“My hamstrings are tight.”

This is something clinicians and coaches constantly hear in reference to a variety of muscle groups or areas of the body. Often times the individual with this complaint is scrawny and de-conditioned, with little reason for feeling this way.

He or she feels this way due to instability and a lack of motor control in the area of complaint. For example, the individual described earlier complaining of “tight” hamstrings could be in a prolonged dysfunctional position proximally at the spine and pelvis, with the hamstrings guarding to protect the area. The local stabilizers at these proximal joints are not doing their job effectively therefore the hamstrings are compensating to pick up the slack.

This would be an example of stiffness as the central nervous system has increased its tone to the hamstrings in a protective response. Stiffness such as this must be differentiated from shortness, which is a physiological decrease in tissue length.

For these reasons, tightness is a meaningless description of an individual or athlete’s symptoms. It must be determined whether this feeling is due to stiffness or shortness so that the clinician or coach can respond appropriately.

Stay tuned for future posts on the most appropriate methods to address these issues!

An injury can be devastating for any lifter or athlete engaging in the never ending quest to become stronger, faster, more athletic, or simply look like a beast. A herniated lumbar disc will stop a powerlifter from squatting, pec tears will interrupt a bodybuilder’s upper body splits and a hamstring pull will keep a football player from improving his 40 yard dash at the NFL combine.

However these injuries can be avoided and once they have occurred can be prevented from becoming a chronic issue. This is not as exciting as lifting heavy things however is essential to ensure many years of fulfilling those savage instincts! Now take a deep breath and let’s get into it.

As a Performance Physical Therapist at Athletes’ Performance I often initially encounter patients on a strictly rehabilitative level, as an injury is what is bringing this individual to me. The most obvious example of the importance of pillar strength within this population is often in regards to low back pain, however the ability to properly stabilize the spine and maintain its neutral position, proper joint centration and movement kinematics apply to any pathology.

Lower extremity injuries are very commonly related to the influence of the pelvis as it directs what is going on below. Commonly seen, excessive lumbar lordosis with an increased anterior pelvic tilt results in a position of resting hip flexion, increases femoral and tibial internal rotation resulting in increased torsion (twisting) at the tibio-femoral joint (knee),and lateral patellar displacement and pronation (flattened arch) through the foot/ankle complex. These alterations in alignment result in increased joint stresses which can lead to pathologies such as femoral-acetabular impingement, ACL tears, medial tibial stress syndrome (shin splints) and posterior tibial tendonosis.

Similarly a lack of pillar strength often relates to conditions affecting the upper quarter. An anterior pelvic tilt with subsequent excessive lumbar lordosis results in an increased thoracic kyphosis, excessive scapular abduction/anterior tilt and increased lower cervical flexion with compensatory upper cervical extension. These postural deviations limit subacromial space, often resulting in shoulder pain, as well as a host of other conditions affecting the wrist, elbow, shoulder and cervical spine.

The trunk musculature controls the position of pelvis, ideally maintaining it in a neutral position between the extremes of a posterior and anterior pelvic tilt, allowing the spine to assume a neutral position, therefore creating an efficiently positioned foundation for the lower extremity to function off of. Furthermore achieving and maintaining optimal spinal positioning via proper functioning of the pillar musculature allows for a stable base to be established at the scapula on the rib cage for the upper extremity. This is often the initial step in treating chronic foot, knee and hip pain, as well as many other conditions other than just low back pain.

Patients usually present to therapy with poor motor programming in regards to spinal stabilization. This begins with a dysfunction breathing pattern as the accessory respiratory muscles are being used for relaxed breathing, rather than the diaphragm, causing it to be resting in an elevated position. Correcting this breathing pattern is the first step in activating the internal spinal stabilizing system (ISSS). This sagittal stabilization system develops when an infant is 3 months old allowing for her to lift her legs off the ground when lying in a supine position. As this individual matures into an adult, society often integrates faulty stabilization patterns into the “software” that is the central nervous system due to a sedentary lifestyle amongst a host of other contributing factors.

For reversal of this to be possible, proper functioning of the diaphragm must be established as it is able to descend during inspiration allowing for compression of the abdominal contents reflexively activating the pelvic floor and trunk musculature. This creates an increase in intra-abdominal pressure providing ventral (anterior) stability to the lumbar spine, which is important as there is no musculature located directly anterior to the lumbar spine to counteract the commonly dominant lumbar paraspinal musculature directly posterior to the spine.

