Assessing Control In the Sagittal Plane

Last weekend I was fortunate enough to be able to attend a superb seminar in San Francisco to further my education in the science of the Postural Restoration Institute or PRI for short. It was such a huge pleasure to be surrounded by a group of high level thinkers, and reminded me of the expression: If you're the smartest person in the room, you're in the wrong room!

PRI science manages to be both simple and complex - it is highly technical and requires an advanced understanding of biomechanics and anatomy.  However, at the same time the principles just seem so obvious once they are explained.  It is safe to say that anyone attending a PRI educational event will experience several 'ah hah' moments - if not full on face palms.

It all seems so obvious now

At this latest event, which was very much focussed on bringing Postural Restoration science out of the clinical setting it is best known for, and applying it in the space of strength and conditioning, the presenters had simplified some of the more complicated orthopaedic based PRI assessment protocols into a series of movement 'screens'.

One of these screens has been designed to assess an individual's ability to fully exhale, and successfully inhibit their Posterior Exterior Chain (one of the various poly-articular chains that PRI science is based upon).  Now whilst this sounds complicated - in essence this was a very simple assessment that would demonstrate if a client / patient / athlete has control in the sagittal plane.

Those who know me, know that I place a great deal of emphasis on an A,B,C of movement coaching that was popularised by Evan Osur in his Integrated Corrective Exercise method.  Dr Osur explains the A,B,C principles as follows  "For a movement to be 'successful' it must optimise the individuals Alignment, Breathing, and Control in that position.  If they don't have control, then they don't fully own that position."

In order to 'clear' this very simple screen the individual must be able to come out of a gross extension pattern (alignment), fully exhale and retract the ribcage (breathing) and successfully inhibit their trunk extensors (control).




So, so simple and really was one of those 'why didn't I think of that!?' moments.  Well.... I didn't, and they did - so huge thank you to James Anderson and Julie Blandin for coming up with this.

What does it mean?

Well - in PRI speak we are looking at core organisation and restricted costal mobility, and therefore airflow on one or both sides of the thorax.

For those who aren't familiar with this terminology, or who don't wish to explore PRI science - if your client can't do this, they are not ready to train outside of the sagittal plane.  Nice and simple.  They need to work on core control in this plane first, master the sagittal plane, and then  be progressed to the more 3 dimensional movements.

So there we have it - a simple simple screen technique born out of a very advanced school of thought.  And one that has an application for all.

To round off - here we have the awesome group of people who attended this latest PRI event in San Francisco.  I'll finish how I started this post - if you're the smartest person in the room - you're in the wrong room!

PRI Integration, San Francisco CA, Oct 2015

Face Pulls

One of my go-to exercises for shoulder health, correcting a number of postural imbalances, and all round ‘good hygeine’ as a client of mine calls it – is the face pull.  It's safe to say if I have been writing programs for someone, they will have become pretty familiar with face pull variations.

Jim Carrey, an outstanding face puller

In my opinion the face pull is a ‘must do’ movement for pretty much everyone, in its simplest form it encourages a posterior tilt of the scapulae, increases the sub acromial space, and encourages activation of both the lower traps, and the posterior cuff – whats not to love!?

 The sub acromial space - there is rarely a lot of it...

A certain amount of 'impingement' is inevitable, however, poor shoulder mechanics, less than optimal alignment at the scapula thoracic joint, and poor centration of the glenohumeral joint can all contribute to decreased sub acromial space, increased impingement, and hurty shoulder

To set up for the standard face pull there are a couple of key cues to remember

- cable column should be set to head height

- adopt a split stance to minimise the chance of achieving the movement through excessive lumbar extension (lock this down even further with a good squeeze of the glute on the back leg)

- pull the lower ribs down and get a solid brace through the anterior core

- pull the rope grip towards your face (towards, not into - I have seen it done trust me).

- ensure the shoulders stay away from the ears, and the elbows draw up higher than the shoulders

- smile

https://youtu.be/nQXjdUNt6nw



I like to program face pulls for medium to high reps - so anywhere in the 12-25 bracket.  I'm rarely looking to develop a great deal of force production in a movement like this, its much more about creating good movement and 'feeling' the exercise.  As for where they sit in a program, this is usually a C2 and acts as a 'filler' between working sets on secondary assistance movements, I also occasionally use it as a D2 to round off an upper body lifting session thats had a lot of heavy pressing, or even as part of the dynamic warm up for those folks 'stuck' in internal rotation and with a heavy kyphosis. 



Like all the best things in life, face pulls have variations to suit different needs ,  our job as coaches is to select the most appropriate version.  I have listed a few variations that feature most often in my programs - its by no means exhaustive  - but should serve as a decent starting point:

Face Pull to External Rotation (Supinated Grip)

Most useful for those wanting to throw a bit more stress on to the posterior cuff,  easiest to cue this one as two movements - the first pull, and then the external rotation.  Clearly loads will need to be reduced vs the conventional set up otherwise there is a tendency to shrug the weight back rather than engage the cuff (yes I know I totally need a haircut)


Half kneel face pull

I like to use this variation for those with an exaggerated kyphosis, the downward moment of the pull really encourages the posterior tilt these folks can often struggle with.  I will more likely use this variation with a newer trainee to help them understand what it feels like to have the low traps work and open out the chest.

Less useful for the 'athletic meathead' posture of shoulder blades stuck in downward rotation  - with these guys this variation could actually make them worse so make sure you conduct a thorough evaluation and assessment.

