I know when I talk about core stability, some people will roll their eyes.

There is always a discussion in the fitness world on what the core is and if we should be focusing in on it.

Well when it comes to injuries, I focus on the core.

It is looking like core stability is playing more of a role when it comes to injuries.

I know in previous Injuries of the Month (patellofemoral pain syndrome, sacroiliac joint pain and piriformis syndrome), core stability has been a component of the exercise program that I have recommended.

I wanted to highlight some research that talked about injuries and core stability.

What They Looked At

They looked at 80 female and 60 male intercollegiate basketball and track athletes.

This was very interesting. They measured core stability by testing:

• Isometric hip abduction strength
• Isometric hip external rotation strength
• Back extensor endurance (modified Beiring-Sorensen test)
• Quadratus lumborum endurance (side bridge test)

Interesting Points in the Introduction

• Decrease in lumbo-pelvic (or core) stability has shown an increase in lower extremity injuries, especially in females
• The injuries that females are at greater risk for are: anterior cruciate ligament (ACL) ruptures, patellofemoral pain syndrome, iliotibial band friction syndrome, and stress fratures (femoral, pubic, tibial, and metatarsal).

What They Found

These were the main results from the study:

• Males produced greater hip abduction, hip external rotation and quadratus lumborum measures
• Athletes who did not sustain an injury were significantly stronger in hip abduction and external rotation
• Hip external rotation strength was the only useful predictor of injury status

Rick’s Comments

Often times when we focus on working on the core we think of crunches or bridge variations. It is interesting how this research expands on things further and looks at core function in different planes of movement and different movements. I like the fact that it highlights the importance of looking at hip abduction and hip external rotation strength. Many times this is not mentioned or covered in an exercise program.

Here is an exercise that I give to work on hip movement and strength:

A few comments on the exercise.  The exercise can be used for:

• Educating the movement of hip movement from the rest of the body.
• A dynamic stretching of the hip rotators.
• A body weight active hip rotator exercise.

The directions given and the cueing can change the function of the exercise.

Where to get more information – Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. (2004). Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004 Jun;36(6):926-34.

If you are looking for exercises to strengthen the external rotators of the hip, these are what I use:

Easy and Effective Exercises for Tennis Elbow

I am working on this month’s Injury of the Month. It is Tennis Elbow.

I was doing my research on the injury and came across this article, which was interesting. It talks about isometrics for an injury and really highlights the new trend in exercise rehabilitation.

What They Looked At

They wanted to see if isometric exercises were as effective as medication for pain relief in those with lateral epicondylitis (tennis elbow).

They had two groups:

• Group 1 – Were shown the exercise and then they did it at home
• Group 2 – Began the exercise after 4 weeks of medication

Interesting Points in the Introduction

• An increase in symptoms from exercise will decrease the compliance rate to the exercise program
• Performing the exercises too aggressively can increase the risk of irritation or injury
• The above two points are obvious but nice to see them highlighted in an article

Tennis Elbow Exercise Performed

The researchers only gave one exercise.  Here are the details of the exercise:

• The subjects did the exercise in a sitting or standing position with the arms flexed to just below shoulder height.  Then the wrists were moved in a slow controlled manner into extension with the fingers relaxed. The focus was on moving the middle finger towards the elbow in order to target extensor carpi radialis brevis.
• The exercise was performed without pain and in a controlled manner.
• Four sets of 50 repetitions with each repetition being held for 10 seconds, done daily.

What they Found

• After one month, group 1 had a greater decrease in their pain levels compared to group 2
• At 3, 6 and 12 month follow up there was no difference between the groups
• Those that did not feel any benefit from the exercise program after one month were referred on to shock wave therapy

Rick’s Comment

Interesting to see the benefits of isometric strengthening on an injury, specifically with lateral epicondylitis. Isometric exercises are not exciting but effective when it is comes to an injury and the safest of the three types of contractions.

A lot of the research out there focuses on eccentric exercises for tennis elbow. This article highlighted the benefits of an isometric exercise which is less stressful on an injured area.

