Multi-Planer Movements Should Be a Part of Any Rehab or Training Program
BY: Chris Lybarger, PT, DPT
Whatever your activity of choice, whether it be running, team sports, dance etc they all require strength and mobility in multiple planes of movement. The major planes of movement are frontal (side to side movement), sagittal (front to back movement) and transverse (rotational movement). Every activity from daily ADL tasks to sports requires some sort of function in multiple planes. Yet, how often do we see people in the gym or the field that are training in a single plane (let alone doing isolated joint movements vs compound)? All too often is the answer. This leads to injuries and time out of your activity.
To emphasize my point, in running the principal movement occurs in the sagittal plane but you need to be able to stabilize in the frontal and transverse plane in order to be efficient and powerful as well as sustain those mechanics over a prolonged time and distance. Many of the injuries that occur with running are related to excessive movement in the frontal or transverse plane. Over pronation, inward collapse (valgus) of the knee, or an opposite side hip drop are all problems of control in either the frontal or transverse plane.
To address the power and strength in the frontal and transverse you could add such exercises as lateral lunges, lateral band walks, any single leg stability exercise, cable chops, side planks, etc.
Improving strength and power production through resistance training can improve performance in any sport or activity (and don’t forget multi-planer mobility and flexibility exercises as well, but if you neglect the frontal and transverse plane you will just increase your risk of injury. To get the clearest picture and advice, you best option is to speak with your trusted Physical Therapist or ATC/Strength and Conditioning Specialist to have an assessment performed and custom program developed to address these areas and movements.
Having trouble sticking to your home exercise program while you are in PT or after you are discharged? There are fortunately many different ways for you to stay on track with your exercises and routine.
1) Try listening to music! Music is a great way to motivate you and stay positive during a workout. It also can be distracting for you when you are doing, especially if you don’t particularly enjoy exercising. The type of music can also impact your output and increase you exertion. A 2009 study counted by Waterhouse et al. entitled Effects of music tempo upon submaximal cycling performance found that music tempo had a positive impact on the participants in the study. When the music was faster the participant in the study increased their effort consciously when compared to biking to slower paced music. The people in the study also enjoyed the faster paced music more when exercising. If you have a favorite genre of music, singer or band that is upbeat it might be a good idea to make a playlist that you think would be beneficial and encouraging for you when exercising, especially when you are on your own. If you are interested in reading more on the subject, the full article can be found here: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2009.00948.x/full
2) Try setting a reminder. With today’s technology you can set daily reminders in your phone or tablet to remind you to do so. Sometimes it is easier to complete a task if you are alerted to do so. Be sure to set the reminder at a time that you are likely to be free to do your exercises so that you do them in the moment and don’t procrastinate for a later time and potentially forget to do them.
3) Try to do them before or after lunch. You are more likely to do your exercises earlier in the day than later while you still have energy and the day is young. Be careful to not do certain spine exercises too early in the morning. Discuss with your PT when the best time for you to complete your HEP is and whether it is safe to do your exercises in the AM.
Article citation: Waterhouse, J., Hudson, P. and Edwards, B. (2010), Effects of music tempo upon submaximal cycling performance. Scandinavian Journal of Medicine & Science in Sports, 20: 662–669. doi:10.1111/j.1600-0838.2009.00948.x
You have all witnessed as you watched the Summer 2016 Olympics when Michael Phelps made his debut at the Brazilian swimming pool. Many were in awe when the media focused on the numerouspurple circles located around Phelp’s shoulders. The circles as the media mentioned are from an alternative therapy technique called, “Cupping”. Cupping has been used for many centuries; this ancient technique utilizes glass cups or bulbs to adhere to the patient’s skin, either through suction or vacuum. The purpose of the cup suction is to aid with a patient’s complaint of pain, a lack of blood flow to a targeted area, improve relaxation to the surrounding muscles and be used as a form of deep tissue massage.
The suction of each cup typically lasts for a few minutes, but in those couple of minutes is enough time to cause the capillaries of the skin to rupture, creating the circular, bruises that have been so visible on Phelps and on the athletes at the 2016 Olympics.The bruising effect would be the same as someone giving you a hickey.
Physiologically, cupping is thought to draw blood to the affected area, reducing soreness and speeding healing of overworked muscles. Athletes swear by it, saying it keeps them injury free and speeds recovery.
While many athletes, coaches and trainers believe in this form of treatment, there’s not much strong evidence/research to determine whether cupping offers a real physiological benefit.
