Adding perturbations to an exercise basically means to manually disturb the stability of a given exercise.  The goal is to make the environment more unpredictable and increase the stability challenge of the exercise, movement pattern or muscle groups used.  I’ve been introduced to this concept a couple years ago at the Optimal Shoulder Performance seminar.  This is a concept that Mike Reinold was (and still is to this day) using for rotator cuff exercises with his baseball pitchers.

A typical exercise would put the athlete in a given position and the coach or trainer would give manual perturbations to the arm to challenge the stability of the humeral head in the shoulder joint, and improve the stabilization ability of the rotator cuff muscles for injury prevention purposes.

I immediately embraced the concept as I thought it was a genius idea, and I’ve been using rhythmic stabilization exercises for the rotator cuff ever since.

The concept can also be applied with other types of exercises…

Any exercise with the purpose of improving stability could be a candidate for a progression using perturbations.

When you’re trying to improve stability, your body and your brain need to be challenged.  This is why so many people use the stability ball; it increases the challenge of stability and makes you work harder.  The thing with stability balls is that they’re not always used smartly, and not always by smart people.  But I digress.

Hint: NOT the smart kind.

A lot of core exercises designed to improve stability can be progressed to manual perturbation.  As I’ve mentioned above, the perturbation will help improve control and stability.  When training stability, the important thing to remember is that motor control (which is the brain-to-muscle connection that works to improve stability) can not be improved unless it fails to succeed doing certain tasks.  Your brain needs to be challenged beyond its own stability limitations.  If you always work within your strengths, or your current level of stability, you’re not going to improve.  This is a great point that Mike Reinold highlighted in Functional Stability for the Core.

How do you actually apply this?

It could be something as simple as adding manual perturbations to a front plank.  A mastery of the front plank is in order before attempting any type of manual perturbation to your clients or athletes.  The same concept can also be applied to other core exercises like dead bugs, belly press, glute bridges, bird dogs, etc.

Again the important thing is to follow the progression; make sure your client or athlete is efficient at the basic exercises and doesn’t compensate in any way.  The logical progression for any exercise would be:

1. Stable
2. Stable with perturbation
3. Unstable
4. Unstable with perturbation

Using this progression with a front plank, the progression might look something like this:

1. Front plank
2. Front plank with perturbation
3. Stability ball front plank
4. Stability ball front plank with perturbation

The idea with the manual perturbations is to make it challenging and push it just beyond the point where the athlete or client maintains perfect form, but it shouldn’t be unbearable- if that makes any sense.

If you want more ideas on how to incorporate perturbations/rhythmic stabilization you should definitely check out Eric Cressey and Mike Reinold’s Functional Stability for the Core.

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The neutral spine concept has been widely accepted as one of the norms for good movement by now.  It is understood that it is one of the basics of functional movements, and it is extremely important when moving external loads.

With athletes lifting weights this would translate into making sure they always squat, deadlift, do core exercises, and any hip extension based movement with a neutral spine.  Most high level athletes don’t have a hard time at all grasping that concept, especially when they’ve learned to lift the right way.  But with younger athletes who are just learning to lift, or with deconditioned clients, what’s the first step in being able to perform lifting exercises with a neutral spine?  Well, you need to teach them neutral spine first!

This looks like a pretty solid neutral spine to me

Including exercises such as planks, birddogs, and bridges that help reinforce neutral spine seem like a good place to start, but if your athlete or client doesn’t understand what neutral spine is, odds are he won’t be able to get it.  And they won’t have the ability to keep a neutral spine under challenging situations like lifting heavy weights, or moving at high velocities.

Teaching neutral spine in different positions is the first step.  Make your athletes or clients feel what neutral spine feels like in different positions, coach them as much as possible, make sure they really get it.  Mike Reinolds delves into that stuff quite a bit in Eric Cressey’s and his Functional Stability Training DVD set.  This is a seminar they held at Cressey Performance a couple of months ago that they put on DVD and just released to the public.  Mike emphasizes the 3 step process before allowing anything to move:

1. Find neutral

2. Brace

3. Breathe

Whether you’re teaching neutral spine using a plank, birddog, bridge or dead bug you should follow the same pattern.  Make the client flex and extend his spine a couple of times, and make him find neutral somewhere in between.  Coach the client as much as possible, and make sure that in the end they can find it by themselves.  From there, brace just hard enough that you’ll maintain neutral (brace shouldn’t be a max effort unless you’re lifting max effort weights), and breathe.  As a rule of thumb, if you can’t breathe through your brace, you’re bracing too hard.

You don’t need to brace THAT hard

One tool that we like to use to teach neutral spine that I like a lot with our athletes at Endeavor is the hip hinge with a dowel.  It is very basic, it gives physical cues (with the points of contact of the dowel on your back) and it’s easy to know when you’re not doing it right.  Again the same concept applies: find neutral, brace, breathe.

If you want to learn more about that and how to train according to the neutral spine concept when training your core, your lower body and with any lifting exercise really, I suggest you pick up a copy of Eric Cressey and Mike Reinolds’ Functional Stability Training.  They just released it and you can get at the introductory price until Sunday at midnight; after that the price will go up.  You can check it out HERE.

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I’ve blogged about the importance of breathing patterns many times in the past, and for a good reason.  Breathing patterns and the muscles responsible for breathing affect so many things in our bodies, yet we too often ignore their importance.  In the presence of a faulty breathing pattern, accessory muscles will compensate for the diaphragm not doing its job properly.  We then see hypertonic neck muscles (scalenes, sternocleidomastoids, upper trap, etc) which can also lead to neck pain and headaches, referred pain in the shoulder, etc.  But this is only the superficial stuff.

If the diaphragm isn’t working properly, chances are that it’s also not positioned optimally.  We could debate which one causes the other (dysfunction causing faulty positioning or faulty positioning causing dysfunction), but it would be a case of the chicken or the egg.

The thing to keep in mind is that when the diaphragm isn’t positioned properly there are also surrounding structures that are affected.  The lower ribs flare out, the T-L (thoraco-lumbar) junction is stuck in extension, and the whole rib cage is positioned differently.  This in turn will affect the positioning of the scapula because it sits on the rib cage, and therefore the positioning of the whole shoulder girdle will be changed.

Faulty breathing patterns can also affect structures lower down the kinetic chain.  Because of the attachment of the diaphragm and its fascial connection through the psoas, that goes through the hips, the positioning of the hips can be affected.  And if the hips are positioned differently, everything below (femur, tibia, foot) might be in compensated positions.

Not the best picture, but you can still see the convergence of the psoas and diaphragm

Before this turns into an anatomy course, I’ll stop here!  The goal was just to make you understand how powerful breathing patterns can be and how it can affect the whole body.  That is why school of thoughts such as the Postural Restoration Institute put such an important focus on breathing patterns and diaphragm function to treat all sorts of problems (overuse injuries, low back pain, shoulder pain, flat feet, etc, etc).  All of their corrective work involve very specific breathing patterns.  They have a bunch of different exercises incorporating breathing patterns to get you back into a “neutral alignment” as they would put it.

I have learned a great deal from PRI and started including a lot of their stuff with my athletes, which has worked almost like magic in many cases.  Here is one of my favorite exercises that I stole from them to teach proper breathing patterns:

The position: Lying on your back with your feet up on the wall and your knees and hips at 90° angle, squeeze a foam roller or a small medicine ball between your knees.  Dig your heels into the wall and posteriorly tilt your pelvis just enough to get tail bone slightly off the floor.  Get your right arm straight up and reach with the palm of your hand towards the ceiling.

Execution: Take a deep breath trough your nose, Blow out through your mouth as hard as possible trying to inflate the balloon as much as possible.  Blow all your air out in the balloon.  When you have no more air in your lungs, pause for about 4 seconds while pushing your tongue against the roof of your mouth (your teeth should not be clenched).  Then, breathe back in through your nose, and repeat the sequence. You can do anywhere from 5 to 10 breaths, but start on the lower end, and make sure you control everything.