The number of repetitions was a surprise to me. Over a day performing 200 repetitions or about 33 minutes of exercise sounds like a lot. This is a trend that is occurring in exercise rehabilitation. The standard used to be 1 set of 10 repetition but this is fading away and does not correlate well with what many people do during the day (number of movement cycles performed in a day). Performing low load (isometrics) more frequently transfers more over to what one does on a daily basis and assists in recovery.

Just so you know, the tennis elbow exercise program will be coming out at the end of the month.

Where to get more details – Park JY, Park HK, Choi JH, Moon ES, Kim BS, Kim WS, Oh KS. (2011). Prospective evaluation of the effectiveness of a home-based program of isometric strengthening exercises: 12-month follow-up. Clin Orthop Surg. 2010 Sep;2(3):173-8. Epub 2010 Aug 3.

That is it for another edition of the research review.  I hope this helps you out when it comes to core stability and injuries, plus a great little tennis elbow exercise.

Rick Kaselj, MS

I don’t know why I like doing these research reviews so much.

I always end up learning something or it confirms what I am doing.

I try to break them down for you so they are easier to understand and you can get the take home message from them.

For those that want a lot more detail, I have included the reference so you can read the original article.

Lets get to the research.

Do Elite Athletes Have Muscle Imbalances?

What They Looked At:

They looked to see if elite athletes performing team or individual sports had muscle imbalances.  They looked to see if they did with MIR investigation.

What Did They Find?

They found a variety of muscle imbalances in the trunk and pelvic region.  They feel muscle imbalances may be related to injuries athletes get.  They suggested that each sport needs to be looked at to determine what muscle imbalances are common and what specific muscle rehabilitation can and needs to be done.

So What?

It shows that athletes do have muscle imbalances.  It is tough to say if these imbalances are needed in order to excel in their sport or are leading to injury or decreased performance.

It is cool that the concept of muscle imbalances is being discussed more and more.  Even in research papers.

I wish I had more to say but I was not able to get the full journal article as it was still being processed.  I look forward to getting it soon enough.

It was interesting that they identified muscle imbalances using MRI, I have never heard of this before.

Where to get more information:  Franettovich M, Hides J, Mendis MD, Littleworth H. Muscle imbalance among elite athletes. Br J Sports Med. 2011 Apr;45(4):348-9.

Is a Single Leg Squat a Good Indicator of How Your Hip Functions?

What They Looked At:

The researchers wanted to see if a single-leg squat was a good tool to determine poor hip muscle function because lately the focus of addressing knee pain has been by focusing on the hip.  They felt that people that performed better on a single leg squat would have earlier onset of gluteus medius activity, greater lateral trunk strength, greater hip abduction strength and greater external rotation strength.

They had 5 people evaluate 34 participants when performing a single leg squat.  They measured the muscle activity of the participants when it came to their hip strength based on electromyographic activity.

What Did They Find?

They determined that a single-leg squat is a good tool to determine if someone has poor hip muscle function.

So What?

I have been using the single-leg squat for an assessment for a long time and use it in the Core Stability of the Hip program.

It just highlights that getting your client to do a single-leg squat is important and will give you a good idea of what you need to focus on in your exercise program.  If you or your client perform poorly on a single-leg squat, you will need to work on gluteus medius, lateral trunk, hip abduction and external rotation strength.

Where to get more information:  Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011 Apr;39(4):866-73. Epub 2011 Feb 18.

What is a Good Test for the Core?

What They Looked At:

They looked at a dynamic core test of a chop and lift test and compared it to a static endurance posture tests of the Biering-Sorensen and side-plank.

Cool Points that Were Brought Up:

- “Trunk musculature absorbs, produces and transports multidirectional forces to and from the upper and lower extremities by maintaining a balance of stability and mobility.”

- “Researchers have hypothesized that defects in muscular capability (power, strength, endurance) and motor control (amplitude, timing) lead to poor trunk stabilization and can alter performance or increase injury susceptibility.”

What Did They Find?

The chop and lift is a good power test to test dynamic trunk control.

So What?

I have seen the chop and lift around for a while.  I have not used it very much but I will now.  I will use the two endurance tests to measure directional endurance for the core but will add the chop and lift in order to look at more dynamic core function.

Always great to take the time to read these research articles.