With spring time rolling around quickly on the east coast, countless people flock outside for different activities. One of those most often performed is gardening/yardwork. People love to get those flower beds looking pretty to go with all the sunshine! However, with this increased motivation to get active comes an influx in patients in most Rehab clinics. Most often people tend to not pay attention to body mechanics, or if they do the long hours spent gardening finds the body fatiguing and falling into improper positions. We see complaints anywhere from overuse shoulder/elbow/hand injuries to knee pain from squatting/kneeling as well as neck and low back pain.
To avoid these common injuries and pitfalls, you need to gardening like exercise or a sport. You should always warm-up and not head directly from inside to out without doing so. This includes stretching the large muscle groups of both the lower and upper body in preparation for movement and to take some stress off joints during strenuous tasks (you should also stretch afterwards as well). Several other crucial strategies to remember are:
– Plan out your time, and be honest about how much time you can physically afford to perform the task. Everything will eventually get done, do not worry!
– Good body mechanics are key! When lifting remember to bend the knees, keep back straight, hold object close to body, and lift through the legs not the back.
– Avoid all twisting motions and refrain from bending forward for long periods. If you must bend forward, keep the core tight and back straight to limit stress on the low back. Sitting on a small stool is your best option.
– Alternate tasks, not needing to completely finish one before, to use different muscle groups and avoid placing repetitive stress upon the spine and extremities
– Take small breaks every 30-60 minutes to get a drink of water
– Stop before you are fatigue as this is the time when most injuries occur
If you begin to notice and pain and soreness make sure to stop and stretch, ice and rest. If the pain persists more than a few days, it is best to then consult your MD or Rehab Provider.
A Physical Therapist’s training includes how to combine subjective history with objective measures and tests to determine an accurate diagnosis of a patient’s pain. Following an accurate diagnosis, the initial evaluation (or even in subsequent treatments) turns toward describing the areas of dysfunction to the patient and what measures will be taken to address them. Pertaining to the low back, we often use complex terminology to describe the injuries which some patients may not completely grasp. Below are some of the most commonly used terms:
Spodylolisthesis: Forward or Anterior displacement of one vertebrae on the vertebrae below it. Varies in severity from causing no pain at all to compression of nerve roots or spinal cord, which may cause pain/numbness in one or both lower extremities.
Sciatica: compression of the sciatic nerve or the nerve roots comprising it (mainly L5-S1, and less so L4) causing pain from the low back and gluteals and possibly extending down to the foot. Usually only occurring down one leg or the other. Common causes are disc herniation, lumbar/facet stenosis, degenerative disc disease, pregnancy, and piriformis syndrome.
Degenerative Disc Disease: not truly a disease, but term used to describe normal degenerative changes of the discs in your spine. Vertebral discs are fluid based shock absorbers between the vertebrae that allow proper movement of each segment. As we age the discs break down from use and dehydration, causing limitations in vertebral mobility and affecting spinal stability which can lead to other injuries of the spine.
Radicular Pain: also known as radiculopathy/radiculitis, is pain across the dermatome (sensory pattern) of a particular nerve root due to compression or injury at the nerve root level branching from the spinal cord. A common form is Sciatica. Common causes can be disc herniation, osteophytes, degenerative disc, and facet stenosis/arthropathy
Bulging Disc: means the vertebral disc of the spine is injured but “contained.” A small bubble of the outer fibrous ring of the disc (annulus fibrosus) protrudes into the spinal canal, sometimes impinging on nerve roots and causing pain. There is no tearing of the disc and no portion of the gel-like center (nucleus pulposus) has leaked out.
Herniated Disc: means the vertebral disc of the spine is injured and the disc is “not contained.” A tearing or rupture of the outer fibrous layer occurs and a portion of the gel-like center has leaked into the spinal canal. It may begin as a bulging disc but continued excessive pressure led to rupture. Usually associated with intense pain in the low back as well as radicular pain.
While the above terms are frequently used, the list is not all inclusive. Your best bet is that if Physical Therapist, or other medical professional, is describing a medical diagnosis or treatment plan for you and you do not understand a term, just ask them what they are referring to. We find that the more a patient understands about their own body and course of treatment, the more compliant they are and better results they tend to see.
Vibration therapy, founded to help astronauts maintain muscle mass in space, has down-to-earth benefits that can help patients.
Dr. Jim Tholany said that whole body vibration (WBV) therapy is offered at the Bordentown office where he works as a physical therapist and rehabilitation manager. WBV treatments are a few minutes in length, and used in conjunction with other therapies.
WBV works by a stretch-reflex contraction of the muscles when they are activated through vibration.
