
16) pull something (pull)

If I take a look at #1: lay down in any position, this requires a couple of basic fundamental physical abilities.  First is a balance in the relative flexibility (Sahrmann) of leg muscles to trunk muscles.  Tighter hip flexors than abs will make lying supine or prone very uncomfortable.  Similarly, you need full hip extension, full knee extension and neutral spine posture.  If you want to lie prone, you better have full cervical mobility.  If you want to lie with your arms overhead, you better not have any upper thoracic mobility restrictions or thoracic outlet issues.  If not you’ll need to modify this activity.  This doesn’t sound very challenging, it’s just lying down, but I have seen many people who need to modify this activity with pillows, bending their knees, not lying in one of the positions.  If you have an ability to lie in any position, this sets you up well for the next activities.

I’ll take a look at each of these activities in the next few weeks.

Keep Moving, Jason

Correcting Femoral Anterior Glide with Hip Extension

Femoral anterior glide is a common movement dysfunction in many hips.  It is similar to humeral anterior glide syndrome and occurs with extension past neutral or external rotation when the hip is in neutral in the sagittal plane.  It also occurs in flexion when rectus femoris and tensor fascia lata dominate as hip flexors vs. iliacus, pectineus, and whatever very small component of flexion comes from psoas (https://www.youtube.com/watch?v=cvnme9NFoGo).

Testing this during prone hip extension is fairly easy with Shirley Sahrmann’s method.  Simply palpate the greater trochanter as someone performs hip extension and you will feel if the trochanter moves anteriorly or posteriorly during the movement.  Anterior movement (toward the table) indicates uncontrolled femoral anterior glide in hip extension.  Another way to assess is to watch the movement and see if the patient is using their proximal thigh (distal to the hip joint) as a fulcrum.  If so, once again, they are demonstrating anterior femoral glide.  Hip extension should cause the entire femur to lift off the table if the femur is performing movement through the hip joint.

Other things to look for in this movement are initiation with the glutes and not dominated by the hamstrings and some increase in lumbar extensor activity, but not enough to cause an increase in lumbar extension motion.

Fixing this dysfunction should focus on abdominal stabilization to prevent lumbar extension and cuing to lift the entire femur from the table, not just the distal femur.  Cuing and isometric glute contraction prior to lifting can help reduce the anterior glide as well.  It’s not easy, but worth the effort in decreasing anterior hip pain during running, walking or other hip extension activities.

Cuing the glutes during other activities such as standing up out of a squat or deadlift and finishing a bridge or hip thrust can focus more on posterior pelvic tilt (to neutral) rather than hip extension.  This coordination of the glutes and abdominals will help a lot of people get out of that low lumbar extension hinge.  I believe I’ve heard Stu McGill mentioning to think of the glutes as hip external rotators as well vs. hip extensors to protect the hip joint.

“The goal is to be resilient to stress.”

“Can your body get in the right position to adapt to stress?”

“If you have the 2s and 3s and FNs you have the right hardware to put your progressions into place.”

-Charlie Weingroff

Seemingly Obvious Research

It’s good to see evidence backing up this idea that has been held for awhile.  Lower body aerobic exercise before lower body strength training is not ideal for strength.  But ok for upper body strength.

http://journals.lww.com/nsca-jscr/Abstract/2014/05000/Effects_of_a_Single_Bout_of_Lower_Body_Aerobic.8.aspx

Compliance with exercise program helps hip abductor strength.  Isn’t this obvious?

http://journals.lww.com/nsca-jscr/Abstract/2014/05000/Effects_of_Compliance_on_Trunk_and_Hip_Integrative.2.aspx

If you wait 30 min after warming up in a cold weather environment, you will have decreased performance.

http://journals.lww.com/nsca-jscr/Abstract/2014/05000/The_Effects_of_Elapsed_Time_After_Warm_Up_on.22.aspx

Unstable Surface Training

I recently did a little searching for some information on unstable surface training and found some interesting results.
-unstable surfaces increase muscle activity during planks and birddogs, but not as much during bridges, curl up, and side planks (side bridges)
-unstable surface doesn’t add to serratus, upper, low trap, biceps
-raising feet will increase serratus and upper trap EMG
-pecs don’t increase EMG w/ unstable surface
-triceps and rectus abdominis do increase EMG on ball
-external oblique increases with push up plus on ball
-rectus abdominis and external oblique increased on ball
-erector spinae and internal oblique no increase on ball