Functional Stability Training

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FST$|$Functional$Stability$Training! !

Core! ! !

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Michael!M.!Reinold,!PT,!DPT,!SCS,!ATC,!CSCS! Eric!Cressey,!MA,!CSCS! !!!!!!

FST!|!Functional!Stability!Training!|!FunctionalStability.com!

Copyright © 2012 by Mike Reinold and Eric Cressey. This video and manual is copyrighted by Mike Reinold and Eric Cressey. All Rights Reserved. Images, text, graphics, and other intellectual property are protected by United States and International Copyright Laws, and may not be copied, reprinted, published, reengineered, translated, hosted, reproduced, or otherwise distributed by any means without explicit permission. You may not copy, modify, create derivative works of, publicly display or perform, republish, store, transmit, or distribute any of the material in this video without the prior written consent of the Advanced Continuing Education Institute. Disclaimer This video, manual, and the following guidelines have been provided as general information for exercise and rehabilitation and are intended for educational purposes. Any individual beginning exercises contained this video or manual, or beginning any other exercise program, should first consult with a qualified health professional. Discontinue any exercise that causes discomfort and/or dysfunction and consult with a qualified medical professional. Please consult with a physician prior to implementing any rehabilitation or exercise protocol. This video and manual does not contain medical advice. The instructions and advice presented are in no way a substitute for professional testing, instruction, or training. The creator, producer, and distributor of this video, manual, and program disclaim any liabilities or loss, personal or otherwise, in connection with the exercises and advice herein.!

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FST$|$Functional$Stability$Training! In order to function properly our joints need to be mobile, but control and stabilization of this mobility is often less than optimal. Unfortunately, stabilization is often overlooked in the design of rehabilitation and performance programs. Traditional program design relies too much on stretching what is tight and strengthening what is weak. We are missing the boat on stabilization. Functional Stability Training is designed to optimize movement It begins with the simple understanding of how the human body works most efficiently and integrates those concepts into rehabilitation and performance training. It is based on functional anatomy and biomechanics, not simplistic anatomy. It is a combination of functional assessment, mobility, strengthening, corrective exercise, manual techniques, dynamic stabilization, and neuromuscular control. In essence, this isn’t one system, but rather the integration of thought processes from several sources and disciplines that Mike Reinold and Eric Cressey have accumulated during their careers. Basically, Functional Stability Training is how Mike Reinold approaches building his rehabilitation programs for injured people and how Eric Cressey builds corrective exercise progressions for injury prevention and performance training. Functional Stability Training is the integration of physical therapy and performance enhancement training, the integration of exercises and manual techniques, and the integration between mobility, strengthening, and dynamic stabilization.

Outline! ! Functional Stability Training – An integrated approach to rehabilitation and performance training – Reinold Recent Advances in Core Performance - Understand the concept of Functional Stability Training for the Core, true function of the spine, and how this impacts injuries, rehab, and training – Reinold Maintaining a Training Effect in Spite of Common Lumbar Spine and Lower Extremity Injuries – Outlines the causes and symptoms of several common injuries encountered in the lower extremity, and how to train around these issues to keep clients/athletes fit during rehabilitation – Cressey Understanding and Controlling Extension in Athletes – Looks into the causes of and problems with excessive lumbar extension, anterior pelvic tilt, and rib flairs in athletes – Cressey LAB – Assessing Core Movement Quality: Understanding where to begin with Functional Stability Training exercises for the core – Reinold LAB – A Dynamic Progression of Core Performance Exercises Progression from simple core control to advanced rehab and training techniques – Reinold LAB – Understanding and Controlling Extension in Athletes – Progresses on the previous lecture with specific technique and coaching cues for exercises aimed toward those with these common issues – Cressey LAB – Advanced Stability: Training Power Outside the Sagittal Plane – Traditional power training programs are predominantly focused on the sagittal plane, but in most athletic endeavors – especially rotational sports – power must be displayed in other planes of motion – Cressey !

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About&the&Authors! Dr. Michael M. Reinold, PT, DPT, SCS, ATC, CSCS is considered a leader in orthopedic and sports rehabilitation as a clinician, educator, and researcher. Mike is currently the Head Physical Therapist of the Boston Red Sox. Mike has lectured extensively throughout the nation, published over 50 scientific journal articles and book chapters, and is the author of the textbook, The Athlete’s Shoulder, 2nd Edition. Mike’s contributions to sports medicine have earned recognition by groups such as the APTA, ESPN, Sports Illustrated, The Sporting News, Men’s Health, The Boston Globe, and The Boston Herald. MikeReinold.com

Eric Cressey, MA, CSCS is the president of Cressey Performance in Hudson, MA. Cressey is a highly sought-after coach for healthy and injured athletes alike from youth sports to the Olympic and professional ranks, with baseball development as his greatest focus. Behind Eric’s expertise, Cressey Performance has rapidly established itself as a go-to high-performance facility among Boston athletes – and those that come from abroad to experience CP’s cutting-edge methods. Eric has lectured in four countries and more than one dozen U.S. states; written over 200 articles and four books; contributed on scientific journal articles and book chapters; and co-created four DVD sets. A record-setting competitive powerlifter, Cressey has deadlifted 650 pounds at a body weight of 174 and is recognized as an athlete who can jump, sprint, and lift alongside his best athletes to push them to higher levels. EricCressey.com

FunctionalStability.com! Visit FunctionalStability.com for more information on the FST integrated rehabilitation and performance system. More information and modules on the upper and lower extremity coming soon! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

ShoulderPerformance.com!

! Visit ShoulderPerformance.com to see Mike and Eric’s other DVD - Optimal Shoulder Performance. A comprehensive 4-DVD resource of evidence-based testing, treating, and training the shoulder for health and high performance. !

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FST$|$Functional$Stability$Training! Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS( MikeReinold.com-

Introduction* !

1. 2. 3. 4.

A!comprehensive!approve!to!rehabilitation!and!prevention!programs! Traditional!programs!miss!a!critical!component!of!performance!9!stability! Emphasis!on!training!the!body!by!replicating!how!the!body!functions! Designed!to!work!in!tandem!with!manual!therapy!techniques!to!restore! posture,!muscle!imbalances,!strength,!and!dynamic!stability!

The*“True”*Role*of*our*Muscles* !

1. Muscles!designed!to!be!both!prime!movers!and!more!importantly!stabilizers! 2. Joints!are!stabilized!through!static!and!dynamic!stability! 3. Static!stability! a. Joint! b. Ligaments! c. Capsule! 4. Dynamic!stability! a. Motor!control! b. Proprioception! c. Dynamic!stabilization! d. Neuromuscular!control! 5. Different!joints!offer!different!amounts!of!static!stability! 6. The!knee!and!the!shoulder! 7. What!is!the!function!of!the!rotator!cuff?! a. External!and!internal!rotation?!!Nope…! b. That!is!the!“action”!of!the!cuff! c. The!"function”!is!to!dynamically!stabilize!the!glenohumeral!joint!

The*Components*of*Optimal*Programs* !

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1. 2. 3. 4.

In!simple!form!–!strengthen!what!is!weak!and!mobilize!what!is!tight! What!about!what!is!loose?! We!are!greater!at!strengthening!and!stretching! Need!to!improve!our!ability!to!dynamically!stabilize!