“When contractions occur, good things happen,” Tholany said. “You get improved activation of that particular muscle group, improved blood flow and stimulation of joint receptors in the muscles and tendons that help your body have more information to help stabilize you,” he continued.
WBV has many uses, according to Tholany, such as increasing strength, flexibility, post-training recovery, decreasing inflammation, and fall prevention.
Post-training recovery vibration therapy might allow a client to be ready sooner for another training session.
The contractions caused by WBV therapy to decrease inflammation help flush fluid out of the surrounding joints, though it’s not used for acute inflammation. It is also not used immediately post-op, or patients with bone tumor or fracture, clots, kidney stones or those who are pregnant.
When it is integrated into a treatment plan Tholany said it is used two to three times per week. Its usage varies from static held positions to moving around on the vibration plate, such as step ups and squats. It can be used for patients with both upper and lower extremity conditions.
Yoga has become very popular in the U.S. in recent years. It is an ancient activity involving exercise, meditation, breathing and philosophy. Some sources claim its origins date back 5000 years. Many styles of yoga have developed through the years and we can find a variety of classes within most suburban communities.
While you can benefit from any type of yoga, there is also potential for injury. It is wise to be cautious when initiating any new form of exercise and to seek clearance from your MD. If you are new to yoga, it is important to start at the proper level. Speak to the instructor if in a class and inform them that you are a beginner and of any injuries you may have. If using a video, be sure it is appropriate for your level and be extra careful not to perform any activities that cause you pain.
There are some basic yoga poses that may be helpful to introduce the beginner who is considering taking a class or to alleviate some aches which are common among those of us who have sedentary jobs or basic posture-related issues.
Child’s pose: Begin on all fours with hands directly under shoulders and knees under hips. Keeping your hands on the floor, gently shift your weight back until your butt rests on your feet or as far as you can go comfortably. Let your head rest on the floor and breathe. Try to stay in this restorative pose for a minute or more, repeating 2 or 3 times.
Bridge: Start by lying on your back with knees bent and feet flat on the floor, hip width apart. Breathe in. As you exhale, start to curl your tailbone under and lift your buttocks off the floor. Only go as high as is comfortable. Do not let your knees fall out to the side. Hold for a breath, then slowly lower yourself and repeat 10 -20 times.
Bird Dog: In the hands and knees position, keep your back level. Do not arch or round your back. Find your neutral posture then slowly and with control raise your arm and your opposite leg. Only raise as high as you can without losing your neutral spine posture. Hold for a breath then gently lower back to starting position. Repeat with the other side for a total of 10 times.
Cat/Cow: Begin on all fours with shoulders right over hands and hips right over knees. Inhale and as you exhale draw your navel in and round your spine from head to tail, trying to curl into the shape of the letter “C”. (Think of an angry cat) As you start to inhale, slowly uncurl your spine and gently round towards opposite direction. (Think of a cow’s swayback) Sync your movements with your breath. Repeat 10-20 times.
Remember to always be comfortable while practicing theses poses. There should not be pain. Always keep breathing and do not judge yourself!
We have been fortunate enough to add laser therapy to the list of rehabilitation modalities that we offer at Performance Spine and Sports Medicine. This is a tool that very few people have access to in the area. The laser that we have is a class IV high intensity laser from light force. The class IV laser allows you to get deep into injured tissue and achieve a thermal effect that the traditional class III cold laser does not. The thermal effect of the laser promotes increased blood flow to the injured tissue which helps to improve healing time. Deep Tissue Laser Therapy accelerates your body’s own natural healing process through photo-bio-stimulation.
Photo-bio-stimulation is the act of changing the condition of damaged tissue by stimulating cell metabolism which in turn improves the speed of tissue healing. This is achieved by photons from the laser head being emitted into deep tissue cells, which causes soothing warmth in the area. The photon molecules are absorbed by mitochondria in the injured cells. Mitochondria are the driving force behind energy production in a cell. Stimulation of mitochondria produces ATP, nitric oxide, and reactive oxygen species.
Increased levels of ATP will help with energy transfer within the cell.
Nitric oxide is a powerful vasodilator (which means it opens vessels to allow better blood flow) and an important cellular signaling molecule involved in many physiological processes in the human body.
Reactive oxygen species have been shown to affect many important physiological pathways including the inflammatory response.
The production of these signaling molecules in concert has been shown to induce growth factor production and improve cell proliferation (healing).Laser therapy is effective in treating chronic conditions, acute conditions and post-surgical pain. This tool allows us to expedite the healing process which creates quicker recovery times and decreased time in pain and discomfort.