Posts Tagged ‘function’


Yes, I said dormant butt syndrome, DBS for short! I see it all the time in the clinic. In athletes and people of all ages. The cause of DBS is usually tight hip flexors, again, which most people have. This is due to repetitive hip flexion from walking, running, sitting, driving and sleeping in the fetal position.  Other causes include injury and inactivity.   If you remember back to previous posts the gluteus maximus generally attaches proximally to the sacruum, and illiac crest and wraps around the hip to distally attach to the greater trochanter (the big bony bump on side of hip).  Although we think of the gluteus maximus as a powerful hip extender it is actually built for rotation.  Just look at the fiber orientation (yes, you may have to crack open the old anatomy book).  So, functionally its main function is to eccentrically control internal rotation of the femur in the transverse plane during the loading phase of gait or running, eccentrically control hip flexion in the sagittal plane and assist the gluteus medius in stabilizing hip adduction in the frontal plane.  The ability to appropriately load enhances their ability to concentrically contract during the unloadong or propulsive phase.  If the gluteus maximus is inhibited (which V. Yanda taught us) from a tight hip flexor, then the hamstrings and erector spinae group  become overactive to compensate.  This leads to the possibility of hamstring strains, low back pain, knee pain and possibly even plantar fascia.  A simple way to check for DBS is to have patient lie prone and ask them to do a leg lift.  Palpate the gluteus and the hamstring and see which contracts first.  Many times I feel the hamstring contract then the gluteus.  It should be gluteus then hamstring.  Sometimes ive seen people have a 5/5 manual muscle test and not even fire the gluteus.  They used all their hamstring and erectors to lift/hold the leg up.  Some general strategies include a basic muscle re-education of laying prone over table or bed and actively squeezing butt then lifting leg.  Sequence can also be done with bridge exercise.  Stretching the tight hip flexor, of course, and functional hip dominant exercise like single leg balance w/ arm reaches, multi planar lunges, sled walks, various step up and downs.  So now get moving and wake that sleepy butt up!

Get Strong! Stay Strong!




 By Barbara Fuller PT, FAFS

The late-seventyish woman looked at me with a bit of skepticism mixed with a little fear. After I introduced myself to her she said, “Before we start, I want you to know that I would like for you to address my low back pain, but I don’t want you to mess with my hip.” When I urged her, she further explained that she’d had problems with her right hip for a long time, with x-rays revealing severe arthritis and necrosis of the femoral head. She had been to an orthopedist who told her to come back for a total hip replacement when she could not stand the pain anymore. She was not ready for that. Her back pain was relatively new, but it was making her even more miserable, as well as making her unable to do the yard work she loved doing or taking a walk. Most telling was the account of her last experience in physical therapy when her hip was forced passively beyond what she could tolerate, thus resulting in increased pain. Needless-to-say, she never went back. Before I even touched this patient, or put her through any functional movement assessments, I felt a strong need to educate her about the hip – especially its relationship to the lumbar spine. I told her that the hip is the low back’s best friend. I explained how a normally functioning hip, one that moves well and is strong in all three planes of motion, allows the low back to function normally by protecting it from excessive motion and wear and tear. I demonstrated how a hip, with a decent amount of extension, propels the body forward, but without that extension, the task falls to the low back causing all sorts of problems. I told her that her hip had let her low back down and was probably the cause of her low back pain. All that being said, I then told her that I really felt that I needed to at least take a look at the hip or I would be doing her a disservice. I also promised her that I would not do anything she did not agree to me doing and that I would be very gentle. She agreed. In addition to the hip being quite friendly, the hip is BIGGEST of the BIG rocks in our body! Big rocks are the areas of the human body that provide a foundation for normal mobility and stability (mostability). But if they are not functioning well, then they become the culprits of pain and dysfunction in joints above and below. For the hip, that includes its closest neighbors – the lumbar spine and the knee – but it can also include more distant neighbors like the opposite shoulder or elbow. Also, the hip is our power source. We can understand this when we consider the powerful muscles of the back and front butts, and their core connections, including the pelvic floor (with connection through the hip adductors and rotators) and the thoracic diaphragm (with connection through the abdominals to the thoracic spine and rib cage). It is through hip extension that we can most effectively load our abdominals. As promised, I was gentle with my patient and started her functional assessment with neutral standing (XXX) while hanging on to a counter top with both hands. She was limited bilaterally in lateral pelvic glides and rotations. Most significant, though, was her lack of right hip extension in a left stride stance (LXX). She also demonstrated to me a successful short squat – something that applied to her goal of continuing with yard work. Her home-workable exercise program (remember the test becomes the exercise and the exercise becomes the test) became XXX with right and left lateral glides and rotations of the pelvis for a warm-up, which was then followed by LXX anterior and posterior glides. After these, I asked her to do some of her short squats (start with success). On her next visit she beamed and said, “I’ve had very little pain since my first visit!” She progressed beautifully through her physical therapy. Although she did not get full mostability back in her right hip, she gained just enough that on the day when she was able to complete a common lunge matrix (anterior lunge, same side lateral lunge, and same side rotational lunge) – no hands – she looked at me and said, “I feel so empowered!” Wow! I did not heal this patient, but provided an environment in which her body could improve. By giving her complete control, her fears were addressed. By educating her about the truth of the hip, her skepticism was addressed. And by giving her a home-workable program, she was empowered … and so was her hip! This is the beauty of Applied Functional Science.

