Monthly Archives: December 2012

Learning about Movement – 2012 – Part 2

This is part 2 of a series of posts reflecting on some highlights in learning about movement that I experienced in this last year. In part 1, I addressed my experience with Applied Functional Science / Chain Reaction™ Biomechanics and presented an application of this approach using hip internal rotation. In this post, I will discuss how my strength and conditioning beliefs have changed in 2012.

I still believe in heavy sagital plane lifting. Power/explosive lifts, deadlifts, squats, various forms of pressing have important places with strength and conditioning in a number of sports. Gary Gray provides good reasoning to support the idea that athletic development does not gain a great deal from these lifts unless they are a competitive weight lifter. However, standardized tests improved by these lifts have been shown to be related to athletic success in research1,2 and professional experience does show these lifts cross over into training. It is possible these improvements may  be related to changes in coaching over the career of an athlete but it doesn’t change the fact that intense overloads over time result is associated with athletes becoming stronger, more powerful, and faster. The carry over effects might not be driven purely by hypertrophy and increased neuromuscular drive, it could be endocrine related (increasing load is associated with increases in GH, testosterone, etc) and it could even be largely related by the mental discipline it takes to safely and properly lift increasingly difficult loads. The argument that he and others make is that there are other ways to accomplish this carry over and provide more specific tissue and neurological adaptation to sport. That may be the case, but it has not had the sheer volume and history of success as heavy sagital plane loading. There are certainly some sports I could see the value in dumping this type of loading today, but I think we might lose something, or cause a new problem, if we drop it all together.

So what about the multiplanar, multi-joint, functional training, corrective exercise realm? This is where I started my journey into movement through attending a seminar at Perform Better in 2003. At that time and many years looking forward, I just wanted to collect exercises and categorize them for individual purposes. I rode the anti-heavy lifting bandwagon for a good 4 years before I realized there was a value in it and put it back in my own system. I juggled the balance between the use of bigger lifts and the use of mobility/stability/sport specific power/strength development. I also began to realize how stability and mobility training was being scarred by the functional training movement. People see individuals squatting on stability balls and doing bicep curls on BOSUs under the claim of being “functional” when in fact, quite the opposite, they’re producing movements which simply do not exist in typical function unless they have some sort of odd circus specialty as a career.

Squat on ball

In fact, for many the idea of stability training automatically seems to perceived as being on an unstable surface, which could not be further from the truth. Worse yet, when they are not on some sort of unstable surface they are frequently isolated and cued to be worked under artificial constraints of stability. Everyone is given at least 5 cues to tighten one muscle, loosen another, fire this muscle, not that one. These cues have a place when someone is painful or are early in a rehabilitation protocol, but they do not belong in an athlete’s prehab or conditioning program in the long term except if they have another exacerbation of symptoms. They do not allow the athlete the freedom of motion to develop control in multiple planes of motion. Stability is a joint by joint function specific task. Stability is not simply the ability to hollow, brace, or maintain perfect hip hinge technique (go ahead and tell any strong man competitor fully flexed over atlas stone that his spine is unstable while lifting).

Atlas_Stone

Nor is stability hip abduction and external rotation strength and endurance which keeps this hip, knee, and ankle in a perfect sagital position. Stability is also nearly impossible to tease away from mobility. When mobility with load and force are only practiced in one plane of motion (IE: sagital plane heavy squatting, dead lifts, etc.), mobility will not improve in other planes of motion unless loaded in those planes of motion. Which brings me to our next topic, mobility needs training, not just stretching (dynamic or static):

I believe we can incorporate loaded and body weight exercises into general strategies for improving mobility which I think is more beneficial than a stretching regimen alone. We now know that long term static stretching flexibility improvements are primarily related to stretch tolerance, not tissue change. We are beginning to see that long-term resistance training with full ROM have similar flexibility improvements. 3,4 My belief is that incorporating more full body multiplanar movements with appropriate loading will therefore make more lasting changes in mobility in ways which are more functionally applicable than stretching because they reinforce active patterns of movement. Furthermore, performing these mobility exercises in weight bearing may theoretically promote joint stability at these newly acquire ranges of motion.