Cues: Make sure that the tail bone remains slightly off the ground the whole time and the heels keep digging in the wall.  When reaching up with your right arm, you only want to reach as high as your arm will go, meaning you don’t want to lift your upper back off the ground to reach higher.  The pause with the tongue against the roof of your mouth is probably the most important step.  Do not repeat on the opposite side.

We only do it on one side because the diaphragm on the right side and on the left side are shaped and positioned differently; we want to facilitate the air going into the right side to re-position you in a more neutral position.  This is again part of the PRI philosophy that the human body is assymetrical for a host of different reasons; we have a heart on the left side above the diaphragm, we have a liver on the right side under the diaphragm, the left side of our brain manages motor control, etc.  I’m not going to get too deep in the PRI philosophy as it could be the subject of an entire different blog post, but hopefully you get the concept a little bit.

Don’t overlook breathing patterns and make sure that it’s part of your assessment protocol with everything else you assess for.

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I recently came across the Baby GetUp through my good friend Dr. Perry Nickelston.  When I heard him talk about it, what he used it for and the benefits from this exercise I was thinking to myself: “Hey I’m gonna give it a shot; it sounds like a nice corrective exercise to include in a training program to help develop proper muscle sequencing and reinforce a good fundamental movement pattern”.  The Baby GetUp can indeed help you in that regard, but HOLLY SH*T I wasn’t expecting what I was about to experience!  I wouldn’t even say it was hard; I literally couldn’t even do it!!

As someone who takes care about how my body moves and with the time I spend on corrective exercises I wasn’t expecting to be slapped in the face by the Baby GetUp like I did!  The name of the exercise itself suggest an easier version of the Turkish GetUp.  A ‘regression’ of the Turkish GetUp would be a better term, because it might look simpler, but it doesn’t mean it’s easier.  This is the video from Dr. Perry that demonstrate the Baby GetUp:

You’re probably telling yourself it really doesn’t look that hard.  And you’ll most likely be able to perform it more easily than I did, but I’m sure you’ll be surprised by the level of difficulty of the exercise on AT LEAST one side of your body.

In fact, this is a great way to identify asymmetries from side to side in inner core muscle sequencing.  When trying the Baby GetUp, make sure that you’re not cheating by reaching with your neck, getting your top leg off the floor and holding your breathe in.  This should be a movement pattern that feels (or becomes) ‘nice and smooth’ to perform.  It is a fundamental movement pattern, and if you don’t own it, your setting yourself up for compensation movement patterns, and injury in the long run.

I know what I’m gonna be working on in the next couple of weeks!

For an in depth look at the Baby GetUp, check out Perry’s original article on his website HERE.

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We live in a world where low back pain is a very common issue.  We all know people who have back pain or who’ve had hernias or hurt there back playing sports, training or sometimes just picking up grocery bags off the floor.  I read a statistic somewhere that stated that 80% of the population will, at some point in their life, suffer from back pain.  That is A LOT!  And the truth is that low back problems are still very misunderstood.  Even in the research world, we seem to have a better understanding of the injury mechanisms of the lower back, thanks to great researchers like Stuart McGill, but there are still some gray areas.  There seem to be much more that we need to learn.

But as I just mentioned, there is definitely a better understanding of the injury mechanisms of the lower back.  According to McGill’s research there are different movement patterns that cause low back problems.  Hernias and other back problem are usually a result of one of the following:

• repetitive and/or excessive flexion at the lumbar spine
• repetitive and /or excessive extension of the lumbar spine
• repetitive and/or excessive rotation at the lumbar spine
• a combination of flexion and rotation
• a combination of extension and rotation

Most back problems originate from one of these mechanisms.  There are different reasons why these injury mechanisms develop.  Lack of hip mobility, lack of thoracic spine mobility, muscle imbalances and compensation patterns in the hips and core, poor posture, and sitting too much are all reasons why back pain these injury mechanisms can end up causing back pain.

One thing that is really important to understand with back problems is that they do go away.  Having back pain at some point in your life doesn’t mean you have to be stuck with this pain all your life.  Even serious back problems such as hernias don’t last forever.  If it needs surgery, you obviously need to get it.  If you don’t need it (which is often the case with low back hernias), according to McGill, the disk will go back in place by itself if you allow it some recovery time.