Proper diaphragmatic function is trained initially with the patient in supine, working on “breathing into his/her groin”, expanding throughout the abdominal region in a cylindrical fashion during inspiration, as if he/she is trying to fill a tire that around the waist (allowing for further lateral abdominal/rib expansion). It often helps to place an object or the patient’s hand on his/her belly so that a cue is provided allowing the patient to focus on letting the object or his/her hand rise with inspiration and fall with expiration. Those patients that rest in an excessive lumbar lordosis and increased thoracic kyphosis will allow their ribs to flare, therefore focusing on maintaining the lower ribs in a dorsal, expiratory position is essential while training appropriate breathing patterns.

Once proper diaphragmatic function is achieved in supine, the same premises are emphasized with the hips and knees in flexion, as we all were as 3 month old infants! Each position is more challenging as the position is progressed further along the developmental spectrum. During development infants are unable to explore a new position or posture until he or she possesses the motor control to do so, forcing appropriate activation patterning and stabilization to be achieved. This approach works tremendously with adults to retrain the central nervous system in the manner in which it initially learned.

Once sagittal plane stabilization is achieved properly, as evidenced by appropriate diaphragmatic function with the lower extremities in flexion when in supine, the patient can then taught to properly stabilize while performing many common “table top” exercises (examples include hip flexion in hooklying, marching, deadbugs, etc.). Next properly transitioning to prone is taught, in other words the patient must be taught to roll properly. Getting into the nuances of proper rolling is beyond the scope of this post however look for further discussion of this subject in future posts!

Progression to quadruped where performance of common exercises, such as quad rocking and bird dogs are often performed before advancing to pillar stability exercises in half and tall kneeling and finally stance positions. As the patient advances into each new position, the base of support is decreasing, as well as elevating further from the ground, enhancing the challenge. Creativity with exercise selection is often the only limitation in these positions assuming that the patient is able to maintain a proper breathing pattern, as well joint centration throughout the spine and all supporting segments.

A patient must first begin at the lowest level in supine as the dysfunctional stabilization stereotype that brought the individual to physical therapy will be his/her preferred method of activation during a higher level task. However as this person advances, the training principles that was discussed in Essential Pillar Strength parts 1 and 2 begin to apply. As a general rule, the further a patient advances in physical therapy, the more similar it becomes to training.

Now take another deep breath. This is in depth stuff and I strongly advise any clinician or coach looks into premises discussed in this posts.

Much of this information on the neurodevelopmental approach to treatment requires further information. For more information regarding this approach to treatment, I strongly advise exploring Dynamic Neuromuscular Stabilization (DNS), developed by Pavel Kolar out of the Prague School in the Czech Republic. They host many courses in the United States and throughout the World in their various levels.

Part 1 of our discussion on pillar strength described what pillar strength is and why it is so essential. Part 2 will give you the tools to implement pillar training into your programs.

There are a multitude of different templates that an effective training program can be based around (ex. Upper/lower split, pushing/pulling, total body, etc.) and discussing how proper training of the pillar should be implemented into each type is beyond the scope of this article.

However, regardless of your training template, training proper pillar stability and strength can be separated into planes of movement (as discussed in Part 1).

While every plane can be trained in a given session, it is easiest and less time consuming to focus on one at a time. Perhaps training session one has a sagittal plane focus, therefore exercises are based on resisting or moving through/controlling movement in the sagittal plane. These exercises can often be included within the training block of another exercise (often referred to as “supersetting”). For example, an anti-extension exercise such as a body saw or rollout can be placed with an exercise that has the potential to exaggerate lumbar extension, such as a back squat or bench press, due to the strong anterior pelvic tilt that is associated with these lifts. Placing these anti-extension exercises with extension dominant movement’s train the body to buffer these stresses. These exercises can also be incorporated as their own training block within a training program or at the end of a lifting session. The possibilities are endless!

Pillar training should begin by teaching yourself/your athletes how to properly stabilize or maintain neutral spinal positioning despite external forces, before progressing into controlling movement through these planes. After stability in the sagittal plane has been increased, exercises such as hanging leg raises that incorporate controlled, segmental spinal mobility/stability can be incorporated. Be sure to use caution with this aspect of your training programs as loading the spine outside of neutral positioning is never advised, however when training athletes such as gymnasts or overhead athletes, a certain amount of spinal flexion/extension is required and they must be taught to control it. I have found bodyweight exercise variations to be most effective in training these attributes.