Get Strong! Stay Strong! (and don’t forget to be functional!)




By Andrea Wasylow PT, FAFS  

  The  billing  coordinator  at  the  small  hospital‐based  rehabilitation  clinic  where  work  is  

phenomenal.  In  addition  to  being  one  of  those  people  who  you  just  enjoy  spending  time  with,  

she  is  exceptionally  skilled  at  finding  those  small  discrepancies  that  could  potentially  delay,  or  

give  reason  for  denial,  of  payment  for  services.  Prior  to  joining  our  team,  she  worked  at  well  

meaning,  yet  very  “conventional,”  physical  therapy  practice.  Since  coming  to  work  with  us,  we  

have  had  many  conversations  discussing  the  principles,  strategies,  and  techniques  behind  

treatment, based on an Applied Functional Science approach.  


One  such  discussion  occurred  recently  when  she  asked,  “Can  you  help  me  understand  why  

‘balance  stability  training’  was  included  as  part  of  the  treatment  plan  for  this  patient  being  

seen  for  shoulder  diagnosis?”  The  discussion  that  followed  highlighted  some  of  the  

misconceptions  surrounding  balance  rehabilitation  and  training,  and  hopefully  helped  provide   

better understanding of balance as an integral part of all function.  


Our  coordinator  had  become  accustomed  to  seeing  static  testing  on  the  ground,  or  on  less  

stable  surface,  as  common  way  to  determine  whether  or  not  an  individual  had  “good  

balance.”  Unfortunately,  someone  who  may  do  well  standing  on  one  foot  with  their  eyes  closed  

for  predetermined  period  of  time  may  stumble  or  fall  when  turning  to  look  at  who  just  called  

his / her name while he / she was walking.  


Though  commonly  used,  these  traditional,  static  tests  provide  limited  information  when  the  

fundamental  truths  about  balance  are  understood.  Balance  is  dynamic  and  three‐dimensional.   

It  is  our  body’s  ability  to  integrate  the  information  from  all  of  our  body  systems  during   

functional task and  use that information to displace our center of  gravity. The system  must  then  

decelerate  that  motion  and  either  bring  the  body  back  or,  more  likely,  move  in  completely  

different  direction.  Three  of  the  main  systems  that  feed  the  body  information  are  the  vestibular  

system,  the  visual  system,  and  the  proprioceptive  system.  Though  there  is  minimal  amount  of  

information generated to those systems in a static position, it is motion that truly “turns on” and  

feeds  these  systems  the  information  required  for  function.  Balance  requires  the  ability  of  the  

neurological  system  to  successfully  receive  information,  process  that  information,  and  then  

convey  an  appropriate  motor  plan  for  task  completion  –  all  while  controlling  the  center  of  mass  

against  gravity.  Balance  requires  range  of  motion  and  strength.  If  body  segment  lacks  motion,  

then  not  only  do  accommodations  of  additional  motion  in  other  areas  need  to  be  made  to  

complete a task, but proper muscular loading and exploding at the restricted joint can not occur.   

Balance  can  be  impaired  if  the  surrounding  musculature  is  unable  to  control  movement  into  

that  motion,  even  when  full  passive  range  of  motion  is  available.  Most  importantly,  balance  

requirements are determined by the functional task the body is being asked to perform. In order  

to  insure  successful  task  completion,  the  individual  should  be  able  to  control  three‐dimensional  

motion  beyond  that  required  of  the  functional  task.  Balance  rehabilitation  and  training  

programs should reflect that goal.  