Finally, addressing the concern of timing of implementing all of these exercises into anyone’s program. Overall, I see some effectively implementing multi-planar/multi-joint mobility and stability into supplement work for their heavy sagital plane work. Some incorporate into into their metabolic days. To some extent, I will acknowledge it is possible that the advent of diverse multi-planar dynamic stretching prior to every session is already adequate to address my concerns. However, I still wonder if these are enough to make long standing changes in freeing up movement patterns, in particular in the transverse planes. Simply peppering a couple of mobility exercises from time to time may not be enough.

I began this year developing a program meant to complement existing training programs rather than replacing anything. It started first as a way to implement many of the old school strong man training and unconventional training techniques popular these days: focusing on grip strength and lifting and moving diverse objects into a dedicated session, as a way to expand motor patterns for force generation and just to mix up training. Some of this was just for entertainment and variety. Ultimately, after my exposure to the AFS approach and some of the group training at Shoreline Sport & Spine, this progressed to include a variety of multiplanar activities to promote mobility and stability. I now call these the “Mix” sessions, with the idea being utilize full body movements, lift and move diverse objects which require multiple forms of grip and body positioning, and integrate multiplanar/3D mobility and stability to complement an existing training plan.

The idea behind having these as separate sessions rather than integrated into existing sessions was that although I wanted some mild/brief fatigue from a metabolic style warm-up and a finisher at the end, I wanted to not have neuromuscular fatigue be so great prior to, or during, the session as to prevent the body from learning new movement it might not be familiar with.

I put together a video of some the exercises used in group sessions over the last year as this thought process evolved. This video is not the best representation of everything involved in a mix session or the balance of single plane vs. multi-plane diversity. I still have a large number of sagital plane based exercises, but it still demonstrates how the movement is changed by using objects other than barbells and how freedom of motion is promoted throughout. Of additional note, these sessions were designed for group sessions, the exercises recorded below were primarily for non-competitive athletes, these are different than a competitive athlete and the sessions can be customized be more “general sport specific”, but they are inherently limited in the ability to address an individual’s functional needs.

And if I’m completely honestly, it is just fun to have an entire dedicated session to experiment with movements that are different than what are traditionally used. Sometimes a little change is all that we need to move forward.

1.) Hansen, Keir T., et al. “Do Force–Time and Power–Time Measures in a Loaded Jump Squat Differentiate between Speed Performance and Playing Level in Elite and Elite Junior Rugby Union Players?.” The Journal of Strength & Conditioning Research 25.9 (2011): 2382-2391.

2.) Gonzalez, Adam M., et al. “Performance Changes in National Collegiate Athletic Association Division I Women Basketball Players During a Competitive Season: Starters Vs. Nonstarters.” The Journal of Strength & Conditioning Research 26.12 (2012): 3197-3203.

3.) O’Sullivan, Kieran, Sean McAuliffe, and Neasa DeBurca. “The effects of eccentric training on lower limb flexibility: a systematic review.” British Journal of Sports Medicine 46.12 (2012): 838-845.

4.) Morton, Sam K., et al. “Resistance training vs. static stretching: effects on flexibility and strength.” The Journal of Strength & Conditioning Research 25.12 (2011): 3391.

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Abdominal Hollowing, Bracing, or Neither?

Sometimes I forget how long the debate over abdominal hollowing (drawing in) vs. bracing has been going on. We’re close to 20 years on this topic. A year and half ago I started writing a clinical commentary on a herniated lumbar disc rehabilitation protocol which included addressing this very topic. A recent resurgence in interest regarding core stability (I guess it never really goes away) made me want to pull an excerpt from the article before it is published. I believe there is a time and a place for abdominal hollowing and abdominal bracing, but there is also a time for neither. The “neither part” has further been bolstered by my experience with Gary Gray’s Applied Functional Science (See Learning about Movement – Part 1). Here is the excerpt:

