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The Single Leg RDL-Baby Steps, Training Wheels and Driver’s License

Filed under: Balance/proprioception,Exercise Instruction,Exercise Technique — Shon @ 3:44 pm January 25, 2012

The single leg RDL (also known as the one leg single leg deadlift) is an extremely useful and functional exercise for many training and patient populations.  In one movement, you get: 

1) Fantastic triphasic (eccentric-isometric-concentric) activity of the hamstrings through a functional range of movement.

2) Great gluteal (maximus and medius) activity and stabilization throughout the movement.

3) Appropriate involvement of Janda's "deep longitudinal subsystem" and Myers'  "lateral line" (including the peroneals and anterior tibialis in concert with the lateral hamstrings, sacrotuberous ligament and gluteus maximus/ medius).  In simpler terms:  Awesome co-contraction and integration from the foot/ ankle through the hip and pelvis. 

4) An excellent stimulus for torso muscular stability training.  Appropriate dynamically stiffness of the torso is much easier and efficient to "drive" though the SLRDL movement pattern then one that is limp wristed. 

The problem that I have with the exercise is inherent in the fact that most people I see in the clinic generally have multiple impairments, not limited to strength/ contractility, mobility /stability, and balance, all of which will generally disqualify them from going full bore into the single leg RDL.  In particular, most, if not all post operative anterior cruciate ligament (ACL) patients are significantly deficient in all of the above, especially early in the rehabilitative process.  This study in the Journal of Sport Rehabilitation shed light on significant motor control deficits 12 months after ACL reconstruction, while Howells and colleagues in a systematic review of the literature noted impaired postural control as an issue in post operative ACL patients. 

So what does this have to do with the single leg RDL?  Really in the way it is taught most of the time.  Most texts and or instructional videos teach the SLRDL in a "hands free" mode, which while acceptable for many healthy trainees as well  as proprioceptively gifted patients (an outlier group for sure).  It is the way I taught it for a long time as well, with the expectation that sooner or later most people would catch on to the "correct" technique.  Recently, however, I decided that I was wasting both my patient's  and my own time by not streamlining the process better by incorporating additional external stabilization, tactile cueing and environmental constraint to facilitate capture of the technique.  

Below, I give you three simple but effective steps to teach just about  anyone how to subliminally slip into the single leg RDL. 

Phase 1- "Baby Steps"

Below is video of one of my patients, six weeks post ACL reconstruction, demonstrating the first progression of the SLRDL.  We are assuming the person has major issues with unilateral balance, let alone moving through space on one leg.  Here we are using maximal support of both arms for balance as well as to keep the pelvis and shoulders level, allowing a proper hinge at the hip (as well as a hurdle to allow tactile cueing of the back leg): 

 

Keeping the trunk and pelvis level without using the arms for support would have made this much more of a difficult proposition so soon after reconstruction.  Here, the pattern gets grooved quite nicely, with the ability to steer posture through the upper body, while the foot learns to make tactile adjustments without having to control the whole chain by itself.

Phase 2- "Training Wheels"

The next phase involves utilizing a dowel (or similar prop) for support, decreasing the upper extremity involvement as well as adding a bit more proprioceptive challenge:

As you can see here, we are using a kettlebell in the opposite hand to add load.  Weight can be utilized as soon as the athlete/ patient/client demonstrates appropriate trunk/ pelvic control; adding weight too soon can lead to trunk rotation-something desirable for Stuart McGill's excellent "Hip Airplane" exercise, but not the response we are looking for in this particular progression. 

Phase 3- "Driver's License"

After we have grounded and sealed technique using the first two progressions, we then take off the "training wheels" and allow performance to roll without props/ support: 

At this point, we have the outcome we want- appropriate head to toe alignment, good pelvic/ trunk stability and the hinging mechanics we are looking for.  More importantly, the patient is now independent in the performance of the exercise-it's his for life.  Of course, it will be useful not only in his clinical care, but as a performance enhancement tool after discharge.

In Summary

The single leg RDL is a fantastic exercise, but can be a challenge for certain clients and patient populations to master, namely due to impaired proprioception/ balance and whole system stability.  Fortunately, the remedy for this is pretty simple: use your available environment to externally stabilize and groove the movement pattern you are looking for.  Rely on upper body support, tactile cues, or whatever other tools you have available to get your patient/ client to understand the basic pattern, then take support away as technique allows.  Before you know it, they will perform the way you want independently, with great technique that they now own. 

   

 

 

 

     



Serratus Anterior Training Progressions

The serratus anterior is like that kid you knew in high school everyone knew: a bit mysterious and misunderstood, who was not necessarily in trouble, but was always around trouble when it happened.

