Download with Multiple Movement Planes

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.