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Soooooo…..here are three exercises that are intended (among other things) to train sagittal control of the lumbo-pelvic junction.  You will notice that in order to accomplish these exercises that neutral spine maintenance would be impossible…which is the point.  We need to start ‘injury proofing‘ our clients/patients/athletes so that their bodies/tissues can deal with real life situations that frequently occur — in the case, teaching spinal control/stability during flexion/extension moments at the lumbosacral junction.

Before people shoot out comments that none of their patients/clients can do these exercises….I draw your attention to the word “ADVANCED“ in the title of the blog.  These exercises are obviously NOT the next step after ‘bird-dogs.’  However I will tell you that many of my clients and patients (of various ages – one who is currently 57 years of age) who would have thought them impossible were able to progress their way to them.  Isn’t this the point training?  To better peoples ability?  To have them move more efficiently?  To IMPROVE?  Also note that I NEVER refer to these exercises as ‘Rehab’ exercises…..Rehab DOES NOT EQUAL TRAINING and TRAINING DOES NOT EQUAL REHAB.  Rehab returns people to a previous state of ability….training advances them to a NEW state of ability (or at least it should IMO).  I believe that far too often manual therapists and trainers forget this point and are content to wait for injuries to occur in people…then proceed to get them back to where they were.  Once their, they only maintain there current status by never really stressing their systems in order to bring about progressive adaptations that will bring their clients/patients to the next level…but enough of my rant….

Exercise One:  

Pre-requisites:  1.  One minute supported handstand hold – 2.  Moderate core strength & coordination – 3.  Moderate balance levels – 4.  10 Handstand Push-ups

-  The key to this exercise is teaching the person to control the moment where gravity will force the lumbosacral junction into flexion

Exercise Two:

Pre-requisites:  1.  Approximately 15-20 supine ‘jack-knifes’ – 2.  5 hanging toes-2-bar – 3.  Moderate core strength & coordination

-  The legs must remain straight.  The body folds only at the L/S junction.

Exercise Three: Special thanks to my friend & colleague Mr. Ido Portal for introducing me to this exercise through his amazing youtube channel

Pre-requisites:  1.  Controlled Headstand – 2.  Moderate to Advanced core strength & coordination

-  The key to this exercise is teaching the person to control the moment where gravity will force the lumbosacral junction into flexion

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The truth of the matter is that during activities of daily living, and even more so during athletic activities, our spines are frequently demanded to come out of ‘proper alignment,’ ‘proper posture,’ and neutral spine position….it’s a fact.  Need some examples?

Thus the question is, “why do we continue to associate the concept of stability with the concept of rigidity?”  A joint can have a large range of motion, while simultaneously being ‘stable’ so long as the nervous system is able to control the entire range.  This is the big difference between “flexibility” = the ability to passively achieve a range of motion, and “MOBILITY” = flexibility + strength.  Joints/people can definitely be too flexible which can lead to loss of stability…but they can never be too MOBILE – this is a concept central to FUNCTIONAL RANGE CONDITIONING (FRC)™  – stay tuned for future posts expanding on this concept.

TAKE HOME POINTS:

1.  Being stable does not mean being stiff or rigid

2.  Our bodies are consistently forced out of “proper alignment”….then why do we only train in neutral spine postures.

3.  The current concept of CORE training strengthens the spine in the one position that we need it the least….neutral spine.

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Also discussed is how to use Progressive Angular Isometric Loading (P.A.I.L.’s) to correct ‘winking’ (counter-nutation of the sacrum) in the ‘basement’ of the squat.  While most think this problem can be corrected by simply improving hamstring flexibility, it actually requires more….

Take home points:

1.  When prescribing squats for your patients/clients, the maximum possible depth should be encouraged (of course this means the maximum depth that can be achieved with proper form…for example without squinting).  To progress to lower depths, use progressively lower ‘targets’ to sit back onto.

2.  In order to prevent squinting at the bottom of the squat (the basement), it is not only a matter of creating improved flexibility in the hamstrings…but creating eccentric strength in the hamstrings outer range of motion…thus the utilization of Progressive Angular Isometric Loading.

