The Misunderstood QL

On January 19, 2012, in Abdominal Training, Examination, General, by Craig Liebenson
Thanks to Chad Waterbury for filming & posting Videos of the assessment & training for the lateral stabilizers of the torso & pelvis. Here is an introduction to the function of the QL & lateral stabilizers.


I will be showing

Assessment

Side Plank Endurance (lateral chain)
Importance of Asymmetry

Basic Training

Side Plank
: Key Points – couple Lats w/ QL by packing shoulder down

Plank Roll
: Key Points – maintain core stability by rolling not twisting; pack shoulder down throughout

Side Bridge
: Key Points – pack shoulder down; use hip hinge pattern to achieve plank form knees to occiput

Functional Progressions

The Kettlebell Carry
- Suitcase
- Rack & Bottoms Up w/ elbow tucked in
Key Point – elbow tucks in to reactively facilitate core; Bottoms Up also facilitate core

- Waiter (overhead) Rack & Bottoms Up
Key Points – Use weight that allows for ideal gait pattern; observe for motor control errors such as pelvic or shoulder unleveling

Developmental Exercise

The Baby Get-Up

- Note: This is essentially the movement achieved by an ideal 7.5 month baby. It is “hard-wired”
- Goal: Achieve side plank on knee & feel lateral chain w/out feeling shoulder/neck region
- Key Point – Push off wall w/ balls of foot on bottom leg



Check out the Basic, Functional & Developmental Series of Training Exercises for the Lateral Stabilizers of the Trunk I would like to credit 2 great inspirations – Pr Stuart McGill & Dr Pavel Kolar PT





References:
Endurance times for low back stabilization exercises- clinical targets for testing and training from a normal database

Functional training with the kettlebell. J Bodywork Movement Ther. 2011 Oct;15(4):542-4.The Baby Get-Up J Bodywork Movement Therapy 2012 Jan; 16(1):124-6

Sources from "craigliebenson.com"

Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention

On Aug. 18, 2008, just a couple of weeks beforethe start of the NFL season, a 45-year-old NFL official was referred to us with a diagnosis of right Achilles tendinosis with specific orders from our medical director to check his orthotics and to startthe Graston Technique® as part of his treatment.

History

Three years before this bout of right Achilles pain/tendinosis, this patient had a diagnosis of bilateral achilles tendinitis and right plantar fasciitis. At that time,the patient presented with tight gastroc/soleus and had pain with running on his tread mill, which is what heused to get into shape for the upcoming season. He had been trying to stretch, was strengthening, and was taping his ankles for the support he thought he needed. As this was prior to use of Graston Technique,® his treatment consisted of: iontophoresis; XFM to each Achilles tendon and the right plantar fascia; stretched the gastroc andsoleus; strengthened the lower legs, and ordered orthotics. The patient had nine treatments, was discharged with only mild stiffness in the morningsfor 15 minutes until warmed up and had instructions to continue home exercises.

This history was noted when he presented in August of 2008 with mainly right Achilles pain at the medial M-Tjunction, stiffness in the calf with running that progressed to bothering him when walking, and tingling inthe plantar aspect of both feet during running. The patient said he thought he had been stretching correctly,was taping his gastroc and ankles with no relief of the pain and stiffness, and that he also felt his orthotics rocking in his shoes. The physician had given him Don Joy Air heels and they did afford some relief. This patient was fairly active in his off-season playing golf and tennis. I was asked to assist with this case because I was the clinician on our staff who was certified in GT and because I had the most experience doing gait evaluations and orthotics.

Exam Findings

Tenderness and tissue restriction at the right med MT junction, hypertonicity of the gastroc, soleus, hamstrings, and plantar fascia bil, decreased flexibility of the great toes in flexion bilaterally with excessive “grit”felt in the extensor tendon of the right > left great toes as well as in all of theafore mentioned areas bilaterally,decreased dorsiflexion with knee flexed on the right only, weakness in inversion and eversion > plantar flexion, decreased balance on the right LE, good hip/pelvis alignment, over pronation in gait with moderate RF varus deformity, moderate FF varus deformity,slight tibial varum bil, the metatarsal arches had collapsed bil, typical over pronation calluses noted on themedial aspect of the great toes and over the second and third met heads, and the posting on the orthotics he had from 2005 had compressed in the rear foot.