“Selective recruitment of the TA and multifidi utilizing “abdominal hollowing” or “drawing in” has been described in the literature and is widely practiced. (88,90) In contrast, the simple “abdominal bracing” exercise is another common exercise which not only emphasizes TA and multifidi recruitment, but has demonstrated recruitment of other musculature of the abdominal wall including the internal and external obliques.(89,91) Hodges et al.(85) have demonstrated, using an in vivo porcine model, some increased intervertebral stiffness utilizing TA activation by replicating “hollowing”, more recently, authors have demonstrated that this increased stiffness from “hollowing” is significantly less than during “abdominal bracing” due to decreased activation of the remainder of the abdominal wall musculature. (91,92) When sudden posterior trunk perturbations are introduced, abdominal bracing yielded significantly greater cocontraction of the trunk musculature, increased trunk stability, and better resistance to lumbar displacement than abdominal hollowing.(93) It also appears that the greater the conscious effort utilized to activate the muscular wall, the greater the decrease in spinal stability.(94) Abdominal hollowing has been shown to cause sufficient inhibition of the erector spinae and other musculature to decrease anterior pelvic during hip extension.(95) Inhibition of the erector spinae may have specific therapeutic and treatment benefits in addressing potential muscular imbalances, however they are valuable contributors to stable functional movement, which may result in decreased pelvic control if inhibited.

Although cocontraction of the TA and multifidi has been perceived as vital for muscular stabilization of the lumbar spine, their attempted selective activation may decrease anteroposterior trunk stability,(91-94) theoretically placing rotational trunk stability at risk through decreased activation of the external obliques in comparison to abdominal bracing.(89,91) Despite this, utilizing “hollowing activity” in the early in treatment phases of treatment can provide some symptom relief, kinesthetic awareness, motor control education, and provide some early activation of the TA and multifidi during the acute phase. However, once an individual progresses to postures that involve weight bearing, utilization of bracing may be better to enhance multiplanar stability.

Ultimately, conscious efforts towards bracing and/or hollowing do not contribute toward functional stability, rather, focus should be redirected towards addressing specific motor patterns utilizing multiple muscles in order to develop comprehensive spinal stability.(96) Moreover, from a theoretic functional perspective, consciously constraining movement in any region of the body over an extended period of time may alter the demands placed upon numerous other regions of the body. This may be best illustrated with the influence of external fixation, such as the use of a spinal orthosis for reducing pelvic mobility,(97) single segment spinal fusion influencing segmental motion around it,(98) and the increased risk of degeneration above and below the segment of lumbar fusion.(99) Although these examples entail extreme measures of stabilization beyond the level produced consciously by an individual, it serves as a reminder that a balance between mobility and stability is necessary to enable responses to the dynamic demands during movement of the human body.”

85. Hodges P, Kaigle Holm A, Holm S, et al. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: In vivo porcine studies. Spine (Phila Pa 1976). 2003;28(23):2594-2601. doi: 10.1097/01.BRS.0000096676.14323.25.
88. Richardson CA, Jull GA. Muscle control – pain control. what exercises would you prescribe? Manual Therapy. 1995(1):2-10.
89. Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976). 2002;27(4):399-405.
90. Hides J, Wilson S, Stanton W, et al. An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine (Phila Pa 1976). 2006;31(6):E175-8. doi: 10.1097/01.brs.0000202740.86338.df.
91. Grenier SG, McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabi. 2007;88:54-62.
92. Stanton T, Kawchuk G. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine (Phila Pa 1976). 2008;33(6):694-701. doi: 10.1097/BRS.0b013e318166e034.
93. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol. 2007;17(5):556-567. doi: 10.1016/j.jelekin.2006.07.004.
94. Brown SH, Vera-Garcia FJ, McGill SM. Effects of abdominal muscle coactivation on the externally preloaded trunk: Variations in motor control and its effect on spine stability. Spine (Phila Pa 1976). 2006;31(13):E387-93. doi: 10.1097/01.brs.0000220221.57213.25.
95. Oh JS, Cynn HS, Won JH, Kwon OY, Yi CH. Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. J Orthop Sports Phys Ther. 2007;37(6):320-324.
96. Kavcic N, Grenier S, McGill SM. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine (Phila Pa 1976). 2004;29(11):1254-1265.
97. Konz R, Fatone S, Gard S. Effect of restricted spinal motion on gait. J Rehabil Res Dev. 2006;43(2):161-170.
98. Schwab JS, DiAngelo DJ, Foley KT. Motion compensation associated with single-level cervical fusion: Where does the lost motion go? Spine. 2006;31(21).
99. Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P. Dynamic stabilization adjacent to single-level fusion: Part II. no clinical benefit for asymptomatic, initially degenerated adjacent segments
after 6 years follow-up. Eur Spine J. 2010;19(12):2181-2189. doi: 10.1007/s00586-010-1517-4.