FST!|!Functional!Stability!Training!! 2( Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS(

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Dynamic*Stability* !

1. Several!components!of!dynamic!stability!

Joint*Compression* ! 1. Muscular!co9contraction! 2. Compression!of!joint!(closed!kinetic!chain)!

Dynamic*Ligament*Tension* !

1. Muscles!blend!to!fascia!and!capsule! 2. Contraction!tightens!capsule!and!reduces!tension!

Force*Couples* !

1. Muscles!working!together!to!move!and!position!the!joint! 2. Both!in!terms!of!agonists!and!antagonists! 3. Agonistic!force!couples! a. serratus!and!lower!trapezius! b. Hamstring!and!glute!maximus! c. Internal!and!external!oblique! 4. Antagonistic!force!couples! a. Subscapularis!and!infraspinatus! b. Rectus!abdominis!and!paraspinals! 5. Kinetic!chain!force!couples! a. Ripple!effect! b. Fascial!continuity!

Neuromuscular*Control* ! 1. 2. 3. 4. 5.

Proprioception! Kinesthesia! Efferent!response!(motor)!to!afferent!input!(sensory)! Skills!can!be!learned!and!reflexive!–!motor!learning! Reactive!neuromuscular!control!

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FST!|!Functional!Stability!Training!! 3( Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS(

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What*Influences*Dynamic*Stability?* !

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1. 2. 3. 4. 5.

Muscular!weakness! Fatigue! Muscle!imbalances! Decreased!joint!awareness! Injury!

Functional*Stability*Training* !

1. Training!the!body!to!perform!coordinated!functional!activities!without! compensation,!minimizing!stress!of!the!surrounding!structures! 2. Combination!of!several!components! a. Motor!control!re9education! b. Isolated!strengthening! c. Reverse!posturing! d. Dynamic!stability! e. Reactive!neuromuscular!control! f. Endurance!training!

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Functional*Stability*Training*for*the* Core! Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS( MikeReinold.com-

Introduction* !

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1. Paradigm!shift!in!“core!training”!and!the!treatment!of!the!lumbar!spine! 2. Movement!away!from!traditional!core!exercises! a. Increasing!muscle!strength!and!spine!range!of!motion!has!not!been! successful! i. In!fact!some!studies!show!negative!outcome!possible! b. New!research!assessing!effectiveness!and!safety!of!these!exercises! c. Shift!to!more!functional!activities! d. Shift!away!from!restoring!motion!and!towards!enhancing!stability! 3. Key!is!understanding!the!function!of!the!core!in!functional!activities!and! spinal!control! 4. The!role!of!the!core!muscles!is!to!help!spare!the!spine!from!excessive!load!

How*Low*Back*Injuries*Occur* !

1. Typically!not!linked!to!one!specific!incident!(lifting!a!box),!but!rather!a! history!of!excessive!loading! 2. Pathology!from!a!combination!of!lumbar!flexion,!twisting,!shear,!and! compressive!loading! a. High!repetition!and!light!load! b. Low!repetition!and!high!load! 3. Motor!changes!are!present!in!those!with!low!back!pain! a. Delay!in!onset!of!transverse!abdominis! b. Decreased!multifidus!activity!in!unstable!spines! c. Faster!fatigue!rates!in!spine!extensors! 4. The!lumbar!spine!will!buckle!at!20!pounds!with!no!muscular!contribution! a. Muscular!contraction!dramatically!increases!stiffness!of!the!spine! b. This!has!to!be!360!degree!stiffness!or!instability!occurs! c. All!muscles!work!together!to!create!this!stiffness! d. Any!deficits!will!create!an!imbalance!in!stiffness!and!vulnerability! 5. Ability!to!develop!spinal!stiffness!is!first!key,!keeping!that!stiffness!is!second! key!–!endurance! !

Functional!Stability!Training!of!the!Core! 2( Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS(

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The*Problem*with*Traditional*Exercises* !

1. Many!put!the!spine!in!a!disadvantageous!position! 2. Lumbar!mobility! a. Leads!to!greater!mobility!and!instability! 3. Abdominal!hollowing! a. Does!not!produce!360!degree!spinal!stability!–!isolated!TA! 4. Sit!ups! a. Excessive!lumbar!flexion!places!3000N!of!compressive!force! 5. Posterior!pelvis!tilts! a. Places!spine!in!too!much!flexion! 6. Superman’s! a. Places!very!high!compression!load!on!spine!

Keys*to*Functional*Stability*Training*of*the*Core* !

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6. 7. 8. 9.

DeWemphasize!lumbar!mobility! Increase!muscular!stiffness!to!protect!the!spine! Increase!muscular!stiffness!in!360!degrees!around!spine! Emphasize!neutral!spine! Emphasize!endurance,!not!strength! a. Core!stability!not!designed!to!maintain!position!with!moderate! activity!for!long!durations! b. Holds!for!8W10!seconds!–!longer!depletes!oxygen!and!builds!up!lactic! acid! c. Increase!endurance!through!repetitions,!not!holds! Challenge!the!stabilizing!system!randomly! Train!for!stability!in!functional!motions!and!positions!(athletes)! Stop!worrying!about!specific!muscle!activity! a. They!are!all!important!and!involved!in!spinal!stability! b. Focus!on!groups!based!on!function! This!is!not!an!independent!home!exercise!program!!!Importance!of! coaching/cueing!

Functional*Stability*Training*Progression* !

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1. 2. 3. 4. 5.

Addition!by!subtraction! Train!neutral!spine! Train!abdominal!bracing! Teach!proper!muscle!firing!patterns! Train!simultaneous!bracing!and!extremity!movement! a. Exercise!in!stable!position! b. Exercise!in!unstable!position! FST!|!Functional!Stability!Training!|!FunctionalStability.com!

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c. Perturbations!and!rhythmic!stabilization! 6. Progression!to!functional!movement!patterns! a. IsoWholds!

* General*Progression* !

1. Each!exercise!group!follows!the!same!progression!

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Stable!!!Perturbation!!!Unstable!!!Perturbation! ! 2. Exercise!progression!is!a!blend!of!levels! Phase!1!stable!!! Phase!2!stable,!phase!1!unstable/perturbation!!! Phase!3!stable,!phase!2!unstable/perturbation!!! …!

! 3. Build!endurance!through!repetitions,!not!time! 4. Transition!from!reps!to!breathes!

* Neutral*Spine* !

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1. Import!place!to!begin! 2. Gentle!pelvic!tilting!(avoid!forced!posterior!pelvic!tilting)! 3. Cat!and!camel!

Abdominal*Bracing* !

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1. 2. 3. 4.

Avoid!abdominal!hollowing! Contraction!of!entire!core!stabilizers! Palpate!and!facilitate!more!than!rectus!abdominis! Biofeedback! Each-exercise-progress-begins-with-finding-neutral-spine-and-then-bracing-

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Anterior*Chain*Progressions* !

