Hip Pain

Hip Pain

Hip pain is a common diagnosis for many people.  But what is the source of the pain?  Click HERE for some possible causes.

"If You Keep Picking At It, It Will Never Heal"

"If You Keep Picking At It, It Will Never Heal"

Recovering from a lower back injury is similar to any other injury.  If you fall and cut your knee, the healing process will be postponed if you constantly pick at the scab.  When you are rehabilitating from lower back pain, the more frequently you irritate the injury, the longer it will take to heal.  This means that you must protect your spine during everyday routine activities.  

Stu McGill describes your lower back as a savings account, advising you not to "spend" it frivolously.  If you continue to unnecessarily involve/mobilize the spine in activities that do not require its involvement/mobility, then when you do "need" the spine, it will not be there for you at 100%.  

One example of this is...click here for full article

When Verbal Cues Are Not Enough, Continued...

              When Verbal Cues Are Not Enough....Continued

In the previous post, we discussed how providing verbal cues some times does not get our clients or patients to perform therapeutic activities using proper technique.  Therefore, we must use other, more physical cues in order to reach our goals.  Another common every day functional movement that we perform is the Lunge.  Upon initially asking a client to perform a lunge, we may see this....


                      

In the second and third images, you can see a forward head posture and rounded upper back (protracted scapula), as well as a slightly rounded lower back.  I can choose to verbally overwhelm the client as she moves from static stance into her lunge position by asking her...(read more)

When Verbal Cues Are Not Enough

When Verbal Cues Are Not Enough

Many times, when educating patients/clients on performing specific exercises correctly, our verbal cues just don't seem to do the trick.  We verbalize how we want the exercise to be performed, yet sometimes our patient/client just can't get it.  Session after session, we find ourselves making the same corrections.  This can be problematic, especially if we expect our clients to be performing the same exercises at home, when we are not present to assist them. Simple techniques can be used to prevent recurring technique errors.  

One example of an exercise that is repeatedly performed incorrectly is Resisted Shoulder External Rotation.  To be performed correctly, simple commands that are used are "Keep your bent elbow tucked into your rib-cage.  Then turn your arm outward by rotating at the shoulder joint so that your hand moves away from the midline of your body." Performed correctly, Shoulder External Rotation in the neutral position should look like image 1 and 2. 

Image 1

Image 2

Unfortunately, most clients/patients perform the exercise as shown in Image 3 and 4

Image 3

Image 4

In Image 4, you can see that instead of keeping the elbow and upper arm tucked closely into the rib-cage, the arm raises in a diagonal direction.  There are times when you may want a client to perform this diagonal or PNF pattern with resistance, and there are times when you may want your client to perform Resisted Shoulder External Rotation in the shoulder abducted position.  However, if you want the exercise to be performed in the neutral shoulder abduction position (upper arm tucked into the rib cage), then you must correct any errors to the technique.  If verbal or manual cues only correct the exercise temporarily, try the following...

Image 5

Image 6

Roll up a towel and place it between the elbow and rib-cage of the 'working' arm.  Tell your client that they must perform Shoulder External Rotation without dropping the towel.  This external cue works like a charm.  And if the client performs this exercise as part of their home exercise program, you can rest assured that they will perform it correctly once you educate them to use a towel roll.

For more Shoulder Rehabilitation Exercises, click here

Another exercise that is commonly performed incorrectly is the    2-Leg Bridge.  Performed correctly, the Bridge exercise focuses on hip extensors, and is beneficial in improving gait, transferring out of a chair, scooting in bed and rehabilitating patients suffering from lower back pain.   Image 1 and 2 show correct form.

Image 1

Image 2

 At times, it may be difficult for your client to maintain proper lower extremity positioning during this exercise, particularly if they are recovering from a stroke, in which one side of their body is weaker than the other.  Image 3 shows an example of a patient I worked with in the past who could not keep her right leg in the proper position throughout the Bridge.  Her right knee kept falling out to the side due to weak hip muscles.

Image 3

No matter how many times I cued her to keep her knees close together, she would only correct it temporarily.  Eventually the right knee would drop to the side again.  I used a pillow to correct this problem and I never had to cue her again.  She was also able to perform the Bridge as part of her Home Exercise Program without making the same mistake.  All she had to do was remember to place a pillow between her knees, and no further cues were needed.  In Image 4 and 5, you can see that the patient's focus is not only lifting her hips off the bed, but to do it while squeezing the pillow.

Image 4

Image 5

FYI: With patients who are unable to  maintain the initial Bridge position with their knees bent and feet flat on the bed/floor due to extreme weakness or lack of flexibility, you can still train the hip extensors by performing a Straight Leg Bridge.   

Place 2 or 3 pillows under your client's lower legs.  Ask them to clench their butt and raise their hips off the bed by pressing their lower legs into the pillows.  Avoid hyperextension of the lower back in the top position.  See Image 6 and 7

Image 6

Image 7

For more Hip Rehabilitation Exercises, click here

Make Sure To Do This When You Plank

Don't Just Hold The Plank...Crush IT!!

When training in your gym, you most likely have walked by another member holding the Low Plank for anywhere from 30 seconds to even minutes in some cases.  Initially, this is a challenging exercise.  However, with practice, you "learn" how to hold the position for extended times.  The plank is a great exercise for shoulder, scapula and trunk stability.  I have found that upon simply "holding" the plank position, with protracted scapulae and a flat (not arched) lower back, I can withstand it for a long duration before fatigue sets in.  When I incorporate other muscles, however, my tolerance goes way down.  In my opinion, if I can hold the Plank for 60 seconds, it's time to make it harder.  Kind of like being able to do 60 straight reps of biceps curls.  If you can do that, then it's time to raise the weight (depending on what your goal is, that is).      