Learning about Movement – 2012 – Part 1

This is part 1 of a series of posts reflecting on some highlights in learning about movement that I experienced in this last year. I hope to be able to do this on an annual basis as a record of self-reflection and hopefully provide some value to others out there on the same journey.

Applied Functional Science / Chain Reaction™ Biomechanics

SKBK_WuShu_Aerial_R

I have previously discussed my interest in going more in depth into multiplanar movement with my posts on 3D stretching as well as regional interdependence. I have used the FMS and SFMA off and on for a few years and felt they were both efficient and useful for their respective purposes, and I love that the research community is actively exploring the validity and reliability of these tests. I will still utilize components of these tests from time to time. However, I have personally found I need to change to a more customized approach to evaluation. In the past, I have found that in the middle of testing, I would break out of the protocols established trying to “tease” out something that did not fit cleanly into any of the tests. Part of this is just my nature, I have a difficult time adhering to standardized procedures and the way I do things just kind of evolves and varies depending by how I perceive something is presented to me. As these breakout sessions grew in complexity, I knew that for me personally I needed to explore some other philosophies which probably have figured out things I have yet to even think to ask about. Gary Gray’s Applied Functional Science (AFS) was the first approach that peaked my interest after that point. Gary Gray arguably pioneered much of the functional training movement, with Gray Cook stating publicly he has been strongly influenced by Gary Gray’s thought process. However, getting to the point of wanting pursue learning about the AFS approach has been a 4 year journey. When I first watched videos of Gary demonstrating and discussing his thought process, I completely disregarded it because my bias at the time of what I was seeing was an awful amount of poor quality movement with no regard for what is currently considered stability, in particular with movement of the spine. But over time, I could not deny that this freedom of motion looked more useful than I had first thought. I finally bit my lip and jumped in, eventually realizing I need to at least give it a try. It was probably one of the best decisions I could have made and now has significantly influenced how I view movement and exercise prescription.

I was given the opportunity to be exposed to the AFS approach through a nine week clinical rotation at Shoreline Sport & Spine in Spring Lake, MI. There are currently 6 Fellows of Applied Functional Science™(FAFS) at this location. A FAFS has completed a 40 week fellowship through Gary Gray’s Applied Functional Science (AFS) approach. The clinicians at Shoreline have integrated AFS with a wide variety of manual therapies and other interventions which was a fantastic eclectic experience that allowed me to explore a number of ways to integrate this philosophy.

Before presenting on this topic, I must first acknowledge that these are my personal reflections on the experience, and if they are in error, they should not reflect upon the excellent clinicians at Shoreline Sport & Spine. I am certain more than one FAFS will perceive I might have missed the boat on key points, and to that, I respond that I plan to formally take a Chain Reaction™ course in the future to see what else I might have missed. Furthermore, I am commenting on but a drop in the ocean of what the AFS system entails. The “Functional Nomenclature” alone requires a 44 page manual to address simply the language and fundamental principles. That being said, here are some key things I learned from this experience:

“Drivers facilitate chain reactions throughout the body”

This was the earliest, most applicable, concept I learned from my exposure to the AFS/Chain Reaction model. It may seem like a simple statement but it is incredibly profound when broken down even a small amount. Rather than simply thinking about one joint moving on another and leaving it at that, the Chain Reaction model demands that every joint be examined from a proximal on distal and distal on proximal perspective, what are the joints above and below doing, and what planes of motion (sagital, frontal, transverse) all of the joints are moving in during any musculoskeletal action. Central to this is the concept that during movement, a driver leads the movement and the joints above and below follow that same movement, but at different speeds as they progressively move in the direction dictated by the driver. This delay in speed/timing of a bone following another bone is the Chain Reaction explanation for much of what we understand about arthrokinematics. When bones move on top of each other in multiple planes of motion in the various representations of roll, glide, spin, etc.,  they are doing so according to the congruencies afforded to them to allow them to follow the next bone and joint as led by the driver.