Where to get more information:  Palmer TG, Uhl TL. (2011). Interday reliability of peak muscular power outputs on an isotonic dynamometer and assessment of active trunk control using the chop and lift tests. J Athl Train. 2011 Mar-Apr;46(2):150-9.

That is it for today.

Time to put the papers away and head to work.

Have a great day!

Rick Kaselj, MS

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I was training a client and she was getting knee pain when she was squatting.

I wanted to share with  you what I did it in order to get rid of her knee pain when she squatted.

I know it will help you and your clients.

Your Core Maybe Causing Your Knee Pain

The squat is important but at times it can bring on knee pain.  If you do get knee pain when you squat, look at your core strength.

This is not the only thing to look at, but one of the things to look at.

Let me explain what I mean.

When we are standing, we don’t use much of our core.  When our trunk or upper body starts to move forward, we need our core to support and stabilize our spine.

The trunk moves forward when we do a squat.

If our trunk moves more than 45 degrees forward, the extra weight of our bodies moves over the balls of our feet and leads to greater activation and stress on the knees by pressing the knee cap (patella) and the knee joint together.

This shift in weight is a compensation pattern for a weak core.

If you move your upper body so your trunk is less than 45 degrees, you put greater stress on your core. The deep and superficial muscles of the core have to work harder to keep you in the position but this also shifts your weight so it is over the middle of your feet and heels.  This shift in the weight on your feet will decrease the stress on the knee.

Now lets go through some exercises you can do to improve your core when squatting.

How to Strengthen Your Core For Less Knee Pain

Standing to ¼ Squat

You can begin by moving from standing into the squat position with the trunk less than 45 degrees forward.

I teach this with one hand on the stomach and one hand on the lower back.  I get my clients to activate the core and then move from standing into a squat position.

I will get them to hold the squat position for 10 seconds and then move back into standing for 10 repetitions.

We are working on the activation, endurance and strength of the core, and good motor patterns for the squat.

¼ Squat Exercises Exercises

After they have mastered the “standing to 1/4 Squat” exercise, I will get them to hold a 1/4 squat position and perform a variety of exercises.  It can be narrow grip rows or pec fly exercises.  They activate their core and hold the quarter squat position during the full set of the exercise.

I hope this gives you some more ideas on what to do if you or your client has knee pain when squatting.

Before I go, here are some kind words that I just received.

Here are some kind words that I received about Knee Injury Solution from a Personal Trainer and Pilates Instructor:

Rick’s Knee Injury Solution program is without a doubt a huge asset to anyone! I was excited to find out that many of the exercises are easily incorporated into a regular training routine without even noticing.  Many of the things we already do, such as planks, but Rick lays out how to put them together in proper progressions to gain success!  What is also great, is that you don’t need to have background knowledge to understand the program.  More and more people are complaining about knee, hip and foot pain, why not address these issues now?  Anyone can do the Knee Injury Solution program with Rick’s simple, progressive explanations of not only how to perform each exercise, but how to perform the exercises correctly (or correct for instabilities).

Knee Injury Solution is a tool I needed to get my clients permanent results. Thank you Rick for your insight!

Stacey Prejza

Kind Feedback from a Personal Trainer that Has Been Helped by Muscle Imbalances Revealed:

That is it.

Thanks for reading and we will talk to you soon.

Rick Kaselj, MS

Core Stability of the Lower Back

DESCRIPTION:

OBJECTIVES:

Hey, it is Friday and I am going to ramble.

It has been a while since I actually rambled on Friday.

I Know You Are Sick of If, But I am Not

The rave reviews and incredible feedback for Muscle Imbalances Revealed 2.0 keep pouring in:

“Muscle Imbalance Revealed 2.0 has proved an invaluable investment. As a strength and conditioning coach working with swimmers from all age groups, Muscle Imbalance Revealed has provided me with a wealth of new insight into the role and function of both the hip and shoulder.  Through both the assessments and mobility exercises both myself and my athletes have a much better understanding of imbalances and how to correct them. It is an amazing educational tool and I highly recommend it.”

I am very thankful and happy that MIR2 has been able to help so many trainers, coaches, and therapists from around the world.

Read the rest of this entry »

Another research update.

I am so glad I take the time to do this.

