Showing posts with label mobility. Show all posts
Showing posts with label mobility. Show all posts

Monday, April 10, 2017

Assessing and Improving the Hollow Body Position w/ Dr. CJ DePalma PT, DPT

Intro & Simplified Kendall Leg Lowering Test:


#MondayMusings:
From @the_movement_dr:


This week I teamed up with Doctor of Physical Therapy candidate, CrossFit coach, #CWCC & @clinicalathlete student forum member, @physio.praxis to use the reliable and valid #KendallLegLoweringTest as an objective measure to determine where your athlete or patient is on the #HollowBody spectrum.


Scoring is as follows:
3 - From 90 to 45 degrees: These athletes will compensate through the hip flexors, extending the lumbar spine when asked to hold a hollow just off of the ground. They will build upon dysfunction in an effort to get into appropriate position.
2 - From 45 to 15 degrees: These athletes maintain control throughout most of the movement, but begin to lose that control at the end range of movement - say on a heavy-ish shoulder to overhead or after a few toes to bar.
1 - From 15 to 0 degrees (or to the ground): These athletes exhibit good strength, endurance, and control of the anterior core and are well prepared for loading and dynamic movements.

Here @dani.f.baby would be on the border of 2 & 1. 


Over the next few weeks we will be providing exercise progressions and suggestions to build upon where the athlete currently stands. Keep in mind, core strength and endurance can be subjective—but this system aims to provide a starting point for you, your athlete, and/or your patient. Tune in next Monday for the first progression, or for the full series, follow the link in @praxis.physio's bio! 

Cite:
Staniszewski B, Mozes J, Tippet S. The relationship between modified sphygmomanometer values and biomechanical assessment of pelvic tilt and hip angle during Kendall’s Leg Lowering Test of abdominal muscle strength. Proceedings of the Illinois Chapter of APTA, Fall, 2001.



Level 3 First Progression: Single-Leg Active Leg-Lower:



#MondayMusings:
This test is a good starting point for those athletes who have difficulty getting into the hollow position. By taking a limb out of the equation, we reduce the force demand of the core and the difficulty of the task.

Many athletes make a common fault when “contracting” the deep core, or transverse abdominus (#TrA), where a hyperactive or excessive contraction is produced. This in turn engages the lumbar parapsinals -- creating over extension of the lumbar spine.

Points of Performance:
-Exhale the entire downward motion of the exercise while keeping the lumbar in contact with the ground.
-Once 15 degrees is reached, the athlete will isometrically hold—inhale and exhale—then bring the leg back up to 90 degrees.
-Avoid External Rotation of the leg, focus on keeping the leg linear throughout the full movement.
-Repeat 8-10x


Progressing from Level 3 to 2: Dead Bug Upper Extremity Isometric Variant


#MondayMusings:
The #DeadBug against the wall is a good starting point for those with a score of 2, or as a warm up/ramp up for athletes who score a 1 prior to lifting or gymnastic movements. This variation employs the use of upper extremity isometric firing to light up the central nervous system (#itsLIT), which in turn increases neural firing to the deep core musculature.

Points of Performance:
-Forceful exhale prior to initiating the movement followed by a quick inhale to breathe into the created tension while pressing into the wall or weight.
-Raise the tailbone slightly off of the ground and lower one leg slowly. Make sure that the pelvic positioning is maintained during this eccentric motion
-Repeat for 5-6 breaths per side.


Tune in Monday for the next progression with @the_movement_dr, or head over to #MusingsOfMills -- link in bio. 


Level 2-ish: Plank to Pike on Rower:



#MondayMusings:
Our 3rd installment for the #KendallLegLoweringTest is the Plank to Pike on Rower. This exercise is for those who scored a high-level 2, moving closer to a 1 during the test.

The starting position of this movement is opposite to the starting test position and the previous two exercises. We begin in a bottom up fashion: starting in a plank then working towards a Pike. By doing so, we are able to increase our initial lower core engagement in a concentric fashion.

We need variance to create change, and this movement fulfills just that.

Points of Performance:
- ROM may become an issue, just pike as high as you can and the exercise will still maintain the benefits.
- Exhale as you pike up
- Hold for 1 to 2 seconds at the tope
-Slowly lower the body back down
-Repeat 4-5x 


Levels 2 to 1: Bar-Supported Leg Raise:


#MondayMusings:
In our second to last exercise, again for those on the border of 2 & 1, we use a barbell (or heavy resistance band) to externally cue the athlete (@dani.f.baby) to maintain a #hollowbody position while perform an active leg raise.

Points of Performance:
-Begin by exhaling and elongating your spine, while gently hollowing the low back into the bar or band
-Brace the core, squeezing the feet and quads together synchronously.
-Initiate the movement with your lower abdomen (focusing on engaging the internal obliques and TrA) similar to how you did with the #pike.
-Only lift so high as you can maintain the position without compensation, i.e. beginning position.
-Repeat for 5-6 reps/breaths or until fatigue


This can be paired with a #hollowarch to begin working on the movement specificity needed to perform all #kipping movements, especially if you turn into a #FloppyBaby as soon as you attempt full speed. Tune in next for the final exercise - or visit #MusingsOfMills -- link in bio .  

Level 1: Strict Hollow Body to Arch


#MondayMusings:
For the athletes who have made their way through the progressions or for those who scored a 1.

The Hollow Body to Arch Strict Transitions are the ideal precursor to any kipping Bar or Ring movements.

Focused and controlled transitions will help engage the #Lats and #Trunk in the free-hanging #HollowBody position, as well as improve our bodies kinesthetic awareness as we engage in movement towards an arched position.