*As a side note, I do not train into excessive spinal extension as this is an aggravating position for a high majority of athletes due to the high amounts of spinal compression associated with these positions.

Below are examples of sagittal plane stability and controlled mobility exercises.

Sagittal plane stability:

Plank

Plank with upper and/or lower extremity lifts

Plank with hip flexion (using a valslide or TRX)

Anti-extension or anti-flexion cable press

Rollouts (with a barbell or TRX)

Body saws (using a TRX or anything that allows your feet to slide)

Sagittal plane controlled mobility:

Hanging leg raises

Monkey bar hanging leg raises

Curl ups (many variations)

Deadball slams (if you do not have a deadball, use caution when using a med ball-in other words, protect your face)

Turkish Get ups

**I will train thoracic extension in athletes that must work on it, however I do not advise incorporating this into your programming unless you have a great understanding of how to emphasize thoracic, versus lumbar extension. Very commonly, people will compensate for a lack of thoracic extension with lumbar extension, which incorporates more mobility into an area often predisposed to hypermobility, as well as greatly increasing compressive forces at the lumbar spine, while also reinforcing poor motor control patterns (lumbar paraspinal dominance due to using them as prime movers, rather than stabilizers).

While training in the sagittal plane is essential, I usually spend more time working on the frontal and transverse plane. This is due to the dominance of sagittal plane movement within the vast majority of training programs. Exercises that training programs are often based on take place in the sagittal plane. These include to majority of our double leg power/strength movements such as; squats, cleans, deadlifts, bench press, military press, pull-ups, etc. Therefore sagittal plane pillar stability is being trained with each of these lifts, decreasing the volume needed to focus on it.

As discussed earlier, I prefer to begin by training stability (anti-motion) in these planes before progressing to movement within them. As a continuation of Part 1, Frontal plane stability is essential in any activity that is played on one leg (essentially every sport). Running, jumping, kicking and throwing all require movement to take place over one fixed lower extremity, which decreases the base of support and increases the challenge to maintain the pelvis neutral (along with many other attributes). Furthermore many internally or externally generated forces in sport influence the body into a laterally flexed position.

The ability to maintain the spine and pelvis in a neutral position despite these forces, and avoiding a subsequent energy leak can be emphasized in training.

**As a side note: I generally do not train the movement of lateral flexion, as sports do not contain a great deal of lateral flexion. From a rehabilitation standpoint, I will train lateral flexion to promote segmental spinal mobility if a large asymmetry is present, however it does not appear necessary from a training perspective.

Frontal plane stability exercises include:

Suitcase deadlifts

Farmers walks (with weight placed in 1 hand or asymmetrical weights)

Kettlebell windmills (also incorporates rotation)

Single arm overhead carries

Finally the transverse plane is an area that receives a great deal of attention from both coaches and clinicians. Many prefer to avoid training in this plane due to the inherent risks that come with generating excessive rotatory forces through the spine, while others do not shy away as great amounts of rotation are present in a variety of sports.

Sports such as baseball, tennis, golf and mixed martial arts incorporate high amounts of rotational torque that must be controlled to enhance performance and avoid injury. As mentioned when discussing the sagittal plane, I first train stabilization, followed by controlled mobility. If these athletes cannot stabilize in a plane of movement, it is unrealistic to expect them to efficiently and effectively move through it. Therefore I will train rotational movement and power once the athlete is ready to do so by first developing a base of stabilization.

Below are examples of different types of exercises in the rotational plane. There will be an overlap between rotational movement and rotational power, with the only change being that once the movement pattern is mastered, speed is incorporated into it (making it more sport specific).

Rotational stability exercises:

Chops and lifts (from ½ kneel, tall kneeling , split stance, base stance)

Anti rotation (pallof) press

Cable push-pull

TRX anti rotation press

Rotational movement exercises:

Rotational chop or lift (from ½ kneel, tall kneeling, split stance, base stance)

Cable rotations

Landmines

TRX landmine

Rotational push-pull

Med ball side throw variations

Rotational power exercises:

Rotational push-pull

Rotational chop or lift

Med ball parallel throws

Med ball perpendicular throws (from waist, shoulder height, stepping into it, etc.)

