Dynamic slings and optimal 3D function

Dynamic slings and optimal 3D function Abstract Trish Wisbey-Roth Olympic/Specialist Sports Physiotherapist (FACP), Masters of Sport Physiotherapy (AIS/UC) Active Rehabilitation Consultant Layered over the deep stabilising muscles are dynamic slings which both counter the effects of gravity and carry the large external loads associated with dynamic function. Discover how to efficiently recruit the posterior, anterior and lateral dynamic muscular/fascial slings of the body to optimise three-dimensional function for work, daily activity or sporting function. A must-attend session if you work in rehab and performance optimisation. Table of Contents Abstract 1 Posterior Oblique Sling 2 Grade 1 Isolating glut s from hamstrings - prone... 2 Alternative Grade 1 Supine pushing ball into wall, pushing through the heel using gluts and keeping hamstring relaxed2 Grade 2 Hip flexion/extension using partner... 3 Grade 3 Prone over ball (toes on ground) and dropping one shoulder... 3 Alternative Grade 3 Moving toward shin into flexion and rotation... 3 Grade 4 Small squat and moving dynamically... 4 Grade 5 Travelling straight lunge with spinal rotation... 4 Posterior longitudinal Sling 5 Grade 1 Sitting on ball... 5 Grade 2 Squats with ball against wall... 6 Grade 3 Eccentric hamstrings... 6 Grade 4 Hamstrings - all 4 s hip extension + exercise band (hip 90 degrees to hip extension)... 6 Grade 5 Step/stair jump with small bound... 7 Grade 5 Posterior oblique long and lateral sling. Eccentric hamstring control in standing with spinal rotation... 7 Lateral sling 8 Grade 1/2 External rotators activation... 8 Grade 1/2 Glut med in sitting... 8 Grade 2 ¼ squat with the ball and transferring weight... 9 Grade 3 Adding thoracic spine rotation slowly... 9 Grade 4 Eccentric oblique abdominal control with hip movement... 10 Alternative Grade 4 Glut Med for running/jumping... 10 Grade 5 Glut med against the wall ¼ squat, hip extension with thoracic spine rotation +.... 10 Anterior sling 11 Grade 1 Grade 2 Standing with weight transference... 11 Taking knee to side in supine movement through the hips with pelvic control... 11 Grade 3 Grade 3 Bridge on ball with side to side weight transference... 12 Eccentric abdominals and hip flexors... 12 Grade 4 Grade 5 Thoracic spine rotation/extension in kneeling... 12 Speed specific eccentric/concentric cuing for running jumping movements... 13 Post and anterior oblique post long and lateral slings 13 Grade 5 Eccentric abdominals and hip flexors with hip extension and arm reaching... 13 Trish Wisbey-Roth 2012 1

Posterior Oblique Sling Grade 1 Isolating glut s from hamstrings - prone These big muscles are important in supporting the pelvis and hips. If they do not work well your hamstrings (back of legs) will have to do twice the work and will probably be quite tight. Lie on your stomach with your knees bent and lower legs resting against the ball. Gently tense your bottom muscles without moving and keeping the back of your legs (hamstrings) relaxed. Hold for 10 seconds. It may take a while to be able to relax the back of your legs but it will come with practice. Glut/Hamstring differentiation in prone. Have ball against wall and participant prone with both legs bent up and resting against the ball. Alternative Grade 1 Supine pushing ball into wall, pushing through the heel using gluts and keeping hamstring relaxed Hip extension using ball: Supine, one leg positioned with hip at 90 and knee at 60 with ball against wall and foot resting midway on the ball. Other leg positioned with hip and knee flexed, foot flat on the floor. Push through heel into the ball using gluts and keeping hamstrings relaxed. Activate your deep stabilising muscles. Gently contract your bottom muscle and push the ball into the wall trying to keep the back of your thigh as relaxed as possible. It helps to think about trying to push the ball away by straightening from your hip rather than your knee.. Trish Wisbey-Roth 2012 2