Points of Performance:
-Do not swing. Stay as still as possible. Synchronous, co-contraction.
-Keep your body elongated and your feet touching.
-Each transition from Hollow to Arch should take roughly 3-5 seconds
-Repeat 8-10x
     

Sunday, January 22, 2017

A Case Study w/ [sl]Amber

Intro: A Case Study w/ [sl]Amber:

A few hours prior my friend @amberm88 was a Cranky-McCranky-Pants, mopping around the gym with a whole lotta low back pain. She had been unable to pick up a barbell without pain for the past two weeks. Want to see what went into these clips coming to be? Then PAY ATTENTION.

Amber was training hard for a competition. Amber moves a lot of weight frequently. Amber is a proficient and fluid mover. Amber is athletic and knows how to compensate really really well, almost to the point that you probs wouldn’t even notice that something is wrong. WRONG: Amber has a really stiff thoracic spine, or, upper back.

The training that goes into being an elite CrossFit athlete involves weightlifting and gymnastics. These two modalities of movement exist mostly in the sagittal (forward and backwards) plane, this is what one could refer to as a training bias. Considering her impressive athletic history, Amber used to ball on sucka’s in softball and basketball, both of which include frequent thoracic rotation. Now, not so much.

With the foundational idea of treating the athlete as a whole, I made a student-hypothesis: Make one segment move better to offload the other segment. This is what happened.

**Disclaimer**: I am a student, and this is not medical advice. If you are seeking medical advice refer yourself to a local physical therapist.



Testing, Testing; 1, 2, Rotate:

You can think of most joints that don’t move well as a stuck drawer. How do you open a drawer whenever it is stuck? There is a scientific approach to mobilizing joints, but for the sake of simplicity and wit, do you rip that beast straight out? NAH. You wiggle that thing. You wiggle it and then see what happens. More often than not that wiggle will grease the tracks and the drawer will slide right out.

Apply that to your thoracic spine. Amber had limited wiggle once you limited movement in her hips and lumbar spine (low back) on the bench. In my personal experience working extension on a foam roller is waste of time, because you can so easily compensate in other areas.

Not to mention a lack of thoracic rotation can negatively impact the relationship between our shoulder blades ribcage. And who wants their shoulder being codependent and whinny all the time? I certainly don’t. This being said, a hypomobile (doesn’t wanna move) upper back may have negative effects up and down the spine. In Amber’s case, the issue surfaced in her low back.



AAROM, Take a Breathe, Re-Test:

I once read that if you can’t breathe in a position, you don’t own that position. The statement holds true here. I apply gentle pressure opposite the direction that I want Amber to go, I use Active-Assisted Range of Motion (AAROM) to guide her in the range that is there, but dormant. I give her some assistance to hangout in her end range, and to take a few breathes (sped up here).

The same thing can be done by pressing up against a wall, or using a band to pull you in the opposite direction. Just make sure you are moving with your upper back, not your lower. Chances are you have the range of motion, but you don’t know what to do with it because it’s 2017 and everybody has a tight thoracic spine.

SPINE TIP (no, not the coccyx): if one segment is tight, another segment will reflexively “loosen.”



But do you Extend?

Ask a CrossFitter if they’ll get prone on the ground and extend. They’ll get down there, crush it, and look at you and say, “I can do this all day, I can do unbroken “Michael,” [a hero WOD: 3 rounds of 800m run, 50 back extensions on a GHR, 50 situps], duh.” But then you limit the degrees of freedom, and BOOM, #gnarwhale.

Exercisers are fantastic at global extension, but it’s really hard to extend your spine segmentally. I saw @unchainedphysio use this exercise to prevent mashed-potatoes’ing on front squats, but it’s also a great assessment.

Slow your roll, block the hips, and gain some control of how your back extends. I’d say if you can do 3x30 of these your upper back moves just fine.



Your Ribs Aren’t Moving and Your Diaphragm Hates You

The average human takes 12 breathes a minute. There are 60 minutes in an hour, 24 hours in a day…and so on and so on, you do the math. I don’t want to, that’s why I’m in physical therapy school. Did you forget that your ribs attach to your thoracic spine? Its in the name ya’ll.

Here’s a way to get the intercostals (muscles between the ribs) working double time to expand your rib cage. If you sit on one side of a seesaw, does the other side move? Yes, yes it does. This is virtually what is happening here, creating much needed movement around a bound down fulcrum.

Focusing on your breathing, and if you start to cough on your exhales that OK – it just means your diaphragm is moving for the first time in awhile. If you don’t have a wallball, just stack some sturdy pillows under your ribcage and give it a go. And if you fall off like Amber, at least you’re already right next to the ground.



Crawl Before You Walk

As infants, we spend most of our time on our back. Our baby-brains instinctually desire movement and exploration, so we rolled onto our side and then on to our stomachs (in prone). You hated it, and you cried – because your little baby neck was entirely too underdeveloped to hold up your disproportionate noggin.

You began to spend to more time here, then you pressed up onto your elbows, then you began to move around. Eventually beginning to pull yourself up on furniture, getting onto your knees, eventually making your way into standing. These concepts apply to learning exercises. It's easier to learn stuff on the ground, especially if you are like me and tend to be a floppy baby. Try 3x12-15 per side of these exercises to build up rotational endurance.


Stop extending solely from your low back and just hanging out on your passive structures. Please: Use your muscles. Progress yourself with these exercises. If King Soloman were a PT he would probs say something like, “Guard your low back above all else, for from it flows the innervation for everything downstream.” PTverbs 4:23