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Being H.I.P. (High (High Intensity Intensity Progression) Progression) with Multiple Movement Planes Wendy Williamson,, Ph.D. Post Rehabilitation Specialist ACE AHFS & CPT, and NASM CPT Being H.I.P. Focus and Direction _ Structure of the Spine _ Lumbopelvic Regional Contributors _ Planes of Motion _ Research – What do we know? _ ASSESSMENT _ Progressive Training _ Special Considerations _ Pictures (lots)!! How do we move? Sagittal Plane isis vertical vertical and and extends extends from from front front to to back. back. The The median median sagittal sagittal plane plane divides divides the the body body into into right right and and left left halves. halves. Frontal Plane also also known known as as coronal coronal and and lateral lateral plane, plane, is is vertical vertical and and extends extends from from side side to to side. side. Transverse Plane isis horizontal horizontal and and divides divides the the body body into into upper upper and and lower lower portions. portions. Tell me what plane of motion? Squat Squat and row Walking lunges Lateral DB raises Standing band torso twist One arm band chest press out Isometric hold “walk-aways” Ipsilateral one arm, one leg row Prone plank on physio ball One leg standing bicep curl Cross pull across on one knee Overhead rope trice THREE DIMENSIONS OF THE SPINE Plus, sacrum and coccyx Sections and classifications of Vertebrae Vertebrae – Side View Intervertebral disc Core Re-defined • The core is a double-walled cylinder – consisting of the lower back and abdomen and the upper back and chest (the trunk), which links to the limbs via the shoulder girdle (scapula) and the pelvic girdle (pelvis). • The inner wall of the core cylinder – deep local muscle system (inner core) - stabilizers • The outer wall of the core cylinder is made up of the outer global muscle (stabilizers and mobilizers) – These muscles influence postural alignment and contribute to the production and control of ROM. Comerford, M. (2008) Core Stability Training for Peak Performance, Kinetic Control. Spine forces Ground forces Trunk forces Spine forces Converging forces Spinal Movement FLEXION • From a standing position, most common movement • Mean ROM of lumbar flexion is 56.6 degrees. • Lumbar spine should NOT complete more than 50% of flexion before hip flexion is initiated. • At completion of flexion there should be a straightening or flattening of the lumbar spine. Sahrmann, Shirley. (2002) Diagnosis and Treatment of Movement Impairment Syndromes, Mosby, Inc., pg 58. Flexion • When the ROM is 50 degrees, the lumbar spine reaches a maximum flexion curvature of 20 degrees. • (White and Panjabi) Flexion-extension range between the vertebral segments is approximately – 4 degrees – upper thoracic spine – 6 degrees in the midthoracic spine – 12 degrees in the lower thoracic spine • Increases approximately 1 degree for each lower segment, reaching maximum ROM of 20 degrees between L5 and S1. Flexion • In maximum flexion – Erector spinae muscles become inactive • Thus, the stress is on the passive elements of the muscles and ligaments • Subjects with LBP – move more in the lumbar spine than at the hips during the 30-60 degree phase of forward bending – fail to have all segments to maintain their contribution to motion. • Typically, – Men tend to flex more readily in the lumbar spine – Women flex more easily in the hips Lumbopelvic Regional Contributors Muscular Players The cylinder Multifidus Transverse Abdominus Rectus abdominus and obliques Internal Oblique _ Erector spinae Rectus Abdominus _ External Oblique Gluteals and Hamstrings Hamstring Muscles Semi- membranosus Biceps Femoris Semitendinosus Gluteus Maximus Extends Laterally rotates Lower fibers assist in adduction of the hip joint The upper fibers assist in abduction Gluteus Medius Abducts the hip joint. Anterior fibers: • medially rotate and • may assist in flexion of the hip The posterior fibers • laterally rotate and • may assist in extension Gluteus Minimus Abducts Medially rotates May assist in flexion of the hip joint. Hip External Rotators Piriformis Lateral rotation of hip When hip is flexed, may assist in extension and abduction Lays next to the sciatic nerve Obturator Externus, Obturator Internus, Gemellus Superior, Gemellus Inferior, Quadratus Femoris Lateral rotation of hip H.I.P. Direction 1. Movement planes • Sagittal Plane • Frontal (Coronal or lateral) plane • Transverse Plane Sagittal Plane The median sagittal plane divides the body into right and left halves. What do we know about the Sagittal plane? • Normal isolated lumbar ROM is 72º in the sagittal plane. (Deutsch, 1996; Graves et al, 1990) • Advanced age, weight, pelvic structure, and body posture have all been shown to affect sagittal plane alignment of the human spine. (Harrison et al, 2002) What do we know about the Sagittal plane? • Live studies show that repetitive flexion with concurrent compression disc can cause prolapsed (Callaghan injuries. (Callaghan and and McGill, McGill, 2001) 2001) (falling (fallingout outof ofplace) place) • Repeated flexion causes muscular (Dolan fatigue. (Dolan and and Adams, Adams, 1998) 1998) Sagittal Plane: Studies Study: Study: To To quantify quantify (sagittal (sagittal plane) plane) the the moment moment arms arms of of the the lumbar lumbar erector erector muscles muscles group group as as aa function function of of torso torso flexion, flexion, and and identify identify individual individual characteristics characteristics that that are are associated associated with with the the function function of of torso torso flexion. (Jorgensen et et al, al, 2003) 2003) flexion. (Jorgensen Sagittal Plane: Studies Results: the largest _ in the lumbar erector muscle group from neutral to 45-degree flexion occurred at the L5-S1 level. (Jorgensen et al, 2003) Sagittal Plane: Studies Conclusion: The movement arm of the lumbar erector muscle mass decreases as the torso flexes forward. (Jorgensen et al, 2003) Sagittal Plane: Studies Study: To determine whether physical activity influences the mechanics of the pelvis in the sagittal plane. 243 243 individuals individuals were were split split into into 33 groups groups based based upon upon their their physical physical activity: activity: (1)professional (1)professional sportspersons, sportspersons, (2)physically (2)physically active active individuals, individuals, & & (3)non-active (3)non-active individuals. individuals. Each had their pelvis mobility measured in flexion and extension. Sagittal Plane: Studies Result: There was significant influence of physical activity both on pelvis flexion and extension in women. The range of flexion and extension was significantly greater in sports women than in sportsmen. Sagittal Plane: Studies Also, the range of flexion & extension was greater among physically active women than physically active men. Overall, the professional sportsperson or recreationally physical activity person can improve the movement of the pelvis in the sagittal plane among women. ((Kuszewski Kuszewski et et al, al, 2004; 2004; Saulicz Saulicz et et al, al, 2004) 2004) What do we know about the Sagittal plane? • Flexion and extension movements or positions have been advocated in the treatment of various forms of low back dysfunction • Why? ….due to the potential pain relieving effects attributed to displacements of the intervertebral disc (IVD). (Edmondston (Edmondston et et al, al, 2000) 2000) Coronal, Frontal or Lateral Plane Vertical and extends from side to side; divides the body into front and back halves. What do we know about the frontal plane? Study: To investigate the relation between new case occurrences of low back pain and prior personal, anthropometric (human (human body body measurement), measurement), or functional characteristics. 215 215 workers workers answered answered aa questionnaire, questionnaire, aa clinical clinical examination, examination, anthropometric anthropometric measurements, measurements, and and aa set set of of functional functional tests tests on on an an isoinertial isoinertial dynamometer. (measures resistance resistance to to change) change) dynamometer. (measures Measurements Measurements were were taken taken again again after after aa one-year one-year interval interval from from workers workers without without any any history history of of LBP. LBP. What do we know about the frontal plane? Results: The development of LBP is related to frontal plane imbalance of the • trunk, • lower body weight, • and perception of heavy lifting efforts (Masset at the workplace. (Masset et et al, al, 1998) 1998) Transverse Plane Divides the body into upper and lower halves. What What do do we we know know about about the the transverse transverse plane? plane? A number of abdominal and back muscles are involved in producing axial rotation of the trunk and they have different functional roles, namely prime movers, antagonist and stabilizers. (Ng et al, 2002) Axial: center pivotal point What What do do we we know know about about the the transverse transverse plane? plane? Prime movers: muscle responsible for the initiation and maintenance of movement Antagonist: the muscle that opposes the contraction of the prime mover Stabilizer: synergist designed to stabilize a joint during the movement. (Ng et al, 2002) Neuromuscular Efficiency Neuromuscular system allows prime movers, synergists, stabilizers, and neutralizers to work TOGETHER synergistically as an integrated functional unit. (Clark, 2000) What What do do we we know know about about the the transverse transverse plane? plane? Study: McGill (2005) focused on EMG activity of the trunk musculature to determine the link between occupational twisting & the _ incidence of LBP. Measurements of three myoelectric relationships were tried on 10 men and 15 women. – – – Assessed the myoelectric relationships during isometric exertions Muscle activity was examined during dynamic axial twists trials (velocity of 30-60°s) Formulation of a model consisting of a 3-diminisional pelvis, rib cage, and lumbar vertebrae and driven from kinematic measures of axial twist and muscle EMGs. What What do do we we know know about about the the transverse transverse plane? plane? The coactivity suggests that stabilization of the joints during twisting is far more important to the lumbar spine than production of large levels of axial torque. (McGill, 2005) What What do do we we know know about about the the transverse transverse plane? plane? Wagner and colleagues (2005) revealed that the stability of spinal movements depended primarily on the geometrical arrangement of muscles and the position of the centre of rotation of the spine. (Wagner et al, 2005) What What do do we we know know about about the the transverse transverse plane? plane? The rotation of the spine was affected in turn by the activities of the profound Internal obliques muscles, obliquus externus, obliquus internus Multifidus or multifidus muscles. External obliques (Wagner (Wagner et et al, al, 2005) 2005) What What do do we we know know about about the the transverse transverse plane? plane? The stability of the system was influenced by the fibre-type distribution of muscles. - i.e. a high percentage of fast-twitchfibres supported the stabilization. (Wagner (Wagner et et al, al, 2005) 2005) Example: QUICK RELEASE EXERCISE What What do do we we know know about about the the transverse transverse plane? plane? TRAINING: Advantageous - if directed towards not only enhancing the endurance capacity of the muscles, but also increasing the cross-sectional area of oblique fasttwitch-fibres (Wagner (Wagner et et al, al, 2005) 2005) What What do do we we know know about about the the transverse transverse plane? plane? Torso twisting machines found in fitness facilities: – Can and will lead to troubles for many athletes. – There will always be individuals who are able to tolerate specific modes of loading. – Some of the best discus throwers cannot train with these types of exercises without exacerbating their back troubles. (McGill, (McGill, 2004) 2004) H.I.P. Direction Keep in mind………. Prior to spinal exercises, it is critical to warm up Then, begin an exercise/training session with some spine-stabilization exercise If the spine is flexed in one maneuver, then it probably should return to neutral or extension for the next maneuver. (McGill, 2004) H.I.P. Direction Keep in mind (cont.): The intervertebral discs are highly hydrated in the morning. H.I.P. Direction a. a. The The annulus annulus is is subjected subjected to to much much higher higher stresses stresses during during bending bending under under these these conditions. conditions. b. b. Performing Performing spine-bending spine-bending maneuvers maneuvers at at this this time time of of day day is is unwise. unwise. c. c. Discs Discs generally generally lose lose 90% 90% of of the the fluid fluid that that they they will will lose lose over over the the course course of of aa day day within within the the first first hour hour after after rising rising from from bed, bed, we we suggest suggest simply simply avoiding avoiding this this period period (McGill, for (McGill, 2004) 2004) for exercise. exercise. H.I.P. Direction Strategic Periodization of Planes Safest plane of motion?? Depends on ASSESSMENT ASSESSMENT WHY? ROM ROM dysfunction dysfunction athlete athlete vs. vs. nonathlete nonathlete Proprioception Proprioception biomechanics biomechanics body body awareness awareness musculoskeletal musculoskeletal imbalances, imbalances, injuries, injuries, etc. etc. H.I.P. Direction Other issues - Trendelenburg – glute glute weakness weakness as as aa result result of of hip hip drop drop during during one one leg leg stance stance and and gait. gait. - Sacroiliac Joint dysfunction - Sciatica pain - Spinal Stenosis - Spondylosis Joint Issues - Hip replacement - Knee replacement Functional Movement • Integrated • Multi-planar movements –Involving accelerations –Decelerations –And stabilization (Clark, 2000) Functional Movement To develop functional strength and neuromuscular efficiency…..active individuals must train, recondition, and rehabilitate in a functional environment. (Clark, 2000) H.I.P. Direction Progressive training is the key to avoiding disc damage. (McGill, 2004) Functional movements in conjunction with planes * Supine * Seated in chair * Seated on F-ball * two leg * One leg * * * * * Reebok core bd. Airex pad Balance Board Dyna discs etc. _ combination planes of motion H.I.P. Direction Sagittal Plane flexion and extension, stability Frontal stability Transverse spinal rotation, stability SAGITTAL Plane Movements Supine abdominal Crunch with hip/knee flexion SAGITTAL Plane Movements Standing Band Row Progressing from standing to dyna discs SAGITTAL Plane Movements Band Row _ Two Leg balance board row _ One leg balance board row SAGITTAL Plane Movements Spinal Flexion with single leg extension PHASE I SAGITTAL Plane Movements Start out reaching at a higher level and then progress to the floor. Key: Tight Glutes, core, and hamstrings Phase II SAGITTAL Plane Movements Don’t Forget: Wall Squat SAGITTAL Plane Movements Phase III Spinal Flexion on Unstable Surface SAGITTAL Plane Movements Squat Row SAGITTAL Plane Movements Squat Row with one leg; slight hip flexion SAGITTAL Plane Movements One Arm – One leg – Back Lunge Step Through FRONTAL Plane Movements FRONTAL Plane Movements FRONTAL Plane Movements Oblique Contractions: What other exercise is in the Frontal Plane? !!!THINK!!! Keep in mind: Knees Toes/heels Lordosis Kyphosis Elevated chest Smooth and slow Breathing !!!THINK!!! Keep in mind: Knees Toes/heels Lordosis Kyphosis Elevated chest Smooth and slow Breathing Transverse Plane Movements Supine: Manual Resistance Transverse Plane Movements Supine Transverse Plane Movements Seated: Manual Resistance Transverse Plane Movements S e a t e d Transverse Plane Movements - Make sure the knees are 90° - Can use cable, JC bands, FM Cable crossover machines - Knees and feet are in-line with hips - Shoulder and arms move with hands Standing Torso Twist Transverse Plane Movements Progression _ Transverse Plane Movements Dyna Discs Bosu Ball Transverse Plane Movements Square turns in transverse plane Transverse Plane Movements One arm, _ turn * pivot back foot * keep elbow