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1. Curl!up! a. Movement!occurs!through!sternum! b. Train!to!flex!the!thoracic!spine,!not!lumbar! ! 2. Dead!bug! a. Maintain!neutral!spine!and!brace,!incorporate!arm!and!leg! movements! b. Begin!with!one!extremity!at!a!time,!stable! c. Progress!to!unstable!and!both!extremities! ! 3. Front!plank! a. One!of!the!exercises!I!see!most!abused! b. Train!to!contract!the!abdominals!“from!the!ground!up”! ! 4. Chop!&!lift! a. Begin!to!get!off!the!ground! b. Progress!from!half!kneel!to!tall!kneel!but!still!fairly!stable! c. Upper!extremity!PNF!patterns!–!D1!and!D2! ! 5. AntiWextension!isoWholds! a. Begin!to!get!into!functional!positions! b. Add!rotary!component!–!360!degree!stiffness!

Posterior*Chain*Progressions* !

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1. Bridge! a. Large!emphasis!on!glute!max!activity!–!train!to!extend!the!hip!with!the! glutes,!not!the!lumbar!spine! b. Progress!to!single!leg!adds!rotary!stability! ! 2. Hip!thrust! a. Progression!to!add!some!resistance!to!bridge,!takes!pressure!off! lumbar!spine!! b. One!fault!with!the!bridge!is!that!hip!flexor!flexibility!will!limit!the! motion! c. Hip!thrust!can!help! ! 3. Bird!dog! a. Excellent!combination!of!abdominal!bracing,!back!extensor!strength,! and!rotary!stability! b. Start!with!clocks!–!progress!to!arm!and!leg! ! FST!|!Functional!Stability!Training!|!FunctionalStability.com!

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4. AntiWextension!isoWholds! a. Begin!to!get!into!functional!positions! b. Add!rotary!component!–!360!degree!stiffness! ! 5. Deadlifts! a. Unspoken!term!in!rehabilitation,!does!not!have!to!have!aggressive! weight! b. Most!important!aspect!of!deadlifiting!is!technique! c. Single!leg!RDL! d. Standard!deadlift!–!work!within!your!mobility!

Lateral*Chain*Progressions* !

1. Side!plank! a. Effective!QL!and!oblique!activity! b. Many!progressions!–!knees!!!straight!leg! c. Variations!for!shoulder!issues! i. Feet!up! ii. TRX!rip!trainer! d. Incorporate!glute!strengthening! ! 2. Front!plank!to!side!plank!progression! a. Wall!!!table!!!ground! b. Challenging!but!important! c. Begin!with!rotary!stability!planks! d. Avoid!lead!with!hips! ! 3. AntiWsidebending!isoWholds! a. Begin!to!get!into!functional!positions! b. Incorporate!unilateral!weights!into!workouts! ! !

Rotary*Chain*Progressions* !

1. Many!activities!require!us!to!train!rotation! 2. AntiWrotation!isoWholds! a. Important!component!of!beginner!programs! 3. Training!for!rotary!strength!and!power!must!come!after!adequate!functional! core!stability!is!achieved! 4. Disadvantageous!position!for!the!spine,!needs!proper!stabilization! ! ! !* *


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Conclusion* !

1. New!concepts!in!Functional!Stability!Training! 2. Step!back!from!traditional!core!programs!and!emphasize!how!the!core!truly! functions! 3. 360!degree!stiffness! 4. Ability!to!withstand!random!forces! 5. Ability!to!stabilize!while!performing!extremity!movements! !

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11/13/11

The$Versa)le$Strength$Coach:$$ Maintaining$a$Training$Effect$in$Spite$of$ Injuries$–$Part$1$(Lower$Body)$ Eric$Cressey$ www.EricCressey.com$ www.CresseyPerformance.com$

Spondylolysis:$The$New$ACL$Epidemic?$ •  Pars$interar)cularis$fractures$ (pars$defect)$ •  Pars$interar)cularis:$connects$ the$vertebral$body$in$front$with$ the$vertebral$joints$behind$ •  ScoQy$Dog$Fracture $$ •  Trauma)c$vs.$Insidious$onset$ •  Depending$on$loca)on,$pain$may$ be$centralized$or,$more$ commonly,$lateral.$$

Things$to$Consider…$ •  Is$the$pathology$the$problem?$$Or,$are$ mul)ple$pathologies$making$people$more$ symptoma)c?$ •  Are$some$athletes$just$wai)ng$to$reach$ threshold?$$ •  My$guess$is$that$it$is$much$higher$now$(seven$ years$later).$$Why?$ $

Important$Prerequisites…$ •  Primary$goal$should$always$be$to$fix$what s$wrong,$ not$just$keep$things$ fun. $ •  When$applicable,$you$can$always$train$the$uninjured$ limb$with$great$benefits.$ •  Know$when$to$refer$out.$Two$minds$and$skill$sets$are$ beQer$than$one!$$$ •  Make$the$athlete$feel$like$an$athlete,$not$a$pa)ent.$$$ •  Look$to$soS$)ssue$quality$earlyTon…$

Incidence$ Soler$and$Colderon$(2000):$$ –  8%$of$elite$Spanish$athletes$affected$ –  highest$prevalence$(27%)$in$those$in$track$&$field$throws$ –  17%$of$rowers,$14%$of$gymnasts,$and$13%$of$weightliSers$had$ spondylolysis$ –  L5$most$common$(84%),$followed$by$L4$(12%).$ –  Mul)ple$levels$of$involvement$in$only$3%$of$cases$ –  Bilateral$78%$of$the$)me$ –  Only$50T60%$of$those$diagnosed$actually$reported$low$back$pain$ –  Males$and$females$affected$equally$(although$associated$ spondylolisthesis$was$higher$in$females)$ –  Presence$of$spondylolysis$is$es)mated$at$15T63%,$with$the$highest$ prevalence$among$weightliSers.$

As$always…$ •  Everyone$wants$to$compete,$but$not$train.$ •  Socially$and$economically,$opportuni)es$for$ sport$par)cipa)on$yearTround$are$available.$ •  We$sit$too$much.$ •  Modern$footwear$is$atrocious.$

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Which$has$led$to…$ • 

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Debated$Treatment$Protocols$ $Dr.$Jonathan$Reeser:$

Although$some$clinicians$recommend$ bracing$to$minimize$extension$and$resultant$shear$forces$ across$the$affected$segment,$some$evidence$from$ biomechanical$studies$indicates$that$lumbosacral$bracing$may$ actually$increase$intersegmental$mo)on$at$the$lumbosacral$ junc)on.$Therefore,$the$prevailing$opinion$appears$to$be$that$ bracing$should$be$used$only$for$individuals$who$remain$ symptoma)c$despite$aQemp)ng$to$limit$their$ac)vi)es,$or$for$ those$who$require$a$physical/tac)le$reminder$to$avoid$ provoca)ve$ac)vi)es. $

A$standard$rule$in$sports$medicine:$any$ adolescent$athlete$with$lumbar$pain$of$ dura)on$>3$days$must$get$a$bone$scan$to$ rule$out$a$fracture$ Frequently$go$undiagnosed$and$will$ frequently$respond$to$most$modali)es$ (heat,$ice,$EMS,$US,$massage,$exercise$w/ o$extension$and$even$chiroprac)c$ manipula)on).$$$ These$modali)es$treat$pain,$spasm,$ inflamma)on,$etc.,$but$the$fracture$ remains.$$ Acute$diagnosis$is$rare,$but$if$it$happens,$ it s$12T16$weeks$of$bracing$–$and$ generally$with$very$good$healing.$$$$