In most of our manual therapy courses, we examine relative motion of one joint on another and addresses joint movement in various planes of motion based on arthrokinematics. Traditionally, looking at joints this way was left to the manual therapy realm and not the exercise prescription realm. Oddvar Holten likely made the earliest attempt to merge the manual therapy perspective with exercise prescription with his Medical Exercise Therapy (MET – Not to be confused with muscle energy technique) which focused on utilizing various apparatuses to isolate spinal segmental levels and extremities and then focusing on patient induced movement into one or more planes of motion specific to the desired outcome determined in the manual therapy diagnosis. The Chain Reaction approach more broadly addresses this by including concepts more similar to regional interdependence and primarily using the patient’s own body and extremities to control the levels of segmental or joint emphasis through prepositioning such as: Holding on to a stable or unstable support, modifying the weight bearing surface (wedges, angles, instability), conscious prepositioning, etc. It then utilizes another joint or point of the body above or below (could be FAR above or below) to facilitate movement at the joint in the plane, or planes, desired. This approach is both a diagnosis and a treatment, which is the focus of the AFS approach. It integrates extremely well with existing manual therapy interventions, or in Gary’s opinion, independent of traditional manual therapy models, resulting in him developing his own manual therapy system specific to the AFS called Functional Soft Tissue.

Getting back to the idea of a “driver”. A driver is anything which “drives” motor behavior. This could be any part of the upper extremity, lower extremity, trunk, neck, head, eyes, sense organs, and/or even fears and beliefs. The driver itself has numerous variables which can be applied to it: Is it open or closed chain based? What action is performed? What is the direction of movement? What is the speed? What are the force demands? Etc. etc.. This is just a small list amongst many other variables, not even addressing fears and beliefs.  The entire process can get very complex, very quickly, when broken down in the nomenclature which requires looking at every movement from the perspective of:

  • What environment is it occurring in (given available, or specified with certain controls on stability)?
  • What is the beginning position (upright, seated, kneeling, prone, supine, sidelying)?
  • What exactly is the driver (hand, knee, foot, pelvis, trunk, shoulder, etc)?
  • What is the triangulation (direction/target)?
  • What is the action (squat, lunge, reach, pull, etc)?
  • What is the ending position?

I am not qualified to go into that sort of detail, so instead I will provide a broad overview with a contemporary example. Many of us are already applying general versions of this thought process, but do not realize how far we can take it. I will use the example of a kettlebell swing.

 Kettlebell Swing

If you give a new client a kettlebell and only cue them to swing the kettlebell, they will instinctively “drive” the motion using the arms and shoulders, not their hips as you may have originally intended. They do this because you just gave them a cue which facilitates a motor pattern to accomplish the goal in the simplest way the brain understands, which is to swing their arms to swing the kettlebell, rather than to accomplish the exercise prescription goal you had intended, which was likely hip extension. If you change the cue to “Drive the hips forward”, you changed the driver of the motion to the hips, rather than the arms. Now in order to produce the force to swing the kettlebell, the individual will use a hip extension strategy. You just changed the entirety of the neuromuscular patterns utilized, even though you had the exact same exercise setup. Change the driver and the motor behavior changes.  Now, if you expand this to joint by joint, things get really interesting.

Take for example working mobility and stability of hip internal rotation. There are a handful of non-weight bearing activities which involve the femur actively or passively internally rotating on the pelvis.

ch158f14

We may begin with a manual therapy intervention to address mobility, then provide a mobility exercise, then a stretch, then we prescribe an exercise for stability, then we address another joint which may be associated, and we give it a mobility exercise, and a stretch, and a stabilization exercise, on and on we go. We may end up providing a large amount of exercises, all of which take time, with very specific cues and details to remember. Now with AFS, if we apply the concept of a driver along with any number of subtle changes, or “tweaks” as Gary likes to call them (the process is called “tweakology”), we can tailor a custom exercise specific to our patient needs across multiple joints with reduced need for extensive cuing and details. This can be done with fewer exercises overall because we can integrate mobility, stability, and movement across multiple joints, in multiple planes of motion, into simple exercises which require less time for the patient perform. Progression and regression are simple to teach because you are using movement patterns the client/patient already knows, you simply tweak one or two components to make changes towards the movement you want to improve.

As I am already far over my target word count for this post, I will finish with a video in which I discuss some basic strategies to emphasize hip internal rotation in weight bearing and function: