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.

Make sure you enter your info below if you want to receive my 3 FREE reports on sports performance training and injury prevention!!

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.

Sign up for my newsletter by entering your info below; it’s FREE and you get instant access to my 3 reports on sports performance training!