BackTBracing:$Bringing$The$Pendulum$Back$to$ Center?$ Spinal Level

Degrees of Rotation

T1-2

9

T2-3

8

T3-4

8

T4-5

8

T5-6

8

T6-7

8

T7-8

8

T8-9

7

T9-10

4

T10-11

2

T11-12

2

T12-L1

2

L1-2

2

L2-3

2

L3-4

2

L4-5

2

L5-S1

0-5

Remember…$ Motor$Control:$$ Beginner$vs.$Advanced$

Risk$Factors$T$Intrinsic$ •  •  •  •  •  •  •  •  • 

Poor$bone$mineral$density(*)$ Poor$lower$limb$alignment$and$foot$structure(*)$ Faulty$muscular$recruitment$paQerns$(*)$ Height$–$Taller$(nonTmodifiable)$ Body$Type$–$longer$spine$(nonTmodifiable)$ Poor$condi)oning/muscular$fa)gue(*)$ Bone$pathologies$(refer$out)$ Menstrual/hormonal$irregulari)es$(refer$out)$ Gene)c$predisposi)on:$Inuit$>$Caucasian$>$AfricanTAmerican$(nonT modifiable)$

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Risk$Factors$T$Extrinsic$ •  Inappropriate$training$regimen$or$surface$(*)$ •  Spor)ng$discipline:$Sports$demanding$repe))ve$lumbar$hyperextension,$ trunk$rota)on,$and/or$axial$loading$(*$shortTterm,$poten)ally$modifiable$ longTterm)$$ •  Footwear$(*)$ •  CigareQe$smoking$(*)$ •  Insufficient$nutri)on$T$calories,$calcium,$vitamin$D$(*)$

Flexion$vs.$ExtensionTIntolerant$ •  More$pain$in$siqng$(flexion)$or$standing$ (extension)?$ •  Look$at$a$basic$overhead$squat:$ –  Does$the$buQ$tuck$under?$(Flexion)$ –  Does$the$arch$remain,$but$the$individual$comes$up$ on$the$heels$–$or$stop$dead?$(Extension)$

•  It s$just$the$path$of$least$resistance.$

Control$what$we$can$control…$ •  Look$at$the$*$from$above$ •  Make$sure$there$a)$is$a$physical$therapist$ involved$(with$manual$therapy)$and$b)$he/she$ is$proac)ve$ •  Remember$the$psychological$aspect$of$this$for$ a$young$athlete$ •  Appreciate$the$restric)ons$of$the$brace$

Bracing$Issues$ 1.  2.  3.  4.  5.  6.  7. 

Flexion$Intolerant$ •  Tend$to$sit$in$flexion/ posterior$PT$ •  Present$more$like$disc$ injury$cases$ •  Bring$center$of$gravity$ up$to$drive$subtle$ lumbar$extension$ •  Hamstrings$ mobiliza)ons,$psoas$ recruitment$ •  Overhead$SingleTleg$ Work$

It$is$so$easy$to$be$lazy$with$good$posture. $Loss$of$ motor$control$of$key$core$stabilizers:$therapist$should$ get$them$out$of$the$brace$weekly$ Restricts$full$hip$flexion$and$extension$ROM$ Can$actually$restrict$TTSpine$ROM$ Tendency$toward$hip$rota)on$asymmetries$(especially$ postTbracing):$need$for$sprint$mechanics$work$postT bracing$ Avoid$pronounced$axial$loading$ No$rota)onal$training$for$dura)on$of$bracing:$all$plyos$ (<90°$hip$flexion)$and$med$ball$throws$must$be$linear$ Think$an)Trotator$training$

ExtensionTIntolerant$ •  Glute$Ac)va)on$ –  Supine$Bridges$and$progressions$ –  Birddogs$ –  PullTThrough$and$Wall$March$Isometric$Holds$

•  Op)mize$ROM$into$hip$extension$ •  Check$feet$closely;$pronators$tend$to$be$ more$problema)c.$

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The$Scoop$on$Disc$Injuries$ •  1994$NEJM$study$ •  Researchers$sent$sent$MRIs$of$98$"healthy"$backs$to$ various$doctors,$and$asked$them$to$diagnose$them.$$$ •  80%$of$the$MRI$interpreta)ons$came$back$with$disc$ hernia)ons$and$bulges.$$In$38%$of$the$pa)ents,$there$ was$involvement$of$more$than$one$disc.$$ •  Approximately$85%$of$lower$back$pain$cases$have$no$ defini)ve$diagnosis$

So$the$answer$to$the$trick$ques)on$is…$ •  You re$probably$already$training$people$ around$disc$injuries!$ •  Most$just$aren t$symptoma)c$because$no$ nerves$are$being$impinged$(disc$issue$is$ stable).$ •  Adequate$func)on$of$the$ACTIVE$restraints$ protects$the$passive$restraints.$

How$do$we$prevent$disc$issues$ from$becoming$symptoma)c?$

More$Research…$ •  Cappozzo$et$al.$found$that$squaqng$to$parallel$with$1.6$)mes$body$ weight$(what$I d$call$ average $for$an$ordinary$weekend$warrior$ who$liSs$recrea)onally)$led$to$compressive$loads$of$ten$)mes$body$ weight$at$L3TL4$(1).$$That s$7000N$for$a$guy$who$weighs$about$ about$150.$$ •  In$a$study$of$57$Olympic$liSers,$Cholewicki$et$al.$found$that$L4TL5$ compressive$loads$were$greater$than$17,000N$$ •  McGill:$The$spine$doesn t$buckle$un)l$12,000T15,000N$of$pressure$ is$applied$in$compression$(or$1,800T2,800N$in$shear)$–$so$it$goes$ without$saying$that$we re$playing$with$fire,$to$a$degree.$$

How$do$we$prevent$disc$issues$from$ becoming$symptoma)c?$ •  •  •  • 

Deload$the$spine$ ReTeducate$clients$on$their$ neutral$spine $ Be$careful$with$early$morning$training$ Reduce$body$fat$ –  Lumbar$compensa)ons$ –  Makes$diagnos)c$imaging$easier!!!!$

•  Fix$asymmetries$

•  Avoid$lumbar$flexion,$especially$with$rota)on$ and$compression,$by:$ –  Increasing$ankle$mobility$ –  Increasing$thoracic$spine$mobility$ –  Increasing$hip$mobility$

•  Stabilize$the$lumbar$spine$within$the$ROM$it$ already$has$

Hockey:$What$to$Expect…$ Sports$Hernia$cases$ Femoroacetabular$impingement$(FAI)$ Hip$Labral$$issues$ Short,$dense,$fibro)c,$ungodly$disgus)ng$ adductors$ •  Poor$hip$internal$rota)on$and$extension$ •  Poor$psoas$recruitment$ •  ExtensionTbased$back$issues,$history$of$groin/ lower$abdominal$pain,$hip$pain$ •  •  •  • 

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Sports$Hernia$Considera)ons$ •  Adductor$Longus$&$Rectus$Abdominus$Interac)on$at$ Adductor$Aponeurosis$on$Pubis$ •  Zone$of$Convergence$for$Adductor$Longus$(most$anterior$ of$adductors,$but$posterior$to$pec)neus)$ •  Omar$IM,$et$al.$Athle)c$pubalgia$and$"sports$hernia :$ op)mal$MR$imaging$technique$and$findings.$ Radiographics.$2008$SepTOct;28(5):1415T38.$