 The patient whose chart our billing coordinator was reviewing happened to be an avid gardener.  

She  loved  her  flowerbeds  and  spent  significant  amounts  of  time  on  her  hands  and  knees  

weeding.  Her  balance  deficits  showed  in  this  position  when  she  would  bear  weight  through  her  

involved  upper  extremity  and  reach  with  her  other  hand.  Frequently,  she  had  to  quickly  move 

the  reaching  hand  to  the  ground  in  order  to  avoid  face‐planting  into  her  flowers.  As  it  turns  out,  

she  had  thoracic  spine  and  scapulo‐thoracic  range  of  motion  restrictions,  as  well  as  an  inability  

to eccentrically control the motion that her involved shoulder needed in order to accomplish the  

reach  distances  required  by  the  other  arm  for  weeding.  Thankfully,  with  training,  this  individual  

was  back  doing  the  gardening  that  she  loved  without  difficulty.  Also,  “armed”  with  additional  

understanding  about  balance,  our  billing  coordinator  was  able  to  coerce  payment  for  services  


Get Strong! Stay Strong!


Due to the sedentary nature of many peoples lifestyle, the hip (among other things) gets very tight and restricted.  This leads to compensatory movement and muscle imbalances that effect movement and performance.  So, as they sing in the movie Madagascar…you’ve got  to move it move it!

Here are few examples of hip mobility/strength exercises moving in various planes/directions.

p7290103   p7290102

Ant Lunge w/ Ant Reach                      Single Leg Stance w/ Opp Arm Cross Reach

p7290108  p7290109

Posterior Lateral Lunge w/ Rotation    Single Leg Stance w/ Overhead Post. Reach

p7290111  p7290099

Single Leg Stance w/ opp. Arm OH                  Lateral Lunge

Lateral Reach

After mastering controlled ranges with body weight move to increased ranges of motion, increased speed and / or adding weight.  Also think of the various other planes you can move into and how you can drive the hip more with variations of arm and leg reaches.  These movements are also a great active range of motion series for hip mobility and can be use to to maintain mobility after passive stretching or mobilization techniques.

Get Strong! Stay Strong!




By my friend, mentor and all around good guy David Tiberio PhD, PT, OCS

The internal power sources that drive the body are the hips and trunk: the core of the body. There are many ways to activate that power source, but probably the most important for upright function in our gravitational environment is eversion of the calcaneus.

Calcaneal eversion occurs in the frontal plane. It is one component of the tri-plane motion of pronation of the subtalar joint (STJ). Simultaneous with the eversion, a substantial amount of abduction occurs in the transverse plane at the STJ. The motion in the frontal and transverse planes at the STJ complements the ankle joint motion, which occurs primarily in the sagittal plane, to allow the rearfoot to move in all three planes. 
The calcaneal eversion results from the striking the lateral aspect of the heel when we walk. The ground reaction force (GRF) forces the calcaneus to evert. Since the motion is produced by gravity and the GRF (motion given for free), the role of the muscles is to decelerate the motion. In this process, the muscles are lengthened and activated proprioceptively. The strain created in the muscles during the deceleration is transformed into a concentric motion-producing force.

The calcaneal eversion that creates STJ pronation produces two important reactions in the body: one distal and one proximal. When the subtalar joint is pronated, the bones of the mid-tarsal joint (MTJ) are more mobile. During weightbearing this allows the foot to adapt to uneven surfaces and, more importantly, as the arch lowers certain muscles are lengthened (loaded) in order to become more powerful (e.g. peroneus longus). When the calcaneus begins to invert these processes are reversed in order to create a more stable foot at the time the muscles are “exploding.” 
The proximal effects of calcaneal eversion are more significant. Because of the angle of the STJ axis, the frontal plane motion of the calcaneus creates transverse plane motion of the lower leg. The STJ is called a “torque converter” because it converts the frontal plane motion of the foot into transverse plane motion of the leg (and vice versa). This transverse plane motion of the lower leg often transfers to the femur, pelvis, and lumbar vertebrae. Because the STJ is tri-planar and all joints move in three planes, the calcaneal eversion during weightbearing produces tri-planar reactions in the knee, hip, and spinal joints.
During walking, the knee will flex, abduct (valgus), and internally rotate. The hip responding to the calcaneal eversion and ankle motion will flex, adduct, and internally rotate. Since the pelvis is also driven by gravity and GRF, motion will be created in the lumbar spine. Remember that all these motions are “given for free” and muscles must first decelerate these motions prior to creating the opposite motions. It is these motions that turn on the hip and core muscles (both anterior and posterior), all initiated by the calcaneal eversion “switch.”


