Using a S.O.D. Stretch Strap to Assist With Post-Surgical Transfers

Using a S.O.D. Stretch Strap to Assist With Post-Surgical Transfers

 

Very often patients who I evaluate after their hip or knee surgery have a great deal of difficulty lifting their surgical leg into bed in order to lie down. Many of these patients also have weak upper bodies with diminished trunk flexibility and are therefore unable to use their arms to lift their weaker leg into bed.  The Stretch Strap helps them to transfer from sitting to lying down efficiently and safely.



 

 

 



The above 3 pictures shows a typical transfer from sitting to lying down when no strength deficits are present

 

 

 

 

In the above second group of pictures, I use the Stretch Strap to assist lifting the weaker leg into bed.  There is minimal strain to my arms or trunk.  This is especially helpful when there are post-surgical precautions such as those following a total hip replacement which limit how far you can flex forward at your hips

 

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Rotational Stability of The Trunk

Rotational Stability of The Trunk

The Renegade Row

 

The previous blog posts discuss exercises that are beneficial for developing rotational stability of the trunk using body weight.  These should be performed correctly prior to performing stability exercises using weight/resistance. 

 

Assuming you are able to maintain stability with the prior exercises, you may attempt Renegade Rows, using Kettlebells or Dumbbells.

 

Start Position Renegade Rows - Notice the flat lower back

Here, I shift my body weight onto my right arm in order to row the kettlebell using my left arm.  My hips and shoulders remain "squared-off" with the ground - Next I lower the left arm, shift my body weight to my left arm and row using the right arm

Incorrect Form: My hips and shoulders are not "squared-off" with the ground

Incorrect From: My lower back is not flat, but jacknifes prior to the row

The above two incorrect techniques are very commonly seen with clients who do not have the rotational stability to perform this exercise.  They may have trunk weakness or may just need additional verbal and manual cues in order to improve the motor planning/coordination of the activity. 



Rotational Stability of The Trunk

Rotational Stability of The Trunk

 

The Super Plank is a great trunk stabilization technique.  It actually requires you to maintain a stable trunk while transitioning from a static position, 'dynamically' to another static position.  At the point of incorporating this activity into your program, you should have no problem maintaining static trunk positions.  The challenge here is dynamic stabilization.  You are moving from the Low Plank position to the High Plank position with minimal trunk rotation.   

 

Start Position: Low Plank

 I transfer my body weight onto my right arm in order to change the position of my left arm to the high plank position.  With this, a rotational load is placed on my trunk

Incorrect: This would need a correction, as you can see my left hip is no longer "squared-off" with the ground.  I gave in to the rotational force

Correct High Plank Position

Incorrect High Plank Position: I am in a jacknifed position rather than a high plank position

Transition from High Plank to Low Plank: Here, I transfer my bodyweight onto my right arm in order to reposition my left arm into a low plank position without losing the "squared-off" hip position with the ground

Incorrect transition of High Plank to Low Plank.  My right hip is higher than my left hip.  Both hips should be level and parallel to the ground

If you see your client performing the Super Plank technique with any of the "incorrect" behaviors mentioned above, attempt to correct them verbally or manually.  If they can not correct it, then this may be too advanced at this time.  Check out the previous posts for less aggressive stability techniques to master prior to returning to the Super Plank



Rotational Stability of The Trunk

Rotational Stability of The Trunk

 

In the last post, I talked about maintaining stability of the trunk while performing the High Plank Shoulder/Elbow Tap, with various foot positions.  In this post, I will disucss maintaining trunk rotational stability while performing the High Plank Hip Extension technique, with modified hand positioning.

 

 

Start position - Notice the hand and foot position - The hips are "squared-off" with the ground

Slowly lift one leg while maintaining the hip "squared-off" position - If you place a  broomstick across the lower back horizontally from one hip to the other, the stick should be parallel to the ground - One side of the stick should not be higher than the other (This is a good feedback technique)

 

Progress the exercise by adjusting the base of support - Decreasing the base (hand position)increases the difficulty

Completion of the level two exercise

Incorrect Performance - It is subtle, but if you look at my right hip, it is slightly higher than my left - I lost the "squared-off" positioning of my hips - This would be more noticeable using the broomstick to assess - I lost the rotational stability slightly - Look for this compensation with clients when training rotational stability



Another common compensation for inability to stabilize the trunk is the jacknifed position seen here prior to hip extension.  This is no longer the High Plank Position

 



Rotational Stability of the Trunk

Rotational Stability of the Trunk

 

When training your trunk (or core) for stability, resisting rotational forces is one complex and important aspect.  Many of the single arm activities that we do, such as the one arm kettlebell deadlift, apply a weight to one side of our body.  This asymmetrical load applies a force on our trunk, which causes it to rotate to one side (our body gives in to the weight).  To stabilize our trunk, we must fight this rotation, and remain "squared off." 