With each approach and/or exercise discussed in this article, the prerequisites of mobility are assumed. It is beyond the scope of this article to discuss the multitude of mobility deficits that could possibly limit the effectiveness of a given training program. However once a mobility issue is addressed and rectified, training must occur to integrate it into an athlete’s movement patterning.

Many exercises that you are already incorporating into your training programs likely reinforce proper pillar stability. Squatting variations require sagittal plane stability to avoid crumbling under the weight of the barbell, while closed chain single leg exercises require appropriate frontal plane stability to be properly performed. Make sure to take this into account when creating your programs, as to avoid adding an excessive and unnecessary amount of volume.

This article is not meant to be an exhaustive discussion of every way the pillar can be trained, rather it should reinforce or alter the ways in which you approach training. Now go get strong and get after it!

Great pillar strength can make a good athlete great, or a great athlete good when it is lacking. This is also what can allow us to break through plateaus in our own training. Those at Athletes’ Performance have coined the term “pillar” to represent what many others refer to as the “core.” I prefer pillar, as it alludes to the true function of the trunk musculature.

Grey Cook may have come up with the best analogy when he stated “you cannot fire a cannon from a canoe.” A stable foundation or pillar is needed to move, function and perform as efficiently/effectively as possible. When the human foundation is unstable, much like a canoe, functional movement is made increasingly difficult.

Now before you go and begin performing thousands of crunches and sit ups, let’s discuss the pillar’s true function. As the foundation of movement, the trunk musculature must be able to control the forces generated by the extremities, as well as those that act upon the body. A sprinter can have the most powerful hip extension in the world, however if his/her spine cannot control these forces during acceleration an energy leak is created, and the incredible hip extension that this sprinter has worked so hard on is wasted.

In the case of this sprinter, an energy leak at the spine is created as the lordotic lumbar curve becomes excessive with a subsequent anterior pelvic tilt. With this athlete, the spinal flexors are not sufficiently functioning isometrically to counteract the hip extensor force. Therefore the energy produced by the lower extremities is not fully transferred throughout the body with acceleration.

The previous example is of sagittal plane movement however pillar stability/strength is equally important in the frontal, rotational and a combination of planes. Imagine a right handed baseball pitcher as he drives off the mound with his right leg onto his left foot. A great amount of rotational torque is created, which his pillar must control allowing the force generated from his right leg by pushing off the rubber to be translated into his throwing hand.

This athlete must rotate through his trunk to achieve maximum velocity with his pitch, and therefore must control eccentric, as well as generate concentric force. When this is not effectively and efficiently achieved, an energy leak is created that decreases performance, as well as increases injury potential. These athletes are those that seem to “arm” the ball as they throw.

Transverse plane trunk control illustrated despite high amounts of lower body hip seperation and thoracic rotation. Just to name a couple!

Frontal plane strength/stability also remains an essential part of performance and therefore must be addressed in training programs, however it has received a great deal of attention in the rehabilitation field. Much of this is due to the high prevalence of ACL injuries, specifically within the youth population. This illustrates the importance of factors such as; gluteal activation, appropriate femoral control and single leg stability, however frontal plane pillar strength is often ignored.

The trunk musculature in conjunction to previously mentioned factors must be able to maintain the pelvis in a neutral position, preventing dysfunctions such as a trendelenburg sign during gait or running (contralateral hip drop in single leg stance). A variety of musculature such as the rectus abdominus, obliques (both internal and external), transverse abdominus and quadratus lumborum attach proximally within the trunk and affect pelvis position via the muscles distal attachments. When these muscles do not possess sufficient strength or a motor control dysfunction is present affecting timing of activation, the pelvis is not held stable. Therefore, as an athlete with these issues cuts or lands on one leg, the pelvis drops, resulting in femoral and tibial internal rotation, increasing the torque at the tibio-femoral joint and thus increasing stress on the anterior cruciate ligament (ACL).

Now that I live outside DC I had to include this. What dysfunctions could he have corrected to prevent this?

For these reasons, much of the rehabilitation that I perform with my athletes post-ACL reconstruction or as part of a prevention program with training has an increased focus on pillar strength/stability in the frontal plane.

Part 2 of Essential Pillar Strength will be aimed at increasing your ability to implement what has been discussed in Part 1 into your rehabilitation and/or training programs.