Professional Documents
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Craig Liebenson
important that the goal of training is the upper quarter. The trunk
specified and that the exercise accomplishes this force transmission
prescription match the patient’s through its diagonal loops and slings
functional needs. (oblique abdominal/pectorals,
A basic pillar of exercise science is gluteus maximus/latissmus dorsi)
the SAID principle. This means that linking the hip to the shoulder girdle
training causes ‘specific adaptation (see Fig. 2).
to imposed demands’ (Sale & The role of the trunk or ‘core’ in
MacDougall 1981). These force transmission should not be
adaptations are specific to the underestimated. From the creeping
length, movement and speed of the and crawling of an infant, to the
exercise trained (Rutherford 1988). counter-rotation of pelvis and trunk
An example is that knee extensors during gait, to the full coil of a
Craig Liebenson DC (quadriceps) trained on the seated golfer diagonal, 3-D movements in
Private Practice, knee extension progressive functional activities are the rule
10474 Santa Monica Boulervard 202, Los Angeles,
CA 90025, USA.
resistance machine do not become (Lamoth et al. 2002). Yet, most
Tel.: +1310 470 2909; Fax: +1 310 470 3286; stronger on a bicycle (Rutherford modern activities which are
E-mail: cldc@flash.net 1988). sedentary (e.g. sitting, standing,
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Journal of Bodywork and Movement Therapies (2002)
Gary Gray, PT has pioneered slow walking), and even health club
6(4), 248^254 functional exercises such as 3-D exercises (e.g. sit-ups, biceps curls,
doi: 10.1054/jbmt.2002.0311, available online at
http://www.idealibrary.com on
lunges, single leg balance challenges, leg raises) predominately involve
This paper may be photocopied for educational use. and squats (Gray 2001, Risberg only one plane of motion – the
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Clinician’s information for self-help procedures
12:00
9:00 3:00
6:00
Assessment
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Liebenson
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Clinician’s information for self-help procedures
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Liebenson
movements then it can be progressed Squats and should be searched for when
to lunging on the Stability Training squats is valuable for patients have difficulty stabilizing
Trainer. improving lower quarter and trunk any link (i.e. ankle, knee, etc.) in the
function. A seemingly difficult kinetic chain. As an example if a
exercise – the single leg squat – can person’s forward lunge occurs with
be modified so that it is performed excessive hip or trunk flexion raising
with appropriate stability. Weight the arms overhead will
should be back on the heels and the automatically drive extension (see
knees should not drive forward Fig. 11). If subtalar hyperpronation
beyond the toes. With fingertips on a is present an arm reach across the
wall it becomes a novel way to body during performance of an
reeducate appropriate functional oblique or lateral lunge will
movement patterns (see Fig. 10). It automatically facilitate supination
should be performed with eyes open (see Fig. 12).
until 12 slow repetitions can be The addition of arm movements
controlled, then it can be progressed to a trunk or lower quarter exercise
to eyes closed. Finally, it can be instantly makes an exercise much
performed on the Stability more functional. Punches teach
Trainer. the patient to ‘learn’ how to transfer
their weight from back to front
Whole body and ‘tri-planar’exercises leg (see Fig. 12). The weight
Single leg balance, lunge and squat transfer facilitates the lower
exercises can become ‘tri-planar’ quarter kinetic chain to generate
exercises (movement in all three power which the trunk transmits to
planes of motion) by adding arm
reaches. The correct arm motion will
improve squat or lunge performance
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Clinician’s information for self-help procedures
Functional activities
The final common pathway for
functional exercises are movements
which mimic the sports or activities
an individual performs. The
Stability Trainer is ideal for
challenging the balance,
coordination, strength and
endurance of the individual in these
functional positions and movements
(see Fig. 15).
Summary
Improving stability during
performance of daily activities is Fig. 14 (A and B) Sword (Reproduced with permission from DeFranca C, Liebenson C. The
the final goal of rehabilitation. Upper Body Book, 2002, The Gym Ball Store, San Diego, www.gymball.com.).
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Liebenson
body movements coupled with Liebenson CS 2002. Advice for the clinician
and patient: functional exercises. Journal
progressive balance challenges trains
of Bodywork and Movement Therapies
the deep ‘core’ muscles. 6: 108–116
McKenzie RA 1981 The lumbar spine.
Mechanical Diagnosis and Therapy.
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Gray G 2001 Rehabilitation Institute of Risberg MA, Mork M, Krogstad Jenssen H,
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1991 Comparison of spinal mobility and C (ed). Rehabilitation of the Spine: A
isometric trunk extensor forces with Practitioner’s Manual, 2nd edn.
Fig. 15 Golfer exercise with stability trainer. electromyographic spectral analysis in
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Lamoth CJC, Meijer OG, Wuisman PIJM, 2000 Abdominal response during curl-
Manual therapy and non-weight- van Dieën JH, Levin MF, Beek PJ 2002
bearing exercises are frequently ups on both stable and labile surfaces,
Pelvis–thorax coordination in the Physical Therapy 80: 564–569
Functional training part 1: new advances
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functional training does not persons with nonspecific low back pain.
1992 Objective clinical evaluation of
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necessarily need to follow these physical impairment in chronic low back
Liebenson CS 2001 Advice for the clinician pain. Spine 17: 617–628
other approaches. and patient: sensory-motor training.
As the saying goes ‘begin with the Journal of Bodywork and Movement
end in mind’. Functional whole Therapies 5: 21–28
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