If the pain persists or come back, it probably means that the source of the pain hasn’t been addressed (note that I said the source, not the symptoms).  As mentioned above, the injury mechanisms that I outlined that are at the source of most back problems need to be addressed.  That might mean to learn to bend over the right way and learning a good hip hinge (e.g. let the hips move and do the work while keeping the spine in a neutral position).  It could also mean learning to get more hip extension when you run instead of having the lumbar spine compensate and extend too much.  There are also many daily behaviors that will need modifications in order to avoid the faulty movement occurring at the spine.

The bottom line is that you need to re-train your body to move the right way.  If you don’t, the pain will keep coming back because the injury mechanism is still there.  There is also usually a big mental component to any back problem, and understandably.  Folks who suffer from back pain often apprehend the pain coming back, whether it’s when they train or just in their daily activities.  Part of the re-training process in teaching good movement patterns and teaching back pain clients to move better is going to be mental and making sure they understand that they are not stuck with that pain their whole life.

It’s THAT important that you explain all of that as well as possible before you drop the word ‘Deadlift’ in front of them.  The deadlift is not only a safe tool, but an essential part of their rehab.  Most of them will associate deadlift with back injury, or think of it as a dangerous exercise for their back.  This couldn’t be any further form the truth.  And obviously deadlift doesn’t mean ‘heavy’ or ‘full range of motion’ right from day 1.  But there is a very under-appreciated rehab component to the deadlift for clients who’ve had back pain.  The deadlift is probably THE best way to teach someone how to hinge at the hips, while keeping their spine in a neutral alignment.  By reinforcing this movement pattern you will help your clients reduce their risk of re-injuring their back.  A very careful approach must be taken though, and no flaws should be allowed in their form before any type of loading is even considered.  The deadlift is really just a hip hinge and everyone should own that movement, whether you lift weights or not.  It’s just a back saver to know how to deadlift the right way.

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Core training is most often referred to as exercises that work your rectus abdominis.  Sometimes the concept of core training will go as far as including the external and internal obliques and the lumbar erectors, but it rarely goes past that stage.  The term “core” in itself is very loosely used to describe either abs training or stability training, or sometimes both.  But the reality is that your core can include every muscle that runs across your hips, spine (including the cervical spine) and shoulders.

And this is only the back view…

So we definitely need to broaden our horizons when we think about core training and realize it’s much more than just the muscles around our belly.  Here are some of the most overlooked aspects of core training:

• Cervical spine alignment (packing the neck)
• Inner core activation (pelvic floor, diaphragm, transverse abdominis and multifidus)
• Breathing patterns

These are 3 things that go hand in hand with each other, as well as with traditional core training and in my opinion they’re probably the 3 most overlooked aspects of core training among athletes and regular gym-goers.

The trend since Stuart McGill’s work came out is to use neutral spine whenever we train the core and lift weights.  The goal is to reinforce this pattern as much as possible.  But we often forget that the neck is part of the spine and that should also be trained to be neutral.  There is a much deeper core activation when the neck is packed in a neutral position and it provides for greater stability.  The cervical spine often gets into hyperextension when training, especially with posterior chain exercises.  The tendency is to keep the eyes up while the angle of the spine gets closer to parallel.

Notice how hyperextended the cervical spine is.

This position puts a lot of strain on the inter-vertebral discs of the cervical spine on top of having sub-optimal spine stability all the way down to the lumbar spine (each segment of the spine interacts with each other).  Keeping the neck in a neutral/packed position will facilitate a proper breathing pattern (Try and take a deep breath- without thinking about it- first, in a relaxed position with your neck not in a neutral position, and then try it again in a packed neck position.  Notice how the breath with the packed neck position is much more of a belly breath, compared to more of a chest breath without your neck packed).  And that in turn will facilitate activation of the inner core muscles.

