muscle imbalances are the core as a punctum ubiquitous ......making movement patterns more efficient...

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The Core as a PunctumFixum in Sport: A Key to

Making MovementPatterns More Efficient

Craig Liebenson, D.C.Craigliebenson.com

craigliebensondc@gmail.com

Muscle imbalances areubiquitous / due to sitting

Working out should improvethem - right?

Most gym exercises tighten us• “Think of working out in

the gym. All themovements are aboutfolding inwards.Between curls,crunches and squatswe’re always tighteningand closing ourselvesup.”

Laird Hamilton

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Scissors

• Oblique diaphragm• Failure of oblique

abdominal muscleslings

• T/L overload• Hyperlordosis• Lower Cross

Syndrome (Janda)

Over Time Failure ToleranceDrops w/ Repetitive Strain

Time

Load

Failure Tolerance

Margin of SafetyFailure

Derived from:McGill S, Lower Back Disorders:Evidence-Based Prevention andRehabilitation.2002, Human Kinetics, Champlain, IL

Back Injury• …is usually a result of “a history of excessive

loading which gradually, but progressively,reduces the tissue failure tolerance.”McGill SM. ACSM Resourse Manual - 3rd Ed. 1998. Williams & Wilkins,Baltimore

Recovery• Breaks/Periodization/Soft Tissue work

“re-sets” Injury Threshold

Time

Load

Failure Tolerance

Margin of Safety

Derived from:McGill S, Lower Back Disorders:Evidence-Based Prevention andRehabilitation.2002, Human Kinetics,Champlain, IL

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Agonist-AntagonistDysfunction

Muscle response pattern to suddentrunk loading in LBP individuals

• Delayed activation• Over-activation• Delayed relaxation

Radebold A, Cholewick J, Panjabi M, Patel T. Spine2000;25:947-954.

“Weak Link”

1. Upright Posture 2. Core/Respiration 3. 1 Leg Stance

I) The Diaphragm & the CoreHorizontal Axis

of Diaphragm (Kapandji)

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Conclusion: Patients with chronic LBPappear to have both abnormal position anda steeper slope of the diaphragm. JOSPT2012:42:352-362.

Diaphragm Test -p553-555 (ROS)

NO !• Most common faulty movementpattern• Vertical chest breathingpredominates over horizontal• Scalene overactivity

To Cue or Not to Cue• “During movement pattern testing, minimal verbal

cues should be used which test an individual’shabitual way of performing a movement. If the cuesare too “leading” then the test will be of the subjectsability to learn how to perform the movementcorrectly, rather than how they are habituallyperforming it.”

• “graded on how they chose to perform rather thanhow they could perform the tasks given feedback orcoaching”

• “the hallmark of the SFMA design is the use simplebasic movements to expose natural reactions andresponses by the patient.”

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“The irony is thatwhat enhancesperformance preventsinjury”

Who is More Athletic?

IAP TestROS - p555-557

• Bring the chestpassively into thecaudal, expiratoryposition

• Then the support isremoved from underthe patient’s legs

• The patients holds thisposition actively

II) Punctum Fixumfor Punctum Mobilum -The Key to Tri-Planer

Movement

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Ball & Socket Joints Require a Fixed Core

Developmental Movement

Whole Body Tri-PlanerFunction Jan Zelezny/ Barbora Spotakova

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1. Kolar Arm Lifting Test- p557,558 ROS

Initial positionPatient supine, or standing errectsHe/she lifts both arms slowly

L Hamilton “Once you start being conscious of therepetitive motions that we all just accept… you realize

how little we do to counteract those motions.” Lower crossed syndrome)

L/S stability w/ good lower ribstability

• Maintain co-contraction of deepmuscles

• Hold exhalation position of ant-infribs during normal respiration

Vleeming’s Active SLR“The Core Screen”

Test• Supine have patient perform SLR

20 cm up & note if there is:– Pain– Significant trunk rotation

• If the test is negative addresistance/ √ strength _/5

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Abdominal bracing increases lumbaraxial rotation stiffness during the

Active Straight Leg Raise test

Abdominal bracing reduces lumbaraxial rotation during the Active

Straight Leg Raise test

Liebenson, C., Karpowicz, A., Brown, S., Howarth, S., McGill, S.M.(2009) The active straight leg raise test and lumbar spine stability. PhysicalMedicine and Rehabilitation.1(6): 530-535

Overhead Arm Reach

• Overhead Reach

Baby Get-Up

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Get-Up to Sitting to BearWhat is the Goal of

Human Development?

Wall Bug (Kolar) Foam Challenges

Marching Bicycle Kicks

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Stir the Pot

Perform on toes– Perform in a plank on your toes– Start w/ chest against the ball

& then push off the ball before“stirring the pot”

– Start w/ wide stance &progress by narrowing yourbase of support

FRONT PLANKS WITHSAW (2/1)

Vele’s ForwardInclination

Don’t forget the feet!

Anti-RotationPallof Press

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Cable Chop Plank Rolls

A Roll Not a Twist 2. Punctum Fixum - S-T• Be sure shoulder blade does not stick out

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Start on All 4’s- hands under shoulders

- knees under hips

CORRECTION

• Push off the floor w/ your hands• until your shoulder blades are flat against

your back• & your head glides up• AVOID ROUNDING YOUR BACK!

Bird Dog -opposite arm/leg reach

NO

YES Don’t forget thehands!

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1” Punch Dying Bug

3. Posterior Chain Bird Dog &Anti-Rotation Dysfunction

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RDL

1LDL2LDL

• Sit on box w/ 1 footelevated• Squat up and down barelytouching the box each time

Troubleshooting• Find the height you cansquat to on 1 leg• It may be easier if youstand on a bench so thatyour raised leg stays off thefloor easier• Avoid trunk flexion

1 Leg Box Squat

Functional Reacha. Supported

1 Leg SquatTRX

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Reactive

• Gray Cook-"The bestresistance is theone that causesthe problem tocorrect itselfwithout verbal orvisualfeedback."

Ham Curl - Singles

4. Frontal Plane Medial KneeCollapse

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Frontal Plane Stability

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