Frequently clinicians and trainers evaluate calcaneal eversion to see if the STJ pronation is excessive. A better approach is to apply the “Goldilock’s Assessment” – too much, too little, or about right. Although it is important to be cognizant of the role excessive pronation of the STJ plays in raising tissue stress to a symptomatic level, it is equally important to recognize how the lack of calcaneal eversion can inhibit the normal motion and muscle activation of the entire body. If excessive eversion of the calcaneus is too much of a good thing, then limited eversion is not enough of a good thing. Insufficent calcaneal eversion will inhibit the proximal bone movements. This will minimize the loading of the hip and core muscles. The knee will often exhibit a “varus thrust” and will not be an efficient shock absorber. The ankle will be susceptible to inversion ankle sprains. 
All functional assessments should include one or more tests to determine if the client has sufficient eversion available and whether they are using this motion during function. Causes of insufficient calcaneal eversion can be structural or functional. Structural limitations are determined by the amount of eversion when non-weightbearing. Many structural limitations are acquired. Any period of immobilization or protected weightbearing are likely to cause a limitation of calcaneal eversion. This motion must be restored to have a healthy and efficient body. 
Functional limitations are present when the joint motion is available, but other structures inhibit the use of that motion. A structural valgus position of the forefoot or a stiff MTJ will block the calcaneal eversion. Limited internal rotation of the hip often dictates to the STJ that calcaneal eversion should not occur. These functional limitations can produce structural changes if they persist over time. 

When our clients are standing in a weightbearing position (rather than walking or running) they may demonstrate a lot of calcaneal eversion, but they may not have any additional eversion to load the muscles. For example, a client who wants to be a quicker jumper may stand with the calcaneus everted. This excessive eversion may be caused by a structural varus of the rearfoot or forefoot. If the STJ is at end-range there is no more calcaneal eversion in order to turn on the power sources in the body. The excessively everted calcaneus has insufficient eversion to “load and explode.”

Get Strong! Stay Strong!



Injuries to the knee are seen throughout virtually all sports and all age ranges. Have you ever wondered why the knee is the most common reason for a visit to an orthopedic surgeon? Moreover, have you ever wondered how rehabilitation and training programs could better alleviate the stresses placed on the knee? The answers lie in using Applied Functional Science to understand the chain reaction biomechanics of the two “bookend” joints of the knee – the hip and the ankle.

Although the distal femur and the proximal tibia form the primary knee joint, the other ends of these two longest bones in the body reveal the reactive nature of the knee. The knee is referred to as a reactor because it responds to drivers from above and below. These drivers can be ground reaction force, gravity, momentum, hands, feet, or often times the eyes. During initial foot contact in upright function, the ankle joint, comprised of the distal tibia and talus, create a chain reaction from the ground up that directly influences the knee via tibial and fibular motion. Similarly, the hip joint, comprised of the proximal femur and the illium, influences the knee from the top down via the femur. The three-dimensional motions of these two “bookend” joints play a significant role in determining the magnitude of stress placed on the knee. An appropriate chain reaction from these two bookend joints enables the knee to effectively dissipate significant forces. However, dysfunction at either joint can leave the knee caught in the middle with few places to go and nowhere to hide.


A practical example of the chain reaction relationship between the ankle and the knee can be illustrated using a female beach volleyball player. Based on its attachment sites, the ACL it is placed under stress during combined knee flexion, abduction (i.e. valgus), and internal rotation. In this example, as the volleyball player approaches the net and begins to load her lower extremity to prepare for jumping, she steps in an uneven sand hole which causes her heel to abruptly evert and her talus to plantarflex and adduct. This motion of the talus influences the tibia to internally rotate and abduct. This tibial motion, if not properly decelerated, will create excessive knee internal rotation, abduction, and flexion which can directly lead to a right ACL tear. However, this motion can be properly controlled and reduce the risk of injury by muscles properly decelerating the tibia and femur. The specific tri-plane action of muscles that influence the knee are too numerous to adequately describe in this article and, therefore, will be discussed in an upcoming newsletter.