Why is this the first image that pops up when I google “packed neck position”??
…but I have to say that his form is pretty impressive

The bottom line is that everything in your core is interrelated together and when everything is indeed coordinated, you gain amazing stability that you wouldn’t have otherwise.   That’s why it’s so important to train your inner core, your breathing patterns and your packed neck position.  From an injury prevention and a strength gain standpoint it can make all the difference.

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Last week I wrote a post about the importance of the external obliques in pelvic control.  If you missed it, check it out HERE.  Now I wanted to give you a couple drills and exercises you can use to improve the recruitment of the external obliques in pelvic control.

The exercises that follow are not all extremely difficult to perform.  It’s more about focusing on performing them the right way.  The pelvis should be neutral throughout the entire movement and as you as you feel your back arching, it’s generally a sign that you’re losing the external obliques engagement.  These exercises are by no means the only ones that exist to attain better recruitment of your external obliques in pelvic control, but it’s definitely a good place to start if you have no clue how to achieve that.

The first one is probably the most basic one.  It’s a variation of an exercise that comes from Shirley Sahrmann’s book Diagnosis and Treatment of Movement Impairment Syndromes.  The goal is maintain a very slight arch in your lower back throughout the whole movement.  To engage your external obliques as much as possible, you can keep your fingers above your illiac crest on both sides; palpation always helps to feel the right muscles doing their work.

The second one is a little similar, and also a variation of the deadbug exercises.  My colleague Matt Siniscalchi posted this one on his website last week.  I believe that Craig Liebenson or Bill Hartman might have come up with this one.  Again, the goal is to maintain a very slight arch in the lower back and make sure the arch is not increasing as your lowering your legs.  The press against the wall will also favor some inner core activity throughout the movement.

The last one is definitely much harder than the previous two.  I don’t recommend you try it until you’ve mastered the first 2.  It’s basically a leg lowering exercise, but because of the weight of the lower extremities it makes it much harder to keep the neutral pelvis and the external obliques activation.  Again the goal is to maintain a very slight arch in the lower back and make sure yo don’t lose it.

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Pelvic control is an important thing to have at the hips level.  Anterior pelvic tilt is a common problem in the athletic population.  With too much anterior tilt, also comes increased lordosis.

Neutral pelvis on the left. Anteriorly tilted pelvis on the right.

Both of these postural problems can lead to a number of injuries including back pain, hamstring pulls, quad pull, etc.  The traditional approach to reestablishing neutral alignment is to stretch the hip flexors and strengthen the glutes and hamstrings to pull the pelvis posteriorly.

Although this is a good approach, there are other players that can contribute to pelvic control that are often forgotten.  One really important player is the external obliques.  The external obliques’ primary functions are to stabilize the trunk (in combination with the internal obliques, rectus abdominis and spinal erectors) by creating a brace around the spine and to create/prevent rotation at the trunk.  A function of the external obliques that is often forgotten is posterior tilt/control of the pelvis because of its attachment on the illiac crest.  When you’re stuck in anterior tilt the external obliques usually have poor control on the pelvis.

With their attachment directly on the pelvis, the external obliques play a big role in preventing anterior tilt.

Because of their role in posterior pelvic tilt, we could call the external obliques the lower abs.  Not that the bodybuilding guys were right in training their upper abs and lower abs separately, but there might be some merit in making the distinction between the rectus abdominis (who felxes the spine and depresses the ribs) and the external obliques (who posteriorly tilt the pelvis as we’ve just mentioned) in some cases.

Stay tuned for part 2!  I’ll go over exercises you can do to help improve pelvic control using the external obliques.

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I will admit that sometimes I like to use catchy titles for my blog posts, so it makes people curious and catch their attention.  But this one might just be accurate, and nothing else!  The credit goes to my friend and colleague Kevin Neeld for coming up with this one.  This is probably THE hardest exercise ever!

RFE (Rear Foot Elevated) Split Squat + Belly Press Hold with Perturbation:

So what this do (beside making you want to throw up)?? It definitely improves single-leg stability (and possibly endurance, depending how long you hold it for) because of the rear foot elevated position.  There is also a pretty big core strength/endurance involved since your resisting the rotation from the band, and the added manual perturbation just makes it insanely harder on your core!  If you’ve been looking for an extra challenge for your single-leg stability and core training, this is exactly what you need.  A good place to start is 20 second holds per side and you can work your way up to a minute, if you dare!