Next time you try the plank, take these steps before you focus on hold time.  
Step 1: Get into Plank position.  
Step 2: Protract your shoulders/scapulae, tighten your thighs and clench your butt
Step 3: While maintaining a strict Plank position, try to extend your shoulders so that your elbows move toward your feet.  Because your forearms are on the floor, they will not actually be able to slide toward your feet.  But this isometric contraction will engage your trunk muscles.  A visual of what you are trying to do can be seen below....

Use the same technique for the High Plank and Side Plank

High Plank with shoulders flexed 90deg

 A visual of what you are trying to do can be seen below....

Clench your butt and tighten your thighs

With your palms on the floor, attempt to extend your shoulders so that your hands move toward your feet.  Again, because your palms are on the floor, no actual movement of your arms will occur.  You will remain in the High Plank position with shoulders flexed 90 degrees and elbows fully extended.  However, your trunk muscles will engage upon the isometric shoulder extension.  Make sure that you do not arch your lower back.  No movement should occur anywhere.  Just an isometric contraction of your shoulders, trunk, glutes and thighs

Side Plank

 A visual of what you are trying to do can be seen below....

In the Side Plank position, tighten your thighs and clench your butt

Attempt to slide the arm that your are propped on down toward your feet.  And again, the arm does not move as it is fixed to the floor due to your body weight.  Do not allow any motion anywhere.  You will feel your trunk engage laterally. 

With these minor adjustments, can you still hold the planks for 60, 70, or 80 seconds?  Let us know how you did!

Another Lunge Modification

Another Lunge Modification

When performing the Body Weight Lunge, you must maintain a vertical spine.  Do not allow your back to flex forward toward the lead leg or laterally to either side.  

The trailing knee moves directly toward the ground, without allowing the knee cap to touch the ground.  This will prevent patella-femoral compression.  The lead knee remains in line with the center of the lead foot, not allowing the arch of the foot to drop (avoid being flat-footed).  Basically, avoid any "down and in" motion of the lead knee.  To return to upright, push through the front heel (not the toes!), until you are upright with both knees extended and gluteals contracted (clench your butt).

A common modification of the lunge is an Elevated Lunge, where the trailing foot is elevated either on a plyo-box, chair or suspension trainer.  This forces the lead leg to work harder, provides a more aggressive stretch to the trailing thigh, and more aggressively challenges ankle stability of the front foot.  You must maintain the same technique as mentioned above in regards to posture and leg position.

In yet another modification, instead of elevating the trailing leg on a chair, box or suspension trainer, place your trailing foot flat against the wall behind you with approximately 90 degrees of knee flexion.  

Notice the trailing leg has approximately 90-degrees knee flexion and is flat on the wall.  You must push into the wall through the heel, not the toes and your lead knee should not cross in front of the toes

As you move into a vertical lunge, maintain the same form as with the Standard Lunge.  Do not allow your trunk to shift forward or laterally, and do not allow the lead knee to move "down and in."  At the same time, maintain a "push" of the trailing foot into the wall through the heel.  Try to keep the amount of push into the wall constant throughout both phases of the repetition (concentric/eccentric). This creates an isometric hip extension contraction of the rear leg throughout the entire repetition, while the front leg works to lower and raise your body.  As a result, you are working the gluteals on both sides more aggressively than in the previous two lunge techniques.   Try it out and let me know what you think.  Start with just body weight.  Then try it with a kettlebell racked on either side.

Train Smarter!

Train Smarter!

When trying to balance your training with work and family obligations, you may find yourself short on time.  But you figure, "something is better than nothing." So you need to train smart.  Knowing what you are training will help you to train efficiently.  So you should choose exercises wisely.  One example is the kettlebell lunge.

The 1 Arm Racked Kettlebell Lunge:

This exercise is obviously a leg exercise.  But that is not all!  You must hold the kettlebell in the racked position using one arm.  This places an asymmetric downward force on the kettlebell side of your trunk/body.  To prevent laterally "giving in" to the added weight, the opposite side of your trunk must contract to stabilize in order to maintain a neutral spine.  You must maintain grip on the kettlebell handle and not allow the shoulder blade on the side of the kettlebell to drop or protract due to the added weight either.  In all, you are training the legs, the trunk, grip and scapula stability.

Double Kettlebell Lunge:

Although you are lunging with added weight compared to the single kettlebell lunge, you do not have the asymmetric weight applied to the trunk.  So lateral stability will not be as much of an issue.  However, you must still maintain grip of each handle, prevent both scapula from protracting, and the added weight to your chest/trunk will actually make it slightly more difficult to deeply inhale during the set

To increase the challenge further, perform the Bottoms Up Kettlebell Lunge.  Here, you are working even harder to maintain control of the kettlebell handle using hand, wrist and forearm strength.  This also challenges scapula and shoulder stability on the kettlebell side, and the asymmetric weight will again require lateral trunk stability.  

So, if you want to get more bang for your buck, making slight adjustments to a traditional exercise will train more than you initially thought.  You end up training multiple regions of the body using one technique.  This is efficient training!