A second practical example can illustrate a situation when dysfunction at the hip is the underlying cause of patella femoral pain. Recent research has confirmed Gary Gray’s long held belief that patella femoral pain is more a track problem (femur) than a train problem (patella). Dr. Chris Powers, et al, summarized that “patellofemoral joint kinematics during weight-bearing conditions could be characterized as the femur rotating underneath the patella.”1 In another study, Dr. Powers, et al, goes on to assert that “interventions aimed at controlling hip and ankle motions may be warranted and should be considered when treating persons with patellofemoral joint dysfunction.”2


A forty-year-old triathlete with excessive femoral internal rotation during the loading phase of gait presents lateral right knee pain while running. His knee pain can be explained by the inability of the hip external rotators, adductors, and hamstring muscles to decelerate the excessive femoral motion. The track crashing toward midline too rapidly, in effect, causes the train to derail laterally. The symptoms are present at the knee; however, through use of lower extremity chain reaction biomechanics, one can easily understand how the cause is at the hip.

These examples illustrate a few core principles of Applied Functional Science. First, joints in the body move in three planes of motion. Second, function is driven by, among other things, ground reaction force, the environment, and gravity. Third, movement at one joint will create chain reaction responses at other joints throughout the body. Lastly, function is individualized and task-specific.

Applied Functional Science requires us to understand the person, tasks, and goal(s). A thorough understanding of the chain reaction biomechanics of all three joints will assist in implementing rehabilitation and training programs that ensure that, although still caught in the middle, the knee now has two powerful friends by its side. ——-By Brett Bloom

Gray G: Functional Video Digest. Functional Manual Reaction. The Knee. v3.7

Gray G: Functional Video Digest. Patella Femoral. The Train & The Track. v2.5

1. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weightbearing and non-weightbearing knee extension in persons with patellar subluxation: A preliminary study. J Orthop Sports Phys Ther. 33:677-685, 2003.

2. Powers CM. The influence of altered lower extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective J Orthop Sports Phys Ther. 33:639-646, 2003

Get Strong! Stay Strong!



Not that it could ever happen, but if given the opportunity to defend a body part in a court of law, without question I would choose to defend the lumbar spine. With mind boggling statistics such as 80% of all human beings will experience low back pain at some time during their life and that the cost of low back injury is estimated at being $100 Billion each year, there is no wonder why the lumbar spine has been the subject of much maligning and is often referred to as “a bad back”. Despite those daunting statistics, I would argue that not only is the lumbar spine ‘not guilty’ but is in fact most often a victim. The true culprit in low back dysfunction is most often a problem with a link or two in the biomechanical chain somewhere other than the low back. 

     The Lumbar Spine is located at ‘the crossroads of the body’. It lives where everything happens. It is a five segment stack at the base of the spine designed with the vertebral body and intervertebral disc in the anterior segment and bony protrusions in the posterior including the facet joints to either side. In a typical and healthy back the Lumbar spine has between 40-43 degrees of motion into flexion, 30-40 degrees of flexion into extension, 20 degrees of frontal plane side-bending in each direction and only 5 degrees of transverse plane rotation to each side. Initial examination may lead one to conclude that with such limited frontal and transverse plane motion, there is no wonder that the lumbar spine is often breaking down. Some might say ‘This is a terrible design flaw’. However, knowledge of chain reaction biomechanics and Applied Functional Science allow for deeper understanding.

     When fed proper proprioceptive input and when surrounded by ‘friends’ who are functioning properly, the lumbar spine is perfectly equipped to carry out its roles as a shock absorber and force transmitter. The lumbar spine enjoys enough motion to allow the rest of the system to be turned on, facilitating functional strength and motion requirements elsewhere. However, when the lumbar spine is let down by its friends it tries to help the situation by picking up the “slack”. Unfortunately to do so it must work beyond it’s capabilities to try and get the functional job done. That is when the problems start.