 

Kato Kaelin may be the human equivalent of the serratus anterior

 

It isn't really a muscle that takes a regular beating like the long head of the biceps in a thrower, nor is it "married" to a joint complex like, say the supraspinatus.  However, more often I see it being a problem in people with traumatic neck pain (such as whiplash injuries) in addition to older patients with non-athletic shoulder pathology.

Obviously, overhead athletes (particularly tennis, baseball and swimming) with shoulder pain may have serratus activation/weakness issues, but the big trend I'm noticing is serratus under activation/ weakness in cases of neck pathology, particularly those of a traumatic nature.  This applies again to acceleration injuries such as whiplash, but also to athletes involved in collision sports (football, wrestling, MMA).  This recent study highlights the link between serratus dysfunction, poor muscular activation and cervical/thoracic dysfunction.

Anatomy of the Serratus Anterior

The serratus is definitely an oddly shaped muscle.  The best way to think of the serratus is to think of a hand. The origin(s) of the serratus are shaped like fingers and grasp the superior borders/ outer surfaces of the upper eight or nine ribs (o.k., we don't have nine fingers, but I get a pass on this one).  Your palm is the "body" of the muscle, while the wrist crease is the insertion of the serratus on the medial scapular border.

 

The "classic" anatomy book rendition of the serratus anterior

 

 

Typically what we think of when we see a serratus in a lean individual

 

 

The serratus wholly dissected looks  kind of like this, that is if we had eight or nine fingers

 

Function of the Serratus Anterior

According to Kendal (Muscles Testing and Function, fourth edition), the functions of the serratus anterior are numerous, including letting the glenoid cavity of the scapula (the "socket" of the shoulder joint) rotate upward, as well as holding the medial border of the scapula against the rib cage. Also, the lower fibers may depress the scapula a bit.  I think both clinically and from a performance standpoint that the last two functions are very important. 

First, keeping the scapula held firmly to the rib cage by way of proper serratus function allows properly functioning "anchor points" for the rest of the scapular musculature,  the rotator cuff, as well as the middle and lower trapezius, as well as the levator scapula and upper trapezius.  Secondly, as an end range scapular depressor following the mild  concave contour of the rib cage, I believe we may ultimately help foster qualitatively improved glenohumeral elevation by lessening anterior scapular tilt

The Serratus/Rhomboid Fascial Connection

In "Anatomy Trains", Thomas Myers points out the fascial/septal connection between the serratus anterior and the rhomboids.  We know from Kendall that the rhomboids are antagonistic to the serratus (or as she puts it "direct opponents"). Myers coins the term "rhombo-serratus" muscle,pointing out the two muscles form a myofascial scapular sling, setting up scapular "ballast".  The two muscles appear as "kissing cousins" in these illustrations/ dissections.  So, as the serratus goes, the rhomboids will go (and vice versa), both from a length (short/stiff) issue as well as an activation/contractility issue.

 

Thomas Myers- The "Christopher Columbus" of the Anatomy World

 

These passive, active, and cozy connections provided me with an "a ha" moment when working two patients recently, both who had traumatic neck injuries related to whiplash, and my approach to their treatment.  

Both had multiple issues, including loss of neck and shoulder mobility due to soft tissue injury, and the loss of mobility was due to multiple factors, including segmental tightness at the cervical facet level and posterior shoulder capsule/element tightness.  Obviously these were treated in concert with soft tissue work to the rhomboids (at the point of insertion on the medial scapular border), activation work for the middle and lower trapezius, and postural restoration activities.

 

Weaving the Serratus/ Rhomboid Tapestry

When it came time to train the serratus, I utilized a three phase approach based on 1) supporting still sensitive, sub acute healing  cervical/ thoracic structures 2) gradually decreasing external support as our injured tissues allow 3) giving the rhomboids "equal time" to allow seamless integrated contractility/ activation in conjunction with the serratus.

Phase 1

I use a massage chair for trunk support to dial in what I want the patient to perceive as appropriate serratus function (scapular protraction with shoulder elevation).  The key is to maintian scapular protraction while elevating; retraction during elevation indicates poor serratus function and/ or too heavy a load.

 

 

Phase 2

As the patient gains an understanding of how to activate the serratus and control the scapula, we then move to a seated position to allow/ integrate trunk stability while the serratus does it's job:

 

 

Phase 3

After we have mastered the first two progressions, we then move to a standing position, which integrates further the trunk with the hip.  Again, Thomas Myers notes a fascial/septal connection between the serratus as well as the obliques and tensor fascia lata; standing allows potential stabilization/ integration between these elements:

 

Integrating Rhomboid Activation

The X factor that was missing in the equation for me in the past was addressing rhomboid function.  I had been so focused on not aggravating the upper trapezius/ levator scapula that I avoided rhomboid activation as I felt it encouraged too much "turn on" of the aforementioned groups.  However, with recent patients, careful integration of specific rhomboid work "greases the groove" for the rhombo-serratus anatomy train, and allows appropriate tri-phasic (concentric/isometric/eccentric) interplay in a scapula with great myofascial ballast (courtesy of early and appropriate soft tissue work, joint mobilization and postural restoration).  