Grade 2 Hip flexion/extension using partner Hip extension using ball and partners: Supine with one foot resting midway on the ball. Partners feet to feet ball in between. Move through hip and knee flexion and extension by pushing through foot into the ball using gluts and Activate your deep stabilising muscles. Gently contract your bottom muscle and push into the ball so that you start to move your leg from bent knee to straight. Your partner will be doing the opposite. Keep your hamstrings relaxed. Grade 3 Prone over ball (toes on ground) and dropping one shoulder Thoracic spine rotation prone over the ball. Drop one shoulder by bending through the elbow and rotating through the thoracic spine. Lumbar spine remains stable. Position yourself over the ball, with the ball supporting your pelvis. Activate your deep stabilizing muscles and bend at one elbow and drop through that shoulder. As you do this you will allow your thoracic spine to rotate. Bring that shoulder back to the starting point. Repeat on each side Alternative Grade 3 Moving toward shin into flexion and rotation Sitting on the ball with exercise band attached to point above shoulder height and directly behind. Hold onto the exercise band with both hands above your head. Bend forward at the hips and rotate so that you are taking the band toward one shin. Your spine will now bend and rotate at the same time as you move. Ensure your shoulder blades remain fixed against your ribs and that your deep stabilisers are activated. Forward flexion with rotation sitting on the ball with exercise band. Have exercise band behind and hands above head. Movement occurs initially through the hip and then becomes flexion and rotation of the thoracic spine toward one knee. Allow lumbar spine movement toward the end of the movement. Trish Wisbey-Roth 2012 3

Grade 4 Small squat and moving dynamically Reaching in standing with exercise band and partners in a small squat position. Keep exercise band at the same tension and reaching at waist level allowing thoracic spine rotation but keeping lumbar spine stable. Watch for locking through the thoracic spine or excessive lumbar spine motion. Increase speed of movement to increase challenge. Take your arms forward and back allowing your thoracic spine to rotate. Keep your lower back and pelvis still by activating your deep stabilising muscles. Try to gradually increase the speed of the movement to the speed where you can control your lower back and pelvis. Grade 5 Travelling straight lunge with spinal rotation Stand holding your ball and take a large step forward and come into a lunge by bending through both hips and knees. As you lunge take the ball to the ground on the outside of the front foot by twisting through the spine. As you straighten up bring the back leg through past the other so that you perform another lunge. Continue to lunge swapping legs each time and travelling in a straight line taking the ball from side to side as you. A medicine ball can be used. Trish Wisbey-Roth 2012 4

Posterior longitudinal Sling Grade 1 Looking over cliff cue Sitting on ball These muscles are vital for supporting the lower levels of the spine, including the discs and the sacrum. Research has shown that they stop working when there is/has been pain in the area and they need to be trained to work again. Sit on the ball with feet shoulder width apart. To commence ensure you are sitting in the neutral spine position and gently draw your shoulder blades toward each other. Try to gently draw your pelvic floor up and your lower stomach in towards your spine. They may well be a little contracted as they help you to sit up. Hold this contraction for 10-20 seconds as you continue to breathe. Sitting posture +PF/TA Need to find individual cue ant/post tilt and palpation (may have it with correct posture) flaring ischial tuberosities tilting of the top of the sacrum forwards bulging muscles into fingers with PF/TA activation, lean forward at hips to switch mm on and work at keeping it on.need to watch for excessive mult/es activity (check neutral spine). **Participants really need individual feedback and to find the cue that works best for them. Trish Wisbey-Roth 2012 5

Grade 2 Squats with ball against wall Squats with ball against wall : have ball behind back and teach movement at the hips not lumbar spine/pelvis. Aim to use gluts on extension and try to minimise hamstring activity. Stand with your ball between a wall and your mid back. Your feet should be placed in front of you a comfortable distance. Find neutral spine, activate your deep stabilising muscles and gently squat ¼-½ range by predominantly bending through your hips so that your knees do not pass your toes. Gently tense your bottom muscles at the bottom of the squat and keep them tense as you straighten back to the start position. Your spine should stay straight and your weight should be on your heels, not your toes Grade 3 Eccentric hamstrings Lie on your back with the ball against the wall and both feet on the ball. Lift your bottom off the ground by using your bottom muscles and come into a bridge position. Lift one leg and keep it lifted as you slowly lower your bottom back to the ground. You feel the back of your leg working which is the aim of this exercise to have your hamstrings working as they are stretching out. Once your bottom is on the floor also lower the lifted leg back Cue smooth movement and pelvis position. Watch for over gripping of upper body through the floor. Grade 4 Hamstrings - all 4 s hip extension + exercise band (hip 90 degrees to hip extension) Kneel on all fours with a piece of exercise band around the heel of one foot and hold onto the other end with one hand. Straighten the leg with the exercise band out behind aiming to get your back, hip and leg in a straight line parallel to the ground. Now that your bottom muscles are so strong we are adding training of the hamstrings (back of the legs) particularly on stretch. This is vital for many sports and physical activities such as running. Move more quickly remembering to keep control through your low back and pelvis. Increase the speed of movement to teach switching on and off through eccentric/concentric movement. Trish Wisbey-Roth 2012 6