     It is a plausible contention that when the low back starts to hurt, look everywhere else and you’ll find the reason why. For example, say the lumbar spine has just distal to it, two under-nourished hips (please read Joe Przytula’s fantastic take on the importance of the hip in upright 3d function from the June newsletter!). These hips are typically allotted a generous amount of transverse plane mostability (right amount of motion, right amount of stability). However, when they are not ‘properly fed’ the tendency is to seek stability rather than mobility and transverse plane motion at the hips is lost in function. Who then steps in to help? The under-equipped lumbar spine. With the possibility of only 5 degrees of available motion, wear and tear is going to start quickly especially if the person is active despite their hip restrictions. 

     It would be easy if the hips were the only friends capable of letting down the lumbar spine. Typically, however, uncovering the underlying cause behind low back dysfunction is more challenging. Because it is located at the crossroads, limitation in virtually any other biomechanical segment in any plane of motion has the potential to feed abnormal and damaging forces through the lumbar spine. Hopefully your lumbar spine is surrounded by good friends who feed it appropriate forces. If not, and it has been referred to as ‘a bad back’… beware! We may team up in a defamation suit!   —Andrea Wasylow PT

Get Strong Stay Strong!




A few weeks ago, my six-year-old nephew was sleeping over at our house. I was awaken in the middle of the night by him exclaiming, “Uncle Joe, there’s a monster underneath my bed!” I went into his room and said, “Be nice to him and he’ll be your best friend. Give him a pop tart or something.” Okay, maybe I’m not the best uncle, but please read on.

The hip is the like a monster underneath the bed, minus a few dust balls and dirty magazines. If it’s working correctly, it can be your best friend. It can assist far away joints like the shoulder or ankle. Strength Coach Vern Gambetta called it, “The engine that drives the body.” No wonder, it has 17 of the thickest, longest muscles of the body directly attached to it. But do not look for them. They are superficially hidden by that big mattress we call the gluteus maximus. A few years back, researchers Porterfield & DeRosa discovered the monster even has tentacles! Well, sort of – we call it fascia. It functionally links the hips with pretty much the entire body.


This monster is tough all right. It has a deep suction cup of an acetabulum, with a head of the femur as round as Mini-Me’s head, and a thick synovial joint capsule to seal the deal. How does the hip stack up to other monsters, say Godzilla (he just spit fire)? The hip’s secret power is its contribution to three-dimensional loading (force reduction) and unloading (force production). Let’s use the ACL ligament of the knee as an example. Traditional rehab protocols have emphasized the quadriceps and hamstrings. However, physical therapist and biomechanist Daniel Cipriani makes the point that these muscles only become protective as the knee flexion angle approaches 90 degrees. But now look upstairs at the hips gluteus complex. By way of its multidirectional, multiplane orientation on the femur, it is well designed to control the 3D motion of the knee with the most critical being internal rotation, adduction, and flexion.


Let’s follow those tentacles up the kinetic chain to the shoulder. Can they protect the shoulder anterior instability that creates rotator cuff issues? You bet! Now we’ll call on the infamous “front butt,” including the iliopsoas, abdominals, adductors, rectus, etc. Try it yourself: Stand in a left stride stance with your right arm horizontally abducted at shoulder height with the elbow flexed. Feel the tug at the front of hips? This means they’re locked and loaded to explode, and so are the abs by way of chain reaction between the hip and shoulder. Now turn the front butt off by sitting on it. Do the same arm reach. Feel the difference?

We make the monster happy when we feed it. No, not with pop tarts. Hips love ground, gravity, and momentum. They prefer lunges, squats, and step-ups. Adding some arm reaches in with the mix is like whip cream on top. They love variety in the form of direction, plane, speed, and load changes. However, be cautious of feeding the hips with empty calories. Many exercises performed in the prone, side lying, or supine positions are what Gary Gray refers to as “isolated isolation.” They turn off the hip’s phone lines (proprioceptors) to the rest of the body and unhook those fascia links. They should be used sparingly. Dormant daily living does not nourish the hip. Sitting and activities that require prolonged static standing promotes injurious capsular patterns.  Interrupting these patterns with frequent “snacks” helps reconnect those lines.

By Joe Przytula ATC

Get Strong! Stay Strong! (Functionally)


When you think of human movement it can be broken down into 4 basic categories.  Locomotion, Level Changes, Push/Pull and Rotation. These represent the 4 pillars of human movement as described by JC Santana in his book Functional Training; Breaking the Bonds of Traditionalism.  When designing rehab or fitness programs that are functionally based it is important to make sure all 4 pillars are incorporated.