Sports$Hernia$Training$Considera)ons$ •  Pain$is$your$guide!$ •  Most$unilateral$training$is$out.$ •  Everyone$can$s)ll$do$1Tleg$RDL,$1Tleg$hip$thrusts,$etc.$$ Some$can$do$stepTups.$ •  Overhead$pressing$AND$pulling$can$be$problema)c.$ •  Pronounced$axial$loading$should$be$avoided.$ •  Stay$away$from$an)Textension$core$work:$no$ rollouts,$overhead$medicine$ball$stomps,$fluQers,$ fallouts,$etc.$Some$folks$will$even$have$issues$with$ prone$bridging$varia)ons.$

SoS$Tissue$Work$ •  •  •  •  •  • 

Adductors$$ Hip$external$rotators$ Rectus$femoris$ IT$band$ TFL$ Vastus$lateralis$

Sports$Hernia$Considera)ons$ True$Antagonists$ RA:$posterior,$superior$force$T>$elevates$pubis$ AL:$anterior,$inferior$force$T>$depresses$pubis$ In$cadavers,$cuqng$the$RA$increases$anterior$)lt$and$pressure$ in$adductors.$ •  An$injury$to$one$of$these$tendons$predisposes$the$opposing$ tendon$to$injury$by$both$altering$the$biomechanics$and$ disrup)ng$the$anatomic$con)guity$of$the$tenoperiosteal$ origins.$In$turn,$such$disrup)on$leads$to$instability$of$the$ pubic$symphysis.$ $ •  Read$everything$you$can$from$Omar$IM,$Zoga$AC$et$al.$under$ athle)c$pubalgia. $ •  •  •  • 

Sports$Hernia$Training$Considera)ons$ •  Rest!$ •  OSen$a$quick$return$to$ sports$w/out$addressing$ causa)ve$factors.$ •  Improve$hip$internal$ rota)on$and$extension.$ •  Ac)vate$glutes,$psoas,$ and$pelvic$floor$muscles$

Lavigne$M,$Parvizi$J,$Beck$M,$Siebenrock$KA,$Ganz$R,$Leunig$M.$Anterior$ femoroacetabular$impingement:$part$I.$Techniques$of$joint$preserving$ surgery.$Clin$Orthop$Relat$Res.$2004$Jan;(418):61T6.$ $

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Is$a$Hip$Any$Different$Than$a$ Shoulder?$

FAI$Training$Considera)ons$

•  Anterior$scapular$)lt$=$anterior$pelvic$)lt$ •  Reac)ve$changes$to$acromion,$just$like$the$ femoral$head$and/or$acetabulum$ •  Where$do$we$see$FAI$the$most?$ExtensionT rota)onTbased$sports:$hockey,$soccer,$ baseball$ •  A$lost$squat$paQern$in$a$9T12$yearTold$athlete$ is$a$big$concern,$in$my$eyes.$

•  Many$of$the$issues$are$similar$to$what$you$see$with$ sports$hernia$cases.$ •  DO$NOT$SQUAT$AN$ATHLETE$WITH$FAI!!!!!!$ •  Just$about$all$singleTleg$work$is$okay$–$and$it s$ actually$very$beneficial.$ •  Torn$labrum?$$Poor$hip$stability.$ •  Don t$overlook$associated$issues:$back$pain$ (especially$on$same$side),$sports$hernia,$labral$ pathologies$ •  Many$athletes$do$fine$w/out$the$surgery;$it$is$sportT$ and$posi)onTspecific.$

Anterior$Hip$Pain:$ Other $

Femoral$Anterior$Glide$Syndrome$

•  Consider$the$different$ femoral$aQachment$ points$of$the$glutes$and$ hamstrings$ •  Glutes$have$far$more$ control$over$the$femoral$ head.$

Working$around$ACL$rehabs…$ •  Look$to$the$causes$ –  Hyperextension?$ –  Adduc)on/Internal$Rota)on?$ –  What$controls/decelerates$these$ac)ons?$

•  Related$Issues:$MCL?$$PCL?$$LCL?$$Meniscus?$

•  Different$reconstruc)on$strategies$ •  GraS$sites:$ –  Patellar$Tendon$ –  Hamstrings$ –  AllograS$(cadaver)$

•  Shirley$Sahrmann$ •  Anterior$capsule$irrita)on$can$occur$with$hip$ extension$if$there$isn t$adequate$femoral$ head$control$(posterior$pull)$during$hip$ extension.$

My$Experience$ •  The$Fastest$Recoveries$include:$ –  Manual$Therapy$ –  ROM$as$the$#1$indicator$ –  Build$strength$through$the$ROM$one$creates$ –  Training$the$uninjured$limb$extensively$ –  Loads$of$work$for$the$posterior$chain$as$hip$extensors$

•  Programming$is$a$pain$because$they$progress$so$ fast!$ •  Cyberne)c$periodiza)on$

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Let s$Talk$Anterior$Knee$Pain…$ •  Quad$dominant$vs.$Hip$dominant$squaqng$ •  It s$not$lateral$patellar$tracking;$it s$poor$ control$of$femoral$internal$rota)on!$ •  Posterior$Chain$Exercises!$ •  SingleTleg$classifica)ons$ –  Sta)c$Supported/Unsupported$ –  Dynamic$Accelera)ve$and$Decelera)ve$

Training$the$Posterior$Chain$ •  DeadliS$varia)ons:$sumo,$conven)onal,$trap$ bar,$rack$pulls$ •  PullTThroughs$ •  KeQlebell$Swings$ •  Hip$Thrusts$ •  GluteTHam$Raises$

•  Ankle$Mobility?$$Hip$Mobility?$$Tissue$Quality?$

Sta)cs$ •  Supported$ –  Bulgarian$Split$Squats$ –  Split$Squats$

•  Unsupported$ –  1Tleg$squats$to$bench$(pistols)$ –  1Tleg$RDL$ –  1Tarm,$1Tleg$RDL$

Anterior$Knee$Pain:$Cueing$ •  •  •  • 

Weight$on$heels$(pull$through$them)$ Ac)vate$glutes$and$hamstrings$ Drive$knee$over$liQle$toe$ Long$Stride$

Dynamics$ •  Accelera)ve$ –  Reverse$Lunges$ –  StepTups$

•  Decelera)ve$–$most$stressful/advanced$ –  Forward$lunges$ –  Walking$lunges$

Ankle$Issues$ •  During$and$postTbracing,$dorsiflexion$is$ limited.$ •  May$impair$everything$from$squaqng$to$ sprin)ng$ •  Load$unaffected$leg$during$immobiliza)on$ period$ •  Reverse$Extensions$ •  Use$slideboard$reverse$lunges$as$progression$ back.$

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Important$Takeaways$ •  Work$handTinThand$with$rehabilita)on$specialists$to$ formulate$an$appropriate$returnTtoTac)on$plan$ •  Remember$that$different$shoulder$condi)ons$ mandate$different$training$modifica)ons$ •  Understanding$the$causes,$symptoms,$and$ exacerba)ng$exercises$for$each$condi)on$not$only$ makes$it$easier$to$recover$from$the$problem,$but$to$ prevent$its$recurrence.$