There is all kinds of great stuff that comes out every week.

The Problem with Overtraining Your Abs

The article focused on those performing Olympic lifts but they did bring up some interesting points that can be carried over to injured client.

In order to hold a load over head you need good stability in the flexors and extensors of the trunk plus good deceleration of the flexors of the truck.  Not being able to do so increases your risk of injury and decreases you ability to hold a load overhead.  This is important for the athlete but also the general public.  Overhead movements are essential for all and have been avoided of late in the fitness industry due to the perceived risk of injury.  I make sure I do a least one over head pressing movement with my clients but if your client can’t do a proper overhead weighted movement make sure to look at their trunk flexors and extensors.

Many times truck flexion (abdominals) exercises are done on a daily basis while lower back exercises maybe done 2 to 3 times a week.  This leads to muscle imbalances in the flexion and extension muscles of the trunk.  This imbalance could lead to an alteration in the tilt in the pelvis which had an effect on latissiums dorsi which an increase the risk of injury in the shoulder.

The writers provided a sample exercise program to train the trunk flexors and extensors.  The exercises were lever abdominals, medicine ball seated twists, bridge with arms lifted, marching bridge with arms lifted, dumbbell farmer’s walk, supine weighted extended hold, hyperextensions with arms out straight , hyperextension to row with
weight (medicine ball or plate), hyperextension with weight (plate or medicine ball), and barbell over head circle walks.

I wrote a little report on core training that may interest you.  Here you go:

Read the rest of this entry »

I just got the latest issue of BCAK Kinnected magazine.

There were a lot of great articles in it and they also were kind enough to publish one of mine on abdominal hallowing and hamstring injuries.

I don’t know why I keep typing hallowing, it should be hollowing.

Since it has been printed in the magazine, I am now able to share it with you.

It is one of those research summaries that I have done a number of times and fitness professionals have liked them.

Lower Abdominal Hollowing During Prone Hip Extension May Prevent Hamstring Injuries

What is the Big Deal?

Details of the Study

We have been talking about the core since the 90s. Even with fitness focused on the core for so long, there are three core stability exercises often ignored by fitness professionals.

Core stability is the proper activation of the muscles around the abdominal area in order to support the lower back in static and dynamic positions. Most core stability exercises that fitness professionals focus on are supine (on your back) or seated. These are important positions, but often are not the ones in which clients have difficulty activating their cores.

The positions that clients do have difficulty with are:

- Transition from lying to sitting

- Transition from sitting to standing

We have all experienced this or have had our clients let us know about it.

Have you ever had a client that did a heavy day of yard work and the next day complain that his back was sore when he was getting out of bed?

Have you ever had a friend that has had a baby and let you know it is difficult to get up from sitting to standing after nursing?

These are just two examples that we may have heard of and not thought much about.

Now, let’s get back to exercises.

After a client has mastered supine and sitting position core stability exercises, it is important to incorporate positions that are between lying to sitting and sitting to standing. Here are three exercises:

#1 – In Standing Core Exercise

Train the core to activate in a standing position. Prior to a standing strengthening exercise or during a rest break, get them to do a set of core activation exercises in standing position.

#2 – Four Point Core Exercise

This exercise is often ignored because a lot of clients don’t like their rears showing. It is an important position because in sitting the force of gravity pulls down on your body, while in a four point position, gravity pulls in a different direction.

#3 – Bent Over Core Exercise

This activity involves doing core exercises in a semi-squat position. There is a drastic increase on the load on the back in this position and it is important to treat the core muscles to have the activation, strength and endurance to handle this.

Next time you train a client with a history of lower back pain, make sure you train their core properly and add these three exercises that most fitness professionals ignore.

P.S. – I have eight copies of the Core Stability for the Rehab Client DVDs in my office.  I am cleaning out my office and need to get them out.  If you order the Core Stability for the Rehab Client DVDs prior to Friday you will save $10, I will pay the taxes and shipping for the DVDs any where in the world.  Get the DVDs here:

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Rick Kaselj, MS

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Here is a quick video from the the NHPC Conference.

 Enjoy!

 - Rick

For More Information on the Exercise Rehabilitation of the Upper Body Courses Click Here