Monday, March 27, 2017

Exercises to Eliminate Pathokinematics: Part IIX

Last week we discussed the lumbar hip disassociation exercises that are used as a part of the ACL Play It Safe Program.  These particular exercises are ones we implement with the CLX Spiral Technique.  This technique pushes single limb performance and drives increased EMG activity of the gluteus medius.  This week we are going to discuss additional techniques that can aid in pushing single limb performance in addition to hip strength, endurance and proprioception.

Single Leg Proprioceptive Neuromuscular Facilitation (PNF) with Hip Flexion: 

Level I:  Standing on your right foot, reach across mid-line with the left hand while flexing and slightly rotating at the hips allowing you to reach toward the right knee.  Only reach as far as you are able to maintain stability of the knee.  It is important to make sure you are not rotating in the spine but that the motion is coming from the hip.  Return to the starting position.  Perform 3 sets of 10-20 reps.  Repeat on the left.


Level II:  Standing on your right foot, reach across mid-line with the left hand while flexing and slightly rotating at the hips allowing you to reach for the right little toe.  Only reach as far as you are able to while maintaining stability of the knee and without rotating in the spine.  Raise by extending and rotating at the hips and raising the left hand thumb up over your left shoulder.  Follow the motion of the left hand with your eyes throughout the exercise.  Perform 3 sets of 10-20 reps.  Repeat on the left.

  




Level III:    With a small medicine ball (1-2#) in your left hand and while standing on your right foot, reach across mid-line with the left hand while flexing and rotating at the hips allowing you to reach for the right little toe. Only reach as far as you are able to while maintaining stability of the knee and without rotating in the spine. Raise by extending and rotating at the hips and raising the left hand thumb up over your left shoulder.  Make sure to follow the motion of the ball in your hand with your eyes throughout the exercise.  Perform 3 sets of 10-20 reps.  Repeat on the left.






NOTES:  If unable to perform without maintaining knee position or without rotating in the lumbar spine, then modify the range of motion.  The most difficult portion of the exercise is at the end of the range of motion at the reach and when the hand is moving over the head.  If needed, progress the reach first then add in the hand over head.

KEYS TO SUCCESS:  Only reach as far as you can (both toward the foot and with hand overhead) while maintaining proper positioning.  If having difficulty maintaining proper position at the knee and core, then start with lighter ball or decrease the height of the throw.

The athlete's ability to create stability in single limb performance during dynamic explosive movements is critical to mitigating risk and improving performance.  The two exercises here are meant to aid in developing that stability and should be performed at the beginning of an exercise session.

Single Leg Hop - athlete is asked jump in a maximal vertical fashion.  This can be initiated in front of a mirror to provide visual feedback or another device (Motion Guidance) to provide additional feedback.  The key to this exercise is maintaining frontal plane stability during acceleration (take off) and deacceleration (landing).



Single Leg Hop Toss - this can be done with a toss or kicking a ball.  The key is to maintain frontal plane stability of the lower kinetic chain throughout the exercise.




Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

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