Grade 5 Step/stair jump with small bound Stand with both feet on a step/stair shoulder width apart. Jump onto the ground and as you land move into a squat and then bound forward (jump with both feet). Again as you land move into a squat to help soften the impact. Try to remember the important components of squatting such as bending through the hips and knees, keeping control of your spine and keeping your knees from travelling in front of your toes. Do one jump forward after jumping off the step and then return to the step. Commence on step, jump off step, move into squat to shock absorb and then follow immediately by a bound. Cue use of arms to assist propulsion. Cue landing position, soft knees, moving into squat with knees not travelling in front of toes and bending through hips. Grade 5 Posterior oblique long and lateral sling. Eccentric hamstring control in standing with spinal rotation Stand holding onto exercise band with one end under one foot. Lift one leg and have it behind you. Bend forwards at the hip so that your body is moving towards the foot on the floor. The exercise band will give you assistance on the way down and resistance on the way back. Make sure you are moving through the hip and keeping your spine in neutral. You may feel the back of your legs Your hamstring will be working particularly on the way down they should be working on stretch so the aim is to keep the movement smooth. Ensure that the rotation is spinal not just shoulders. Make sure your hands stay in line with your breastbone and keep your eyes in line with your hands. Trish Wisbey-Roth 2012 7

Lateral sling Grade 1/2 External rotators activation (Piriformis, Gemellus superior and inferior, Obturator internus and Externus, Quadratus femoris and gluteus maximus) Lying on your back, knees bent and a exercise band around your thighs above your knees (blue/black). Rotate your knees out from your 2nd to your 3rd toe. You should feel the side of your bottom switching on and not the front of your hip. (Grade 1) Alternatively this exercise can be performed sidelying with pillow under knee. Scoop this knee in an arc to be lifted to level with your hip. The weight of the leg replaces use of exercise band. Grade 1/2 Glut med in sitting Sit on the ball, hands on outside of knees, flaring ischial tuberosities(or turning thighs outward) and then gentle outward pressure against the hands. Add side to side movement keeping shoulders and hips in line. Think about flaring your sitting bones away from each other and then gently push your legs into your hands not letting legs actually move. Exercise band around thighs can replace hands. Trish Wisbey-Roth 2012 8

Grade 2 ¼ squat with the ball and transferring weight ¼ squat with the ball and transferring weight. Holding the squat will begin to build endurance of your stabilisers. Stand with your ball between a wall and your lower back. Your feet should be placed in front of you a comfortable distance so that when you squat down, your knees stay in line with your heels. Activate your deep stabilizing muscles and gently squat ¼ range. Gently tense your bottom muscles at the bottom of the squat and keep them tense as you transfer weight from side to side. Make sure you don t let your hip drop to the side. Repeat 5-10 times side to side and then straighten up. Repeat process 5-10 times Movement is through the hips and the spine remains neutral. Sustained ¼ squat will build endurance and side to side incorporating glut med control. Grade 3 Starting to train slings for walking Adding thoracic spine rotation slowly Glut med in standing with ball against the wall. Side onto the wall and gentle outward pressure with inside leg to hold ball against wall. Now adding rotation of thoracic spine away from the wall. Pelvis, low back and hips remain stable Have the ball off the ground and lift your inside leg off the ground with the knee bent and gently push the ball into the wall with this leg. In this position cross your arms against your chest and rotate to the side by using your thoracic spine. You will move away from the ball. Keep your hips square, pelvis and low back stable. Repeat 10 times and then swap legs. Trish Wisbey-Roth 2012 9

Grade 4 Eccentric oblique abdominal control with hip movement Lie sideways on the ball with the ball on your waist/hips. Your feet at ground level, up against a wall with feet together. Have your arms across your chest and you body in a straight line (this will be diagonal to the floor). Bring your upper body away from the ball by bending in a sideways motion and hold this position. Now lift the top leg away from the other leg and move it up and down. Once you have completed 5-10 reps in this position lower your body so it is sideways over the ball. Eccentric IO/EO - side on to the ball, feet on the wall, feet together, trunk in 2 positions a) lateral flexion b) eccentric lateral flexion, hip abd/add, knee bent, top arm across chest. Have participants place feet together on the wall (can remain apart in needed) with arms crossed against the chest (can have hands on ball if unstable). Have participants move into lateral flexion and sustain this position as they lift the top leg into hip abduction. Alternative Grade 4 Glut Med for running/jumping Stand on step and quick drop of one leg and dip of pelvis with concentric activation of Glut med on standing leg. Fast repeated movements to build eccentric/ concentric endurance. Grade 5 Glut med against the wall ¼ squat, hip extension with thoracic spine rotation +. Stand side onto the wall with the ball in between. Have the ball off the ground and lift your inside leg off the ground with your knee bent and gently push the ball into the wall with this leg. Bend the leg you are standing on into a small squat and keep this position while you move the leg with the ball backwards by moving through the hip. At the same time as your leg moves backwards take the shoulder near the wall toward your opposite knee by twisting through the upper back. This exercise is an essential component of effective and efficient running. This exercise contains essential components of an effective and efficient running pattern. Start with ¼ squat on stance leg and the hip extension with leg with ball and thoracic spine flexion and rotation away from the wall. Keep range of rotation small to keep lumbar spine control. Trish Wisbey-Roth 2012 10