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Understanding$and$Controlling$ Extension$in$Athletes$

Eric$Cressey,$MA,$CSCS$ Founder/President$–$Cressey$Performance$ www.CresseyPerformance.com$ www.EricCressey.com$ $

OverreacEon/UnderreacEon$ •  Alwyn$Cosgrove:$Bring$the$Pendulum$Back$to$ Center$ •  For$a$long$Eme,$we$didn’t$think$the$core$was$ important.$ •  Then$we$overfocused$and$did$thousands$of$ sitLups$and$crunches$and$made$people$worse.$ •  Now$we$are$deathly$afraid$of$moving$a$spine$ through$flexion$or$extension.$

Is$Flexion$the$Devil?$

Flexion$$≠$$Extension$

What$to$Visualize$ •  Anterior$Pelvic$Tilt$and$ Increased$LordoEc$Curve$ •  Anterior$Weight$Bearing$ •  PRI:$Diminished$Zone$of$ ApposiEon$ •  Altered$diaphragm$funcEon$ •  Supplemental$respiratory$ muscles$must$pick$up$the$slack$ •  Lean$guys$look$fat$secondary$to$ anterior$pelvic$Elt$

•  Maybe$in$desk$jockeys$ •  Actually,$the$devil$is$in$the$details.$ •  Flexion$to$neutral$is$much$different$than$ flexion$from$neutral.$ •  Most$young$athletes$live$in$extension$(and$ rotaEon).$

FuncEonal$Anatomy$ •  Janda:$Lower$Crossed$Syndrome$ •  Many$think$it$is$just$an$“X,”$but$in$reality,$ there$are$many$checks$and$balances$within$ that$X.$ •  Examples;$Glute$Max/Hamstrings,$Glute$Max/ Adductor$Magnus,$External$Obliques/Rectus$ Abdominus$

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PotenEal$Injuries…$ •  Achilles$tendinosis/rupture,$anterior$knee$ pain,$proximal$hamstrings$tendinosis,$ hamstrings$strain,$hip$flexor$strain,$anterior$ hip$irritaEon,$femoroacetabular$impingement,$ sports$hernia,$lumbar$stress$fracture,$lumbar$ erector$or$QL$strain,$etc.$ •  And$that’s$just$the$lowerLbody$and$core!$

The$Big$Players:$LaEssimus$Dorsi$ •  Limit$shoulder$flexion,$along$ with$long$head$of$triceps$ •  Lats$internally$rotate$the$ shoulder$–$which$is$one$more$ reason$many$athletes$can’t$ externally$rotate$the$shoulder$ w/out$lumbar$extension$ •  Dr.$Luke$Oh:$47%$of$elbow$ pain$cases$present$with$ subluxaEng$medial$triceps$ (snapping$elbow)$

The$Big$Players:$Lumbar$Erectors$ •  Where$is$the$hypertrophy?$ •  Lumbar$vs.$Thoracic$Erectors$

The$Big$Players:$LaEssimus$Dorsi$ •  Many$aiachments$ make$it$a$powerful$ extensor$ •  Moving$the$enEre$ spine$vs.$moving$the$ scapula$on$the$rib$cage$ •  Less$direct$control$ over$tLspine$

The$Big$Players:$Hip$Flexors$ •  Short?$ •  SEff?$ •  TFL?$Rectus$Femoris?$ Psoas?$ •  Thomas$Test$

The$Big$Players:$Hamstrings$ •  Why$can$hamstrings$be$“Eght?”$ –  Previous$injury$ –  Shortness$ –  Neural$tension$ –  SEffness:$ProtecEve$tension$

•  Hamstrings$posterior$Elt$the$pelvis;$they$may$ be$the$only$thing$prevenEng$debilitaEng$ extensionLbased$back$pain.$

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The$Big$Players:$Plantarflexors$ •  Constantly$“on”$ because$of$anterior$ weight$bearing$ •  Lack$dorsiflexion$ •  “Lose”$the$squat$ paiern$ •  Can$only$squat$with$ heel$lim$(dorsiflexion$to$ neutral)$

The$Law$of$RepeEEve$MoEon$ I(=(NF/AR( •  I$=$Insult/Injury$to$the$Essues( •  N$=$Number$of$repeEEons( •  F$=$Force$or$tension$of$each$repeEEon$as$a$ percent$of$maximum$muscle$strength( •  A$=$Amplitude$of$each$repeEEon( •  R$=$RelaxaEon$Eme$between$repeEEons$ (lack$of$pressure$or$tension$on$the$Essue)$

So$we$just$need$to$stretch,$right?$ •  What$does$stretching$really$do?$$Do$we$even$ know$what$we’re$really$stretching?$ •  Weingroff:$“Get$Long,$Get$Strong,$Train$Hard.”$ •  Get$Long:$Foam$Rolling,$Manual$Therapy,$ Dynamic$Flexibility,$Yoga,$Pilates,$PRI,$DNS,$ AIS,$MAT,$ASAP,$QRSTUV,$or$whatever$other$ acronym$you$prefer.$ •  Sahrmann:$more$about$creaEng$sEffness$than$ “stretching.”$

The$Law$of$RepeEEve$MoEon$ I(=(NF/AR( •  Why$is$it$so$challenging$to$change$lowerL body$posture$and$anterior$pelvic$Elt?$ •  Standing$and$sipng$are$constant$“N.”$ •  There$is$no$“R.”$ •  Many$athletes$compete$at$extremely$high$ levels$with$raging$anterior$pelvic$Elt$and$ lordosis:$“F.”$

$

The$Big$Players:$Gluteus$Maximus$ •  AcEve$in$all$three$planes$ •  External$Rotator,$Abductor,$ Extensor$ •  Controls$Internal$RotaEon,$ AdducEon,$Flexion$ •  AnELPronator$ •  Bridging$!$Wall$March$ !Bowler$Squats$ !Strength$Training$

The$Big$Players:$External$Obliques$ •  Consider$points$of$ aiachment$as$compared$ to$rectus$abdominus$ •  Posteriorly$Elts$pelvis$w/ out$increasing$kyphosis$ •  Reverse$Crunch$ Progressions$and$ Regressions$

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The$Big$Players:$Dorsiflexors$ •  DB$Dorsiflexion$ •  Band$Dorsiflexion$

The$Big$Players:$Serratus$Anterior$ •  Serratus$anterior$is$more$acEve$at$greater$ angles$of$humeral$elevaEon,$which$isn’t$ possible$with$limited$shoulder$flexion$ secondary$to$restricEons$in$lat,$long$head$of$ triceps,$etc.$ •  Forearm$Wall$Slides$ •  Forearm$Wall$Slides$w/Band$ •  FeetLElevated$PushLup$VariaEons$ •  Scap$PushLups/PushLup$Plus?$

The$Big$Players:$Deep$Neck$Flexors$ •  Teach$the$Packed$Neck!!!$ •  Supine$Chin$Tucks$!$Standing$Chin$Tucks$ !$Quadruped$Chin$Tucks$

The$Big$Players:$Lower$Trapezius$ •  Works$w/serratus$anterior$and$upper$ trapezius$to$upwardly$rotate$the$scapula$ •  Prone$1Larm$Trap$Raise$off$Table$$ •  Forearm$Wall$Slides$at$135$degrees$ •  Remember$that$scapular$posiEoning$is$heavily$ influenced$by$thoracic$spine$rotaEon$

