Session Outline ACSM Health & Fitness Summit & Exposition March 31 – April 3 2015 How to Train the CORE FOUR: The Secrets of Stability and Function Peter Ronai, MS, RCEP, CSCS-D, FACSM Clinical Associate Professor Science Sacred Heart University [email protected]

SUMMARY: Workouts employing motions, suspension training, and body weight resistance all require proper body alignment, fundamental movement competencies, stability and strength. They can (in some instances) surpass clients’ abilities to perform them safely. Personal trainers can learn to identify compensatory motions during general movement screenings which can signal the presence of muscle imbalances and the potential for developing specific movement dysfunctions. Supplementary (requiring minimal equipment) can help improve movement competency, joint stability and help prevent injuries. It is important for personal trainers to be able to identify and teach their client’s the right exercises to address their specific postural/movement anomalies and muscle imbalances. Attendees will learn how to perform/teach exercises (which require minimal equipment, space and time) which can enhance stability and function within the neck, shoulder girdle, and low back. They will also learn how to: -identify/perform specific exercises which can enhance strength in (relatively) “underactive” muscles -describe/perform modifications/progressions to basic exercises during the workshop I. Optimal Static Alignment- “Plumb line Posture” (Front-Back-Side Views) -Efficient use of muscles and smooth joint surface movement/stability II. Upper and Lower Cross Syndromes-Common “Stereotypical” Postural Anomalies -Found in many individuals (Janda) and associated with potential movement dysfunction -Attributed to over activity/simultaneous reciprocal inhibition of specific paired muscles a. Neck-overactive cervical extensors & underactive deep cervical flexors b. Shoulder-overactive adductors/internal rotators/underactive retractors/external rotators c. Lumbar Spine/Pelvis-overactive flexors/spine extensors/underactive gluteals/ core III. Common Assessments Which Can Uncover These Imbalances: -Neck-“Cervical Flexor Endurance”, “Tragus to Wall”, “Wall Stretch”, “Overhead Squat” -Shoulder- “Overhead Squat”, “Wall Stretch”, “Wall Lift Off”, “Prone Lift Off”, “Pulling & Pushing” Tests -Pelvis & Spine-“Overhead Squat”, “Wall Stretch”, “”, “Single Leg Squat”,” “McGill Tests”, “Bunkie” IV. What You See Typically During Assessments and During Functional and Athletic Skills a. Neck- Forward Head/Excessive Lordosis b. Shoulder Girdle- Kyphosis, rounded, adducted, internally rotated shoulders, elevation c. Pelvis/Spine-Typically anterior tilt/hyper-lordosis or sometimes posterior tilt/”hypo-lordosis”Other- Lateral pelvic deviation/lateral rotation (drop), Knock (valgus), pronation (foot) V. Fundamental Movement Competencies-Generic Skills Requiring Stability/Control & Alignment -lunging, squatting, single leg squatting, hip hinging, scapular retraction, depression and posterior scapular tilt

VI. Exercises to Reduce “Reciprocal Inhibition” of Underactive Muscles in Fundamental Movements a. Progression -Simple →Intermediate → Advanced →Combined/Complex -Body or limb Weight→ Added Resistance (Bands, Tubing, Weights, etc.) -Neck- Supine →Upright →Against a Wall → Prone-Against Gravity -Shoulder- Supine → Upright → Against Wall →Prone-Against Gravity (floor) → Above Floor on a stability ball and/or bench -Pelvis/Hips-Supine → Side → Prone →Standing -Lumbar Spine-Trunk → Prone → Quadruped → Supine → Side Lying → Standing b. Exercises to Improve Muscle Strength & Endurance for Each of the “CORE FOUR” Areas

REGION KEY MUSCLES BASIC INTERMEDI ADVANCE COMPOUN ATE D D NECK DEEP FLEXORS SUPINE/FLOO WALL PRONE BRUGGER R RETRACTIO RETRACTI TUBING RETRACTION N ON RETRACTIO AGAINST N BELOW GRAVITY 90° SHOULDER SUPINE T-Y-I- WALL PRONE WALL (MID/LOWER)/RHO Ws ANGELS, T- COBRA, STRETCH, MBOIDS/ EXTERNAL (ADD Y-I-Ws, PRONE T- ER FROM ROTATORS TUBING) BILATERAL Y-I-Ws, SIDE PLANK, SEATED T-Y-I- EXTERNAL PRONE SCAPTION Ws ROTATION, LIFT-OFFS FROM SEATED BAND SIDE UPRIGHT PRESS-UPS WALL LYING PLANK, SLIDES, EXTERNAL HORIZ. ABD. WALL ROTATION FROM WALKS & UPRIGHT LIFT-OFFS PLANK PELVIS/HIP , , QUADRUPED SIDE OVERHEAD MEDIUS, PIRIFORMIS SINGLE LEG HIP EXT. PLANK SQUAT BRIDGE, W/ W/ABDUC W/RESISTED BRIDGE W/ FLEXED, TION. HIP ABD. ABDUCTION SQUAT SIDESTEP ON WALL, W/BANDS, W/ABDUCT W/BANDS, “” FREE CLAM ION & STANDING STANDING, SHELLS, BANDS, SINGLE PRONE HIP MINI LEG WALL EXT. W/KNEE SINGLE , FLEXED RDL, MINI SINGLE LEG SQUAT W/TOUCH DOWN