A quick warning though: anybody who wants to try the RFE split squat + belly press hold with perturbation should have a significant level of experience with the split squat iso-holds (for time) and the belly press.  Anyone trying this exercise without mastering the split squats iso-hold and the belly press first will fail miserably.  I think it really is THAT hard!

Give it a shot if you’re game!

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Well that’s a very revealing blog post title, isn’t it?  You now know that breathing is important.  You need to breathe in order to live (you might want to read that last phrase again, it’s very philosophical).  And I also just came across some research stating that breathing might even be associated with brain function and physical performance.

All joking aside, breathing is an important part of any training programs.  I have been guilty as charged for way too long for ignoring the importance of breathing in training.  When I first started in this industry and was working in a commercial gym in my hometown, I would often have questions from the older crowd about what the right breathing pattern is when they lift weights:

“- Am I supposed to breathe out when I lift the weight and breathe in when I lower it? Or is it the opposite?

- Who gives a shit.  Just use heavier weights, anyway.  Passing out while lifting is overrated.”

OK, I didn’t really say that ever, but for a lack of better understanding of how the breathing system works, I just didn’t think it was that important.  And when I got much stronger (relatively speaking, of course) I realized that holding your breath in can be more than useful to lift heavy weights and it can improve core stability (when you brace and hold your breath), I was ready to be done worrying about any type of breathing other than just bracing when lifting heavy in my training and the ones of my clients.  Big mistake!  I still don’t think I ever jacked up any of my clients for not teaching them proper breathing patterns, but I do realize that it has its place in any training program.

The diaphragms (yes I put an ‘s’ because you have 2, one on each side) are the most important breathing muscles in the body.  And one thing that’s really important to acknowledge is that the diaphragm is part of a bigger picture.  Through fascial connections, the diaphragm connects with the psoas muscle, which attaches to your vertebraes of your lumbar spine and also crosses your hips.  Through other fascial connections there are other muscles that “connects” to this same line all the way down your legs.  This is part of what Thomas Myers would refer to as the deep front line.

Because of all these fascial connections, the diaphragm muscles and training breathing patterns are both very important.  Stability can be gained through proper core activation.  And I’m not just talking about bracing and holding your breath when lifting heavy weights.  Of course being able to brace your core, create intra-abdominal pressure and holding your breath is part of getting maximum stability under heavy loads and I believe this is something that you need to learn to do.  But this can also create other problems when this is the only way you know how to stabilize your core muscles and your trunk.  When bracing hard, you have a maximum engagement of your rectus abdominis, your external and internal obliques and your spinal erectors.  Your inner core muscles don’t necessarily get activated in those circumstances.  Your inner core muscles, which includes your diaphragms, your pelvic floor, your multifidi and your transverse abdominis are also important stabilizers of your spine.  Under heavy loads and brace your outer core muscles (rectus, obliques and erectors) can take over and your inner core muscles can get shut down.  That’s why these muscles need to be trained.

There are many different ways to attack this.  Addressing breathing patterns is one.  A general concept you want to keep in mind when training your diaphragms and inner core muscles is the one of a neutral spine.  Whatever drill or exercise you use, you want to maintain a neutral spine from your pelvis all the way through your skull (the neck/cervical region often gets neglected, but needs to be in line with the rest of the spine).  That will put your body in a position that will facilitate proper breathing patterns.  When you’re able to maintain a neutral spine through different movement patterns and breathing through that neutral spine, you can start incorporating these breathing patterns into low load core exercises.  The most basic one is obviously a simple plank.  Trying to maintain a neutral spine and breathing through a plank might be harder than you think.  The goal is really not to brace hard nor get maximum core activation, but rather just owning the position, breathing deeply into it and letting the inner core muscles do their job.  Same thing applies if you incorporate the concept with any other core exercise, you’ll want to keep the load relatively low.

There might be more to this position than you might think…

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