The$Big$Players:$Posterior$Rotator$Cuff$ •  Prone$External$RotaEon,$(Manual)$SideLLying$ External$RotaEon$–$arm$abducted$30$degrees$ •  HalfLKneeling$(Manual/Cable)$External$ RotaEons$at$90$degrees$–$scapular$plane$ •  Standing$(Manual/Cable)$External$RotaEons$at$ 90$degrees$–$scapular$plane$

Overlooked$Paierns$to$Regain$ •  Deep$Squat$

–  Deep$Squat$Belly$Breathing$w/Lat$Stretch$ –  TRX$Squats$ –  Goblet$Squats$

•  SingleLleg$Control$ –  –  –  – 

SideLLying$Clam$!$Bowler$Squats$ Symmetrical$Loading$SingleLleg$Exercises$ OffLSet$Load$SingleLleg$Exercises$ SingleLleg$Exercises$w/Raised$COG$

•  Full$Shoulder$Flexion$ –  –  –  –  – 

Som$Tissue:$Rolling$and$Manual$Therapy$ Deep$Squat$Belly$Breathing$w/Lat$Stretch$ SideLLying$InternalLExternal$RotaEon$ Forearm$Wall$Slides,$Overhead$Shrugs?$ Overhead$Carries$&$StabilizaEons$

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Overlooked$Paierns$to$Regain$ •  Full$Shoulder$Flexion$ –  Som$Tissue:$Rolling$and$Manual$Therapy$ –  Deep$Squat$Belly$Breathing$w/Lat$Stretch$ –  SideLLying$InternalLExternal$RotaEon$ –  Forearm$Wall$Slides,$Overhead$Shrugs?$ –  Overhead$Carries$&$StabilizaEons$

•  NonLRectusLDominant$Bridging$ •  Rotary$Stability$w/out$Extension$

A$Typical$Week$ •  Day$1:$AnELRotaEon$Drill,$Reverse$Crunch,$ Prone$Bridge$VariaEon$ Day$2:$AnELExtension$Drill,$Side$Bridge$ Day$3:$$AnELRotaEon$Drill,$Reverse$crunch,$ Prone$Bridge$VariaEon$ Day$4:$AnELExtension$Drill,$Side$bridge$ Also$mix$in:$GetLup$VariaEons$ •  Above$all$else:$change$the$way$athletes/ clients$live!$

5$

Assessing'Core'Movement'Quality! Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS( MikeReinold.com-

Introduction* !

1. Purpose!of!our!assessment!is!two!fold:! a. Rule!out!pathology! b. Find!our!starting!point!for!exercise! 2. Combination!of!several!components! a. Posture! b. Isolated!core!movements! c. Integrated!functional!movements! 3. Provocative!tests,!myotomes,!dermatomes,!reflexes! 4. Standard!clearing!of!joints,!muscle!imbalances,!and!mobility!deficiencies! should!also!be!performed! !

Provocative*Screening* !

1. Determine!if!beginning!exercise!is!safe! 2. 4!“red!flag”!questions!you!should!ask!every!person:! a. Have!you!had!a!recent!traumatic!event?! b. Do!you!have!any!numbness,!tingling,!burning,!or!weakness!in!your! legs?! c. Have!you!had!any!recent!episodes!of!illness,!fever,!chills,!or!night! sweats?! d. Do!you!have!any!issues!with!your!bowel!or!bladder?! 3. Provocative!tests! a. Heel!drop!test! i. Assesses!end!plate!fractures! b. Seated!compression!test! i. Assesses!compression!intolerance!with!poor!posture! c. Prone!and!standing!extension!test! ! i. Assesses!the!facets,!pars,!lamina,!nerve!root,!anterior!disc! d. Prone!instability!test! i. Assesses!shear!instability! 4. Neural!tests! a. Slump! b. Straight!leg!raise!

Assessing!Core!Movement!Quality! 2& [Type&the&document&title]&

!

Posture* !

!

1. Standing!posture!most!commonly!observed! 2. Will!learn!a!lot!about!the!person’s!deficiencies! 3. Goal!is!to!identify!areas!of!muscle!imbalance!and!mobility!deficiencies!that! will!impact!core!movement!quality!

Integrated*Functional*Movements* !

1. Start!with!functional!movement!pattern!assessment!–!start!with!the!large! pictures! 2. Likely!a!combination!of!mobility,!strength,!and!stability!deficits! 3. We!are!masters!of!compensation! 4. Can!assess!basic!functional!movements!or!progress!to!advanced! a. Balance! b. Activities!of!daily!living!and!transitions! c. Functional!movement!screen! 5. Balance! a. Standing!stork!stance! b. Add!eyes!closed! c. Add!perturbations! 6. Activities!of!daily!living!and!transitions! a. Sitting!!!raising!from!chair! b. Bending!forward! c. Rolling! d. Laying!down!!!sitting! e. Walking! 7. Functional!movement!screen! !

Isolated*Core*Movements* !

1. Initially!more!important!than!functional!movements! 2. Functional!movements!require!mobility,!strength,!and!stability! 3. Impairments!in!isolated!core!movements!will!not!allow!proper!integrated! functional!movements! 4. Stepping!stone!to!integrated!functional!movements! 5. Should!be!qualitative!and!quantitative! a. Stability!and!endurance!

!

!* *


* *

Assessing!Core!Movement!Quality! 3& [Type&the&document&title]&

!

Hip*Assessment* ! 1. 2. 3. 4. 5.

Janda!hip!extension!test! Janda!hip!abduction!test! Janda!trunk!curl!up!test! Active!straight!leg!raise! Standing!hip!flexion!test!

!

Qualitative*Core*Assessment* !

!

1. Similar!to!the!exercise!progressions! 2. Break!down!into!core!quadrants! a. Anterior! b. Posterior! c. Lateral! d. Rotary! 3. Start!with!simple!variations!of!exercise! a. Progressive!multi]phase!approach! 4. When!form!diminishes,!test!is!complete,!exercises!begin!with!previous!phase!

Quantitative*Core*Assessment* !

1. Endurance!testing!of!the!four!quadrants! 2. Timed!tests!of!each!quadrant! 3. Overall!time!and!ratios!important! a. Side!plank! b. Curl!up! c. Back!extension! d. Anti]rotation!iso]hold! 4. A!few!things!about!the!data! a. Endurance!decreases!with!age! b. Females!tend!to!have!better!extensor!endurance!(body!weight?)!but! poorer!side!plank!endurance!(strength?)! c. Right!side!plank!tends!to!be!a!little!weaker! 5. Ratios!are!important! a. Those!with!history!of!back!pain!usually!have!diminished!extensor! endurance!or!imbalances!of!side!bend!side!to!side!

! Ratio! Flexion/Extension! RSB/LSB! SB/Extension! !

!* *

Normal! 0.70]0.85! 0.96]1.05! 0.40]0.60!


* *

Dynamic(Core(Performance(Progression! Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS( MikeReinold.com-

! General!Progression! ! !

1. Neutral,!Brace,!Breathe! 2. Each!exercise!group!follows!the!same!progression! Stable!!!Perturbation!!!Unstable!!!Perturbation! ! 3. Exercise!progression!is!a!blend!of!levels!