LOCOMOTION:  This is the foundation for ground based force production.  It is the linear displacement of our bodies center of mass.  It is a triplane event in which all the muscles and joints are moving simultaneously in all three planes.  While at first glance it appears the body (while walking) is moving primarily in the sagittal plane(SP) (forward) close look would reveal that it is the transverse(TP) and frontal plane(FP) movement that drives us in the sagittal plane.  The TP and FP movement become more apparent when running.  This also requires the ability to efficiently load into the ground (deceleration) followed by the unloading or propulsive phase (acceleration).

LEVEL CHANGES:  This represents non locomotor tasks such as getting up off floor, picking up the baby or taking someone to the ground.

PUSHIN/PULLING: We use various push and pull movements for many everyday activities.  Opening and closing doors, pushing the stroller, taking a hanger off the rack and punching.  Pushing and pulling usually done unilaterally in a reciprocal manner is cross wired neurologically.  As one punch is thrown the opp. arm is retracted to eccentrically load in order to prepare for the next punch.  The same is true for arm swing in walking.

ROTATION:  Responsible for changes in direction and rotational torque production.  Dancing, throwing, and  running are examples of activity with a significant amount of rotation.  The transverse plane is probably the most important and the only plane not loaded by gravity.  The example I like to use to demonstrate the point is that a bicycle only moves forward because the wheels are rotating.  Approx. 90% of all the muscles are oriented in the diagonal to enhance rotational deceleration and acceleration.

Obviuosly many tasks consist of combinations if not all the above categories, but each has a unique and important contribution to human movement.  So, whether you are rehabbing or training it is important to include movements from each of the 4 pillars.

Get Strong! Stay Strong!



While gymnastics is used in this post the concepts apply to any endeavor.  Most would agree that a strong “core” is essential to all sporting activities and tasks of daily living. What is the core and how do we train it to maximize performance? Generally speaking, the core consists of the lower back, lateral trunk and abdominal (rectus abdominus, obliques, transverse abdominus) musculature. For years, largely based on traditional anatomy lessons and body building routines, we believed that endless sit-ups and hyperextensions were the way to go. As our understanding of human movement and sports performance have grown, we began to realize that training for performance often required a different approach – hence the term “sport specifi c” training. Simply stated, the more an exercise looks and feels like the activity to be performed, the greater the carry- over to that activity. When designing exercises to enhance performance, one must look at the activity or skill and ask – how does gravity, ground reaction forces and momentum effect the body and how do all the muscles and joints interact to complete a skill or movement?  In the traditional sit up one lies on their back and attempts to bring the shoulders up towards the pelvis, in essence contracting only the abdominals. For performance/ function we would ask – when in gymnastics do you lay on your back and do this? Are the gravitational forces the same? Are the ground reaction forces the same?  Is the momentum the same? Do all the body parts interact similar to a gymnastics skill?  The answer is rarely, if at all. In gymnastics, the body is primarily in a vertical position with various components of spin and rotation acting against gravity, utilizing and absorbing ground reaction forces and momentum. Therefore, training the core in an upright position would be a better choice to facilitate greater muscle, joint and balance receptor activity, ultimately leading to greater carry-over to the skill or activity. It also facilitates more effective interaction between all the muscles and joints involved in the skill, not just one or a few as seen in the traditional sit-up or hyperextension exercise. The object being to enhance the body’s ability to load to explode.  The true function of the abdominal muscles is to decelerate or control backward bending and rotation of the trunk. You do not need them to forcibly fl ex the trunk forward (as a sit-up does) because gravity will do this for free. The muscles of the low back help decelerate forward flexion and rotation of the trunk. The respective muscles of the trunk rely on various other muscles to assist them with the task at hand.  One common theme that is critical for human movement and sport is that all muscles need to be eccentrically elongated relatively quickly (loading) to enhance their concentric contraction (exploding). Think of a rubber band, the more you pull it the harder and faster it snaps back. Your muscles utilize the same principle called the stretch shortening cycle to enhance the muscles ability to move the body explosively. An easy example of this is in jumping. You always “squat” down or load first to enhance your ability to jump or explode higher. Try jumping up high without bending your knees or ankles first; its impossible.   So when training the core think of how they are going to “react” in relation to gravity, ground reaction forces and momentum in the context of how they will be required to function.

Get Strong! Stay Strong!