tight * engage core before pressing out !!!THINK!!! Keep Keep in in mind: mind: Knees Knees Toes/heels Toes/heels Lordosis Lordosis Kyphosis Kyphosis Elevated Elevated chest chest Smooth Smooth and and slow slow Breathing Breathing Transverse Plane Movements Seated low to high Seated high to low Standing low to high Standing high to low Cables JC Bands _ LOW TO HIGH Transverse Plane Movements Seated low to high Seated high to low Standing low to high Standing high to low Cables JC Bands HIGH TO LOW _ Transverse Plane Movements Forehand / Backhand Movement, ie: Tennis Transverse Plane Movements Oblique work on one arm and one leg (opposite) at the bench Transverse Plane Movements OOPPSS!! Hands in front…. Bicycles Abs Combination Plane Movements Lunge / Twist with physio ball _ Combination Plane Movements Combination Plane Movements Wendy Williamson, PhD Post Rehabilitation Specialist Owner: Williamson Fitness Consulting www.williamsonfitness.com [email protected] (316) 371-6971 Bibliography Callaghan, J.P., and S.M. McGill. (2001) Intervertebral disc herniation: Studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force, Clinical Biomechanics, 16, 28-37. Clark, Mike. (2000) Low back pain, Personaltraining on the net, August 1. Deutsch, F.E. (1996) Isolated lumbar strengthening in the rehabilitation of chronic low back pain, Journal of Manipulative and Physiological Therapeutics, 19(2), 124-133. Edmondston, S.J., S. Song, R.V. Bricknell, P.A. Davies, K. Fersum, P. Humphries, D. Wickenden, and K.P. Singer. (2000) MRI evaluation of lumbar spine flexion and extension in asymptomatic individuals, Manual Therapy, 5(3), 158-164. Graves, J.E., M.L. Pollock, and D.M. Carpenter (1990) Effect of training frequency and specificity on isometric lumbar extension strength, Spine, 15, 289-294. Harrison, D.E., R. Cailliet, D.D. Harrison, and T.J. Janik. (2002) How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis?, Journal of European Spine, 11, 287-293. Jorgensen, M.J., W.S. Marras, P. Gupta, t.R. Waters. (2003) Effect of torso flexion on the lumbar torso extensor muscle sagittal plane movement arms, The Spine Journal, 3, 363-369. McGill, Stuart, Ph.D. (2004) Ultimate Back Fitness and Performance, Wabuno Publishers. Bibliography cont. Kuszewski, M., K. Knapik, E. Saulicz, and R. Gnat. (2004) The influence of sport activity on lumbar spine dynamics, Journal of Sports Sciences, 22(3), 241-242. Masset, DF, AG Piette, and JB Malchaire. (1998) Relation between functional characteristics of the trunk and the occurrence of low back pain: associated risk factors, Spine, 23(3), 395-365. McGill, S.M. (2005) Electromyographic activity of the abdominal and low back musculature during the generation of isometric and dynamic axial trunk torque: Implications for lumbar mechanics, Journal of Orthopaedic research, 9(1), 91-103. Ng, J.K.-F., C.A. Richardson, M. Parnianpour, and V. Kippers. (2002) EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls, Journal of Orthopaedic Research, 20, 112-121. Saulicz, E., R. Gnat, M. Saulicz, B. Bacik, and R. Plinta. (2004) The mobility of the pelvis in the sagittal plane in relation to physical activity, Journal of Sports Sciences, 22(3), 242-244. Wagner, H., C.Anders, C. Puta, A. Petrovitch, F. Morl, N. Schilling, H. Witte and R. Blickhan. (2005) Musculoskeletal support of lumbar spine stability, Pathophysiology, 12, 257-265. Stuart McGill • University of Waterloo, Department of Kinesiology, Ontario, Canada • The spine biomechanics (SB) lab is just one of several that comprise the Biomechanics Laboratories. The broad mandate of the SB lab is to work toward understanding how the low back functions, how it becomes injured and then, formulate and test various strategies for optimal injury prevention and rehabilitation, and high performance training. • The physical lab is housed in two rooms - one for in vivo work with living humans, and another for in vitro work on spine specimens, both areas are well equipped with computers. • The lab is funded with NSERC operating grants plus many industrial R & D grants and contracts.