Here, we perform a static rhomboid activation, careful to minimize upper trapezius and levator activity:

 

 

Beyond Basics:

After we've got our "new normal" scapular function, we can progress through our preferred  "pushing"upper body exercises.  I am biased toward push up progressions at first, as scapular mobility is encouraged vs. locking the scapula down with a bench press.

My personal favorite test of good serratus function is a handstand hold, as I feel  a real satisfying scapular position on the ribcage with this exercise: 

 

 

 

 

At The End of the Day…

1) The serratus anterior is a tough muscle to wrap your head around from a three dimensional standpoint; however it's function really is a keystone for proper scapular function (and the scapula is a keystone for trunk/ extremity integration, if you really think about it). 

2) Serratus function is an interplay between both the serratus and the rhomboids, both from a passive (shortness/ stiffness) perspective, as well as an active one; both need to be addressed.

3) Strengthening the serratus is more about proper, integrated activation in conjunction with the rhomboids after appropriate positioning/ballast of the scapula has been established through appropriate manual therapy/postural intervention.

4) Advanced upper body push activities should allow free scapular movement, such as push up, dip and pressing pattern progressions as tolerated (remember to pick your candidates carefully for pressing and dipping) 

  



Exercise of the Week- “Twelve to Six” Core Stability Challenge

Filed under: Uncategorized — Shon @ 3:13 pm January 5, 2012

A fantastic exercise  that challenges the entire upper quarter from a both a stability standpoint as well as a unique  use of the latissimus is the "Twelve to Six" movement on the rings (the name comes from the movement of the head from the twelve o'clock position to the six o'clock position when a repetition is initiated).  The video below is yours truly performing a typical set:

 

The movement is initiated from the "dead hang" position with as neutral a spine as possible.  The foam roller helps keep the hip and lumbar spine position "honest" throughout the exercise, which challenges the lats and scapular stabilizers even further.

Begin with a strong bracing contraction of the abdominals, then "set" your lats by isometrically depressing your shoulders. Then, pull your knees toward your hands ( the foam roller is key here, as without it, you easily loose the neutral spine position).  When your knees pass the straps of the rings, pause 1-2 seconds and control the descent to the starting position.  Pause 1-2 seconds, and repeat.  

One to three repetitions per set is a great starting point, with a set range of five to ten sets per session being adequate for good progress.  You can increase repetitions as you wish, as long as technical excellence is maintained.  It is best with this type of exercise to leave "one in the tank" so as not to develop a sloppy motor pattern and/or substitution pattern.

This exercise serves as a nice precursor to a front lever progression, part of which I have demonstrated before:

 

 

 

Why This Exercise is Valuable:

1) The Lats Work Differently Than Usual

In this exercise, the latissimus act in "reverse action"; that is, the origin of the muscle (at the thoracolumbar fascia) moves toward the insertion (the humerus) in closed chain fashion against gravity- a pretty difficult and challenging proposition.  The trunk rotating about the shoulder joint provides different training stimulus versus most "traditional" chin up/pull up progressions. 

 

The sternal portion of the pectoralis major also gets some work as a stabilizer, as does the subscapularis and teres major, with the shoulder being internally rotated and adducted. 

2)  The Abdominals Act as a "Chassis Stabilizer"

Bracing the abdominals (as well as increasing intrabdominal pressure)  set the stage for a rigid frame that the latissimus "engine" drives through completion.  Again, the foam roller held with the heels/buttocks is really important in the early stages of learning, or you loose a key part of what makes this exercise worth doing. Moving the distal end of the body through space requires a high level of not only abdominal activity, but integrated proximal hip stabilization and significant intermuscular coordination between all moving and stabilizing parts.

3) You Are Taken Out of Your Proprioceptive "Comfort Zone" 

The psycho biological/ proprioceptive challenge of overcoming the apprehension of an inverted posture is something that will benefit most trainees. There is a skill component in learning and exercise like this that is more fun than a typical straight saggital/frontal plane movement such as a chin up.  When you do this in a commercial gym, the looks are pretty priceless as well! 

Who This Is Not Probably For

-A trainee who can't perform an "honest" 12 chin ups or pull ups.

-Someone who lacks requesite thoracic spine and shoulder mobility.

-Those who have fair to poor ability to stablize the core.

For those who are ready, though, the "Tewlve to Six" is a great addition to a program that adds a lot of value (as well as a lot of strength) to a solid program.