!

Phase!1!stable!!! Phase!2!stable,!phase!1!unstable/perturbation!!! Phase!3!stable,!phase!2!unstable/perturbation!!! …! ! 4. Build!endurance!through!repetitions,!not!time! 5. Transition!from!reps!to!breathes! 6. Can!add!weight!to!extremities!

! Neutral!Spine!&!Bracing! !

1. Supine! 2. Quadruped! 3. Standing! !

!

!

Dynamic!Core!Performance!Progression! 2( Michael(M.(Reinold,(PT,(DPT,(SCS,(ATC,(CSCS(

!

Anterior!Chain!Progressions! !

Curl!up! 1. Stable!surface! 2. Unstable!surface! 3. Perturbations! !

Dead!bug! 1. 2. 3. 4. 5. 6. 7.

Stable!surface! Single!or!single!leg! Double!arm! Double!arm!hold,!single!leg! Alternating!arm!and!leg! Unstable!surface! Perturbations! !

Front!plank!

!

1. Stable!wall!!!Table!!!knees!!!feet! 2. Unstable!surface! 3. Perturbations!!

Anti=extension!roll!outs! !

1. Swiss!ball! 2. TRX!

Anti=extension!iso=holds! 1. 2. 3. 4.

Bilateral! Unilateral! Unstable!surface! Perturbations!

!

Anti=extension!medicine!ball!throws! 1. Chest!pass! 2. Overhead!soccer!

!

!

! !

!


! !


!

Posterior!Chain!Progressions! !

Bridge! 1. 2. 3. 4.

Stable,!two!leg! One!leg! Perturbations! Unstable!surface! ! !

Bird!dog! 1. 2. 3. 4.

Single!extremity!–!clocks! Alternating!arm!and!leg! Unilateral!arm!and!leg! Perturbations! !

Anti=extension!iso=holds! 1. 2. 3. 4. 5.

!

! !

Prone!ball!roll!outs! Standing!two!arms! One!arm! Unstable!surface! Perturbations!!

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Lateral!Chain!Progressions! !

Side!plank!

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1. 2. 3. 4. 5. 6.

TRX!Rip!Trainer! Table! Knees! Feet! Perturbations! Unstable!surface!

! ! Rotary!Chain!Progressions! ! Anti=rotation!iso=holds! 1. 2. 3. 4.

Tall!kneeling! Standing! Perturbations! End!range!of!motion! !

Front!plank!to!side!plank!progression!

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1. Wall!!!table!!!ground! 2. Holds! 3. Turns!

Chop!&!lift! 1. Half!kneel! 2. Tall!kneel!

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11/13/11$

Lab:$Understanding$and$ Controlling$Extension$in$Athletes$ Eric$Cressey,$MA,$CSCS$

Coaching$Prone$Bridging$ •  •  •  •  • 

Glutes$Bght$ Anterior$core$engaged$ Chin$tucked:$“stare$at$fists”$ Watch$for$“hump”$(rectus$dominance)$ UBlize$dowel$rod,$if$necessary$

Stability$Ball$Rollouts$ •  •  •  •  •  • 

Glutes$engaged$ Chin$Tucked$ IniBate$with$hips$and$hands$simultaneously$ Body$should$be$a$straight$line$ Nose$to$ball$ Shoulder$flexion,$not$lumbar$extension!$

1$

11/13/11$

TRX$Fallouts/FluXers$ •  Virtually$idenBcal$cues$as$with$stability$ball$ rollouts,$but$more$challenging.$ •  The$lower$the$handles,$the$greater$the$ difficulty.$

Reverse$Crunch$ •  Progressions$and$Regressions$ •  Simplified:$avoid$anterior$Blt$and$forward$ head$posture$ •  Heavier$counterbalance$overhead$=$easier$ movement$ •  Knees$to$elbows$ •  Once$load$is$as$light$as$it$can$be,$progress$to$ feet$to$floor$w/out$losing$proximity$to$glutes.$

SideaLying$InternalaExternal$RotaBon$ •  Improves$length$of$pec$major$and$minor,$lats,$ and$long$head$of$triceps$ •  Opposite$hand$up$ •  Head$resBng$on$floor$ •  Don’t$allow$working$arm$to$drie$forward$ •  May$be$best$preceded$by$sidealying$windmill$ (greater$taspine$mobility$allows$for$greater$ glenohumeral$mobility)$

2$

11/13/11$

Lower$Trap$Progressions$ •  Prone$1aarm$Trap$Raise$(and$External$RotaBon)$–$glute$ acBvaBon,$chin$tucked,$core$braced$ •  Forearm$Wall$Slides$(w/band)$ •  Forearm$Wall$Slides$at$135$degrees$(matches$line$of$ pull$of$lower$traps)$ •  Allowing$shrugging$is$okay$if$someone$is$stuck$in$ downward$rotaBon$(very$downsloped$shoulders).$ •  Regardless:$acBvate$glutes,$lock$rib$cage$to$pelvis$(no$ lumbar$extension)$and$avoid$forward$head$posture$ •  Make$the$shoulder$blades$move$on$the$rib$cage!$

3$

11/13/11$

Lab:$Advanced$Stability:$$ Training$Power$Outside$the$Sagi>al$Plane$ Eric$Cressey,$MA,$CSCS$

Pairing$#1$ $A1)$RotaFonal$Med$Ball$Scoop$Toss$ A2)$Glute$Wall$March$Iso$Holds$ B1)$Overhead$Med$Ball$Stomp$to$Floor$ B2)$Hips$High$Hand$Switches$ $

Pairing$#2$ $A1)$RotaFonal$Med$Ball$Shotput$ A2)$SplitPStance$Kneeling$Adductor$Mobs$$ B1)$Recoiled$Rollover$Stomps$to$Floor$ B2)$Supine$Bridge$w/Reach$ $

1$

11/13/11$

Pairing$#3$ $A1)$StepPBack$RotaFonal$Scoop$Toss$ A2)$Yoga$Plex$ B1)$SplitPStance$Overhead$Throw$to$Wall$ B2)$Seated$Scapular$Wall$Slides$ $

Pairing$#4$ $A1)$Figure$8$Med$Ball$Shotput$ A2)$Table$90/90$Stretch$w/TPSpine$RotaFon$ B1)$SplitPStance$StandPup$Stomp$ B2)$HalfPKneeling$Adductor$Dips$ $

Pairing$#5$ $A1)$Recoiled$Med$Ball$Shotput$ A2)$Adductor$Rolling$on$Box$ B1)$Overhead$Sledgehammer$Swings$to$Tire$ B2)$Hips$Flexed$Hip$Rocking$ $

2$

11/13/11$

Pairing$#6$ $A1)$HotPFeet$Recoiled$Shotput$ A2)$Squat$to$Stand$w/Diagonal$Reach$ B1)$Recoiled$Rollover$Throws$to$Wall$ B2)$TPPushPups$ $

Pairing$#7$ $A1)$StepPBehind$RotaFonal$Med$Ball$Shotput$$ A2)$Wall$Hip$Flexor$MobilizaFons$ B1)$Crow$Hop$to$Overhead$Med$Ball$Throw$ B2)$Bowler$Squats$ $

3$

Functional Stability Training

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