3.  Utilizing P.A.I.L’s training in the ‘sticking-points’ of a squat, or any other exercise will allow the athlete to overcome the troublesome range.  P.A.I.L’s teach the nervous system to maximally recruit motor units in a given range.  Recall Hennman’s size principal – increased numbers and sizes of motor units will be recruited based on demand – by using isometric efforts, you have essentially created maximal demand as the object is by definition never going to move.

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]]> http://functionalanatomyblog.com/2012/04/26/new-seminar-date-posted-functional-anatomic-palpation-systems-f-a-p-lower-limb-in-ottawa-on-canada/feed/ 0 andreospina postcard-back.jpg http://functionalanatomyblog.com/2012/04/24/changing-posture-and-skeletal-alignment-its-not-as-easy-as-you-think/ http://functionalanatomyblog.com/2012/04/24/changing-posture-and-skeletal-alignment-its-not-as-easy-as-you-think/#comments Tue, 24 Apr 2012 19:01:19 +0000 Dr. Andreo Spina http://functionalanatomyblog.com/?p=2350 ]]> Can we change our posture?  Can we improve ‘skeletal alignment’?  To answer the first question…yes, but it takes a lot longer, and a lot more work than you (and many other’s think).  Regarding the second…I really dislike the term ‘skeletal alignment.’  Your skeleton is aligned in the precise position(s) governed by genetic predisposition and millions of years of natural selection.  When things come “out of alignment”….proceed to the nearest hospital as you have likely dislocated a joint!  Lets just drop that phrase here.

In the video below, Dr. Spina discusses concepts regarding postural rehabilitation and training.  Most important to note is the fact that exercise alone will NOT cause permanent changes to a persons posture.  The idea that stretching “lengthens” muscles, and strengthening “shortens” muscles is an archaic concept best left in the 1960′s.  Current literature clearly demonstrates that muscle length remains highly unaltered unless said alterations are governed by nervous system input.  This is otherwise known as neural drive.

Take home points:

1.  Posture is not determined by the mechanical state of the tissues…but rather by the dynamic control of said tissues.

2.  Good posture is a ‘learned’ phenomenon.  Conscious effort must be translated into unconscious patterns.

3.  Stretching and strengthening while important, only constituted a small portion of what is necessary to improve posture.

4.  Most important concept = POSTURAL CUEING - frequent cueing, increasing the number of times a particular neural signal is sent down a line of synapses will hone that particular signal such that it is automatically generated (think neural plasticity).

5.  Postural breaks are necessary and unavoidable.  It provides rest to posture governing tissues.

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In this short clip, Dr. Spina discusses the contribution of this sling to a proper golf swing via its ability to either allow proper internal rotation of the hips, or restrict it.  If internal hip rotation is hindered during the swing, either by fibrosis of this sling or by capsular restriction, the body will automatically hyperextend at the lumbosacral junction in order to complete the swing…this will lead to abnormal facet impaction and eventual low back pain.

WHAT CAN I DO WITH THIS INFORMATION:

1.  ALWAYS, ALWAYS evaluate internal rotation of BOTH hips in your golfers…..whether they are injured or not!!  If I could only give one piece of advice to a golfer in terms of injury prevention it would be to improve hip mobility…especially in internal rotation.  Provide them with stretches targeting the structures that may block this motion.  For F.R. certified practitioners, go a step further and assign P.A.I.L’s strategies to not only improve the passive ROM, but also to improve their mobility.

2.  Remember this rule of thumb – IF YOUR PATIENT HAS BACK PAIN, CHECK THE HIPS…IF THEY HAVE HIP PAIN, CHECK THE BACK – lack of mobility in one is sure to lead to injury in the other down the line.

3.  In addition to palpating for fascial restriction in this sling, also assess other factors/structures that can hinder hip rotation – ex.  Capsular fibrosis, gluteus minims fibrosis.

4.  Existence of this sling allows the body to connect the arms (lat insertion onto the humerus), to the pelvis – this therefore affords the opportunity to brace the entire  spine, the shoulders, and pelvis simultaneously.  Keep this in mind when you are training clients in terms of injury prevention.

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