Treatment

Because of the bilateral findings, the physician sent aprescription to treat both lower extremities. We rushed his orthotics in for refurbishing asking for RF postingof 6 degrees, FF posting of 2 degrees, an extension of ¾ length to full length with 1/8” PPT padding and CASE REPORT
Achilles, Plantar Pain Resolved in NFL Official Season Started Successfully after GT Intervention By Terri Angelo, MA, ATC, Summa Health System, Akron, OHT his article was published in the Fall 2010 issue of THE EDGE, a quarterly publication by Graston Technique® 2 leather covers added along with PPT teardrop metpads added that I made and sent with the order. The patient warmed up with walking before each treatment; on day 1, GT2 was used first, brushing over the hamstrings, the calf and plantar fascia, and the knobs were used on the sides of the Achilles. GT4 was used more aggressively over the hams and calf during active knee flex and plantar flexion, followed by GT3 used in multi-direction over the med gastro-Achilles MT junction, the Achilles tendons, and the insertion and middle portion of the plantar fascia. The single beveled edge of GT6 was used on the great toe extensor tendons and over the Achilles tendons,working with the single beveled tip on the under side of the Achilles during active PF. This was followed by stretching of the gastrocs and soleus, hams and hip flexors, light strengthening using the Pilates Reformer doing a leg press with heel dip motion, BAPS work,seated calf raises, and eccentric gastroc ex with Pre-Mod e-stim on sub-acute, sweep to light contraction with ice after the session on each calf. GT was progressed aggressively over the next four treatments to using GT4 over the calves and Achilles while thepatient was doing resistive toe raises and while doing the BAPS rotations on each leg. The Achilles tendonswere taped with elastoplast for running.

Outcome

The patient felt some pain relief after the first GT treatment, and by the fifth and final treatment over 18 days, he had no more plantar fascial pain; he could run with no pain in either Achilles; there was minimal to moderate ecchymosis fading, and he felt good with the new orthotics, which also relieved the tingling inthe feet. At the patient’s request, his ankles were taped prior to each game. The patient was so impressed with how GT saved his season that he has referred family members to us and has sent colleagues to other cities to receive it.

By Terri Angelo, MA, ATC, Summa Health System, Akron, OH

Hip weakness again associated with anterior knee pain

Anterior knee pain, also known as patellofemoral pain syndrome, is characterized by knee pain around the patella and patella tendon. It’s quite common in females, and has been associated with muscle imbalances at the hip. Recently, researchers found inadequate control of weight-bearing activities, reporting increased femoral adduction and internal rotation, which may affect patellar movement (Magalhaes et al. 2010). Brazilian researchers examined 50 sedentary females with patellofemoral pain syndrome and compared their hip strength to 50 control subjects without knee pain. They used a handheld dynamometer (Nicholas, Lafayette Instrument Co) to quantify the strength of 6 major hip muscles on both the right and left sides. Their results were published in the Journal of Orthopedic and Sports Physical Therapy.

They found that sedentary females with unilateral anterior knee pain had 15 to 20% less strength in hip extension, external rotation, abduction and flexion, compared to a control group. Females with bilateral pain had weakness in all 6 hip muscles, ranging from 12 to 30% deficits. Subjects with anterior knee pain had 20% less hip abduction strength compared to the uninjured side. This was the first study to demonstrate weakness in sedentary females; most other studies have been completed on female athletes.

This study had a few minor limitations. The examiner was not blinded to the control or experimental group. This study was also retrospective, leaving us unable to determine cause-and-effect. More studies are needed to determine if hip weakness is a cause or result of patellofemoral pain syndrome. Furthermore, this study did not investigate the effects of a strengthening program.

This study supports Dr. Janda’s classification of muscle weakness, noting decreased strength of phasic extension, abduction, and external rotation. It also noted weakness of hip flexors and remaining muscles in females with bilateral knee pain. Janda noted that flexion, internal rotation, and adduction were tonic motions, prone to tightness. This study did not assess muscle length; however, it’s possible that the muscle weakness may be related to short muscle length-tension. Exercises including hip extension may be effective at improving anterior knee pain in females.

REFERENCE: Magalhães E, Fukuda TY, Sacramento SN, Forgas A, Cohen M, Abdalla RJ. A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome.J Orthop Sports Phys Ther. 2010 Oct;40(10):641-7.

by Dr. Phil on January 24, 2011

Fall Prevention Facts

Introduction

Falls can be catastrophic. The 2 year mortality rate for 75+ year old individuals who fall and break a hip is greater than for heart disease or even cancer! Yet, falls can be prevented. It doesn’t take any surgery or medication, just simple, safe, regular strength and balance balance exercises such as in a Tai Chi class.
A fall can deprive an older person of their ability to lead an active, independent life. Each year tens of thousands of older men and women are disabled, sometimes permanently, by falls that result in broken hips and other bones. Besides strength and balance exercise, simple changes at homes and in daily routines can prevent such falls.

When should I see a doctor?
Any person over 65 years of age should have their balance tested. Diabetes, arthritis, and poor vision can each contribute to diminishing agility, coordination and reflexes. Certain medications may also have side effects such as dizziness or light-headedness.
Osteoporosis is a particular risk factor for a fracture due to a fall. Bone density declines in women after menopause and in older people in general. For someone with severe osteoporosis, even a minor fall may cause fractures to occur. Thus preventing falls is very important for all older persons.