SPINE & INTRINSIC & PRONE HIP SUPINE SINGLE PUSHUP TRUNK EXTRINSIC CORE, EXT. STATIC LEG RDL, INTO BIRD TRANSVERS W/FLEXED ROTATION, SINGLE DOG, ABDOMINUS, KNEE, PRONE SUPINE LEG OVERHEAD MULTIFIDUS, BIRD DOG, PULLOVER SQUAT, SQUAT INTERNAL/EXTERNAL OVER BALL, W/REVERSE DIAGONAL W/RESISTED OBLIQUEs, QUADRUPED , PALOF HIP ABD, QUADRATUS BIRD DOG, STANDING PRESS SINGLE LUMBORUM, PRONE PALOF OVERHEAD RECTUS PLANK PRESS, SQUAT ANDOMINUS,, PROGRESSION “McGILL ERECTOR SPINAE, CURL-UP”, LATISSIMUS DORSI, SIDE etc. PLANK c. Encourage clients to do “fewer repetitions with high movement quality”. -premature fatigue can cause compensatory movements and substitution patterns • Shoulder elevation during or pressing movements • Forward head during overhead, pushing and pulling activities (row, press, overhead squat, etc.) -if necessary, perform multiple sets consisting of fewer repetitions added together after inserting a short recovery periods after every 3 or 4 repetitions -increase repetitions and reduce recovery time as fitness, strength and endurance improve. Add sets as tolerated -regress exercises if signs of fatigue or movement compensation(s) still occur after reducing repetitions and increasing recovery period length(s) -supplementary exercises can be performed during the warm-up or cool-down period or on non- workout days THREE TAKE AWAY POINTS 1. Performance of some "advanced-type workout protocols challenge many client's movement competency, proficiency and joint stability. 2. Assessment of client's movement competency and the presence/absents of “stereotypical” postural imbalances and compensatory movement strategies can help direct supplementary exercise selection and should precede novel participation in "advanced or higher intensity" workout protocols. Movement quality always supersedes quantity. 3. Simple exercises employing minimal equipment can enhance multi-segmental stability and function, enhance movement competency and proficiency, and help prevent injuries. References Ayotte N, Stetts D, Keenan G, and Greenway E. Electromyographical Analysis of Selected Lower Extremity Muscles During 5 Unilateral Weight-Bearing Exercises. J Orthop Sports Phys Ther. 2007; 37(2):48-55.

Brummitt, J, Matheson W, and. Meira E. Core Stabilization Exercise Prescription, Part I: Current Concepts in Assessment and Intervention. Sports Health: A Multidisciplinary Approach 2013; 5: 504

Brummitt J, Matheson J, and Meira E. Core Stabilization Exercise Prescription, Part 2: A Systematic Review of Motor Control and General (Global) Exercise Rehabilitation Approaches for Patients With Low Back Pain. Sports Health: A Multidisciplinary Approach 2013; 5:510-513.

Brummitt J, Dale B. Integrating Shoulder and Core Exercises When Rehabilitating Athletes Performing Overhead Activities. N Am J Sports Phys Ther. 2009; 4(3):132-138.

Cambridge E, Sidorkewicz N, Ikeda D, and McGill S. Progressive hip rehabilitation: The effects of resistance band placement on gluteal activation during two common exercises Clinical Biomechanics. 2012;27:719–724.

Hanney W, Kolber M. Improving Muscle Performance of the Deep Neck Flexors. Strength Cond J. 2007:29(3):78-83.

Hirth C. Clinical movement analysis to identify muscle imbalances and guide exercise. Athl. Ther. Today. 2007;12(4); 10-14.

McGill S. Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength Cond J. 2010; 32(3):33-46.

Morris C, Greenman P, Bullock M, Basmajian J, and Kobesova A. Vladimir Janda, MD, DSc. Tribute to a Master of Rehabilitation. SPINE 2006; 31(9):1060–1064.

O'Sullivan K, Smith S, and Sainsbury D. Electromyographic analysis of the three subdivisions of during weight-bearing exercises. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2010; 17:2-9.

Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. Int J Sports Phys Ther 2011; 6(1):51-58.

Reinold M, Escamilla R, and Wilk K. Current Concepts in the Scientific and Clinical Rationale behind Exercises for Glenohumeral and Scapulothoracic Musculature. J Orthop Sports Phys Ther. 2009; 39(2):105-117.

Selkowitz D, Beneck G, and Powers C. Which Exercises Target the While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine- Wire Electrodes. J Orthop Sports Phys Ther. 2013; 43(2):54-65. Websites: Back fit Pro http://www.backfitpro.com/index.php Exercise on the Net http://www.ExRx.net Anatomy Zone http://anatomyzone.com/