Anterior sling Grade 1 Standing with weight transference Even weight through feet i.e. not too much on toes/heels Pelvis on hips, ribs over pelvis, shoulders and head position Stand with both feet about hip width apart. Activate your stabilising muscles and gently tighten your bottom muscles. Tilt your pelvis one way and then the other to find your neutral spine in standing. To progress transfer weight from one side to the other like you were going to lift one leg but don t actually lift it. Maintain the position of your spine and stabiliser muscles on throughout the exercise. Grade 2 Taking knee to side in supine movement through the hips with pelvic control Abdominals activated in supine with one knee to side. Supine, hips and knees flexed with feet flat on the floor. Taking one knee at a time out to the side. The movement should just occur through the hip and pelvis with lumbar spine stable. Lie on your back with your knees bent and feet flat on the floor. Gently pull in your pelvic floor and lower stomach muscles up and back toward your spine. Try to maintain the tension as you take one knee out to the side by moving through the hip. Return to the start position and alternate sides continuing to breathe normally. Ensure you keep your low back and pelvis still and that the movement is occurring just at the hip. Trish Wisbey-Roth 2012 11

Grade 3 Bridge on ball with side to side weight transference This strengthens the stabilisers and gluteals by having to lift some of your body weight. By adding the ball your stabilisers have to work harder which is important to train your body to deal with unstable surfaces Lie with your back and hips resting on the ball with feet flat on the floor. Cross your arms on your chest. Activate your deep stabilizing muscles. Start with participants sitting on the ball and have them walk their feet out and roll down to have their upper back on the ball. Activate stabilisers and gluts keeping hamstrings relaxed.dropping the bottom and moving into more of a sitting position will make it easier for many participants. Proprioceptive feedback on the hamstrings will also assist to turn off overactive hamstrings. Grade 3 Eccentric abdominals and hip flexors Sitting on the ball holding onto exercise band attached to point in front of you. Starting in the upright sitting position move backwards by opening out through the front of your hips. Your spine should stay in the neutral position throughout the movement. You may begin to shake/wobble as you go back and if so just go back a little way to where you start to shake/wobble. As you gain more control you can work on increasing how far back you go. Allow the ball to gently roll up your back as you move more. Sitting on the ball, moving from neutral to hip extension, neutral lumbar spine, black/blue exercise band. Cue opening out through the hips maintaining neutral spine. Partner work challenges proprioception Grade 4 Thoracic spine rotation/extension in kneeling Kneel with one leg up holding onto exercise band at shoulder height attached to a point on the side of the back leg. Moving through the upper back and shoulders take arms toward the bent leg and up to the ceiling. You will be moving in a diagonal pattern. Make sure your lower back, hips and pelvis remain stable. Kneeling, TSp rotation/extension with stable partner, rotation toward the bent leg. Have participants hold for each other and try to have back leg in hip extension (or at least neutral). Trish Wisbey-Roth 2012 12

Grade 5 Speed specific eccentric/concentric cuing for running jumping movements Start in a side plank position than drop hips towards the floor, then arch waist area away from floor. Increase speed as strength and endurance increases. Post and anterior oblique post long and lateral slings Grade 5 Eccentric abdominals and hip flexors with hip extension and arm reaching Kneel with the ball in front of you with your elbows resting on the ball. Roll the ball forward by taking your body forwards so that your hip knees and shoulders remain in a straight line. Your arms should not move higher than shoulder height and shoulder blades fixed against your ribs. This exercise will work your abdominals and hip flexors on stretch and you may get the shakes/wobbles. If so, move until you start to shake a little and then return aiming to increase the range of movement as you get stronger. Add taking one leg backwards and the opposite arm forwards as you roll out. Make sure you can keep your spine in a neutral position and that the movement is occurring through your hip, knee and shoulder, elbow. Watch for lumbar spine extension. S:\WRC\_MASTER_FILES\Z_Conferences\2012_Filex\FILEX_2012_Workshop_Rev0b_Final.docx Trish Wisbey-Roth 2012 13

For more details and upcoming lectures www.bbclasses.com.au/trish To find out more about becoming a Bounce Back Agent www.bouncebackexercises.com.au For additional free resources look in the Resources Section Providers Tab www.bbclasses.com.au Trish Wisbey-Roth 2012 14