Low to High Face Pull

I love this movement for encouraging upward rotation of the shoulder blades.  Ideal for those guys who have deadlifts for breakfast lunch and dinner and find the shoulder blades stuck in downward rotation.   The upward moment on the pull will cause you to initiate a shrug as the arms pass horizontal.  For those with a really aggressive down slope on the collar bone, you may want to cue some upper trap recruitment at this point (yes we need upper traps too).

As above this movement will be great for some, and less so for others - if your client or athlete presents with abducted (winging) and anteriorly tilted shoulder blades,  and upper trap 'dominance', then this one may not be for them.

Summary

The face pull, and its derivatives are an excellent way to keep your shoulders healthy and pain free, improve posture, and allow you to go heavy on the bench press more often (which is the whole point right).

However, and there is always a however, we must must must choose the most appropriate version for the situation in front of us.  As I have alluded to above, the key to designing any form of training program is the assessment - there is no way we can get from point A to point B unless we know where point A is.  And although the face pull is as close a thing as I have seen to a silver bullet for many common shoulder niggles we must choose the correct tool for the job.  To quote the genius that is Eric Cressey if you aren't assessing you're just guessing.

No massive relevance to the article, but there are probably silver bullets in this gun. And who doesn't love Hugh Jackman and Kate Beckinsale.

Is Flexion the Devil's work

I was prompted to write this article after an email exchange with a fellow professional - and it seems its a subject that provokes a great deal of emotive debate - so here is my tuppence worth:

 

[caption id="attachment_108" align="aligncenter" width="300"] Keep your back straight[/caption]

Go to any gym,  sports club S&C facility, or even watch the New Year exercise DVD of whoever most recently traded in their dignity to eat kangaroo balls in the jungle  - and you will continually hear the same 'chest up, shoulders back' instructions over and again for every movement - and more often than not its explained that this is to help prevent back injury...

[caption id="attachment_106" align="aligncenter" width="207"] Chest up, shoulders back - does this look remotely sensible to you?[/caption]

I do understand where this has come from - we live in a society where people spend far too much time sat down hunched over a keyboard or  humancentipad (yeah its a thing - google it), and the majority of folks complain of a bad back....  Well then that flexed spine must be the culprit right?

Quite possibly yes - but does that mean we take everyone to the other extreme and force them into permanent extension?

Well that would just be silly now wouldn't it...

[caption id="attachment_107" align="aligncenter" width="225"] Silliness - almost never a bad idea[/caption]

Unfortunately the world of health and fitness seems to be one of extremes and fads, we as a collective group of fitness professionals don't seem to be able to take the middle of the road on just about anything.  Again, I get it, yeah Ive been in and around this business for knocking on for 20 years, and these days don't give a monkeys' what the current trend or 'approved school of thought' is  - but I have certainly been guilty of throwing myself onto several bandwagons in the past - without necessarily applying some common sense first.

[caption id="attachment_109" align="aligncenter" width="275"] Not always the safest place to be - but at least it means you can see both sides[/caption]

The problem we have with a one size fits all approach to postural correction is that, in driving everyone into a permanent state of extension, we are creating more problems than we solve...  The dropped (or anteriorly rotated) pelvis is - in my opinion - far more likely to lead to potentially debilitating back pain than a moderate amount of spinal flexion.  After all, spines were designed to flex!  (I'll get into who designed us at a later date).

[caption id="attachment_75" align="aligncenter" width="300"] Anterior pelvic tilt - or 'lower body cross syndrome'[/caption]

Cueing and coaching people to extend all the time will, undoubtedly, worsen the alignment you can see above - termed by Janda as 'Lower Body Cross Syndrome'. This is short or over active spinal erectors and quads, weak or inhibited gluteals and anterior core.

[caption id="attachment_96" align="aligncenter" width="300"] All you need for a stable spine[/caption]

Anyone who has ever read anything vaguely health related will know that the big hitters for stabilising a lumbar spine and preventing / rehabilitating low back pain are....  GLUTES AND ANTERIOR CORE!  So why would we be constantly cueing people into a position where these guys can not do their job!?

[caption id="attachment_110" align="aligncenter" width="300"] It just seems so obvious now[/caption]

The simple myokinematics of an anterior pelvic tilt, or lower body cross - not allowing the main spinal stabilisers to adequately recruit is, however, only the start of the problem...  A position of extension is known by the clever folk at the Postural Restoration Institute in Nebraska as a state of 'permanent inhalation'.  A simple overview of respiratory biomechanics demonstrates that for adequate exhalation a ribcage must 'oppose' a pelvis.   Think of this as the bowl of the pelvis, and the arch of the lower ribcage forming a stable spherical shape....    Now why is this important?  The diaphragm is attached around the ring of the lower ribs, and down the thoraco-lumbar fascia...  what else is attached to the thoracolumbar fascia?  The iliopsoas of course!  In fact, in cadaver studies the crurar fibres of the diaphragm are almost impossible to distinguish from these major hip flexors. When one contracts the other gets pulled - think of them as George Dubya and Tony Blair.    If we elevate these lower ribs in a position of extension, the diaphragm will still contract,  but instead of pulling the ribs in, it will pull the lumbar spine forwards (extension) and pull the hip flexors even tighter.

[caption id="attachment_111" align="aligncenter" width="224"] Follow the line of the waistband. Hips are in about 15 deg of flexion[/caption]

Apologies to whoever this guy is, I pulled this pic from an article on the interweb titled 'how to deadlift correctly to avoid back pain'.  Not like this is the answer, sorry dude.

so...

An anteriorly rotated pelvis is in a position in which major spinal stabilisers and respiratory muscles can not adequately function.   What do we want people to do when they are trying to recover from a lower back injury, or brace themselves for a maximal lift?   Breathe and stabilise!

What should we be cueing people to do?  Get neutral!  Get the ribs down, brace and breathe.