INTRODUCING A NEW ONLINE SERVICE FOR FITNESS PROFESSIONALS! 

 Dr. Shawn Thistle 
 

INTRODUCING A NEW ONLINE SERVICE FOR FITNESS PROFESSIONALS! 

This May, a new online service for fitness professionals will be launched that will help you incorporate current science into your client interactions.   

But first, some background information. My name is Dr. Shawn Thistle, and three years ago I launched the original Research Review Service, an online subscription-based service for physiotherapists, chiropractors, and other manual medicine therapists.  Thus far the RRS has been very well received, with subscribers in 16 countries worldwide.  

Now, we are launching a Research