In this picture, the kettlebell in the right hand creates a trunk rotation to the left.  He must stabilize in order to keep his hips and shoulders squared off with a target in front of him

 

There are many beneficial trunk stabilization exercises.  Some are basic, while others are more complex.  Unfortunately, I have seen people in the gym performing most of them with poor technique.  Many people are in a hurry to progress themselves to the more complicated techniques before they really should.  This post will discuss some of the more popular basic trunk stability exercises, proper technique and common errors that I see each day.  It is your job as a trainer to assess your client's abilities in order to progress them properly and avoid injury. 

 

First is the Low Plank and the High Plank.  These are not focused on rotational stability but are more introductory.

Low Plank: Correct - Goal is high reps, holding each one for 5-7sec

High Plank: Correct

 

Low Plank - Incorrect:  This is not acceptable, as you can notice the hyperextension in my lower back and the protruding scapulae.  I am not maintaining stability

  Once you perfect the low and high plank, you may progress to the rotational stability exercise called the High Plank Elbow or Shoulder Tap. 

Wide Base Elbow Tap Start Position

Wide Base Elbow Tap Finish Position: Notice my hips remain "squared off" with the ground

Incorrect Wide Base Elbow Tap: I lost my rotational stability and begin turning my trunk

Progress the above rotational stabilization exercise by modifying the base of support:

Narrow Base Elbow Tap: Start Position and more aggressive due to modified base of support

 

Correct Narrow Base Elbow Tap



Incorrect Narrow Base Elbow Tap: Again notice my rising left hip - If your client is compensating like this even following your verbal and manual corrective cues, they are not ready for this yet

These are just a few of the progressions you can perform when training trunk stability.  Stay tuned for the next post which will discuss other beneficial techniques

 

 

Teaching New Techniques

Teaching New Techniques

 

When working with a client, as they progress from the basics to more complex activities, a close eye on their technique and motor skills is extremely important in order to maximize their "gains" while avoiding injury.  There are three stages of motor skill development.  The first stage, called the Cognitive Stage, provides constant external coaching by you, the instructor.  You introduce the new technique and then provide the visual, verbal and manual cues to your client in order for them to perform the activity properly.  You may have to place your hands on your client to correclty move them or cue them on stability at this time.  Body Awareness and proprioception are touched on here, but they are not the main focus yet. 

The second stage is the Motor Stage.  During this phase, your client is performing the technique efficiently and consistently.  They know when they make a mistake and can adjust appropriately.  Body Awareness for the skill and proprioceptive feedback become the prevalent form of feedback.  This is when I begin to reduce the use of mirrors and visual/manual feedback.  I stand back and only assist to prevent injury.  This is the "practicing stage."  To move onto the next stage, your client must practice the activity frequently. 

The third stage is the Automatic Stage.  Here, your client is able to perform the activity properly, efficiently and with minimal assistance by you.  Know which stage your client is in, because giving too much feedback can be just as bad as too little feedback.



Fitness Center Machines

Fitness Center Machines

 

 

People of all ages purchase memberships to their local gyms in order to gain strength and improve function.  However, is the fitness center training equipment optimal to gain strength and function?  While functional movement requires stability, balance and control at multiple joints simultaneously, most of the gym machines restrict motion to one joint and provide an external, "artificial" stability throughout the movement.  

The Smith Machine stabilizes the body so that you do not have to control the descent/ascent in any other direction but up and down.  Forward and Backward sway is limited and controlled by the machine.  This minimizes proprioceptive integration when training

 

The Smith Machine for Bench Press helps develop the chest.  However the shoulder stabilizers are not working optimally during this movement because the stability is provided by the machine. So you gain pectoral strength without foundational stability

Same as the Bench Press, the machine takes over for the shoulder and scapula stabilizers as you are only moving the weight up and down.  You are not responsible for lateral or anterior/posterior control of the weight

The Leg Extension Machine helps develop the Quadriceps Muscles.  However there is little  carryover into functional tasks such as getting up from a chair.  And if you do not line your knee joint up with the machine's axis of rotation, you are just asking for a knee injury.

 

 To improve function and athleticism, your goal is to mimic the required activity as closely as possible.  Avoid single joint movements in which the stability is provided by an external machine.  You want to maximize proprioception and body awareness by controlling your own balance, movement and stability at multiple joints.