What can I do for myself?

Falls and accidents don’t “just happen.” There are steps that can be taken to reduced our chances of falling. Here are some things you can do to prevent falls and fractures.

Check with your pharmacist if dizziness or light-headedness is a side effect of any of your medication

Be evaluated for diabetes

Have your vision and hearing tested.

Wear a properly fitted hearing aid and eyeglasses if recommended by your doctor.

Don’t drink too much alcohol

Avoid become overheated or dehydrated

Don’t get up too quickly after sitting or lying down. Low blood pressure may cause dizziness at these times.

If your walking is unsteady or if you sometimes feel dizzy, use a cane, walking stick, or walker.

Be particularly careful when walking outdoors on wet or icy sidewalks.

Don’t wear just socks on stairs or waxed floors where you could easily slip.

If you are carrying something when going up or down a stairway, keep one hand on a handrail.
Ways to increase your activity.

Keep up a regular program of exercise.

Join a Tai Chi or similar type exercise class

A simple self-test for balance involves testing if you stand in a doorway on 1 leg for 10 seconds

If you can, try it with your eyes closed

If you can’t do it for more than a second or two then try standing with 1 foot in front the other.

Always reach out to the doorjam for support if needed

Here are some other examples of ways to modify your activity:

How to Make Your Home Safe Checklist:

Stairways & hallways should have:

good lighting and be free of clutter

secure handrails of all stairs

light switches at the top and bottom of stairs.

Bathrooms should have:
grab bars placed in the bath tub or shower and if necessary near toilets
nonskid mats, traction strips, or carpet on all surfaces that may get wet
nightlights.

Bedrooms should have:
night lights or light switches within reach of bed(s)
area rugs should be removed or firmly attached to the floor
telephones that are easy to reach, near your bed.

Living areas should have:
couches and chairs with arm rests and at proper height to get into and out of easily.
Loose cords should not be present in any walkways


Rehabilitation

When you see a functionally oriented health care provider they will give you a comprehensive functional assessment. This will include a battery of tests to assess your balance, agility, coordination, strength, and flexibility. One of the most important treatments will involve balance training.

Your health care provider will identify balance exercises which you can do for a few seconds, but are not too easy.


For More Information

The U.S. Consumer Product Safety Commission can send you a free copy of the booklet Home Safety Checklist for Older Consumers.
U.S. Consumer Product Safety CommissionWashington, DC 20207800-638-2772800-638-8270

(TTY)Website: http://www.cpsc.gov/CPSCPUB/PUBS/701.html

Source from "clinicalrehabspecialists.com"

Abdominal Exercises Made Simple
Part 3 - Advanced Exercises

Once the basics of abdominal bracing and dying bug exercises are mastered curl-ups, side bridges, advanced dying bugs, and abdominal bracing in functional positions such as the squat are recommended. For each exercise perform 8–12 slow repetitions. This type of training should be performed twice a day.

Bicycle kicks on a foam roll
•Lie on your back on the foam roll.
•Bring your feet up in the air so that your shins are horizontal and your thighs vertical (90/90 position).
•Place both hands on the ground.
•Tighten your ‘‘core’’ by pushing your ribs down without flattening your lower back or holding your breath.
•Alternately kick your legs out like you are riding a bicycle (Figure 1).


Dying bug on a foam roll

•Lie on your back on the foam roll.
•Bring your feet up in the air so that your shins are horizontal and your thighs vertical (90/90 position).
•Reach to the ceiling with one hand as high as you can while your other hand stays on the ground for support and balance.
•Tighten your ‘‘core’’ by pushing your ribs down without flattening your lower back or holding your breath.
•Tap a knee with the opposite hand (Figure 2a).
•Then extend your arm and leg on opposite sides (Figure 2b).
•Progress by adding a small medicine ball in your hand.


Wall slide squat

Lets transfer what you have learned on the floor and foam roll to an upright more functional activity such as squatting.

•Stand with your back against a wall.
•Raise your arms overhead bending them at the elbow so that the back of your hands touch the wall. J At the very least the thumb side of your hand should be on the wall.
•Move your feet a few inches forward of the wall and be sure the back of your head touches the wall as well.
•You should notice that your back arches somewhat.
•Tighten your ‘‘core’’ by pushing your ribs down without flattening your lower back or holding your breath (Figure 3a).
•Hold this abdominal brace and slide down the wall with your torso, but leaving your arms fixed.
•Your elbows should straighten (Figure 3b).
•Try to keep your back flat and ribs down in front while you slide up and down the wall.

Sorces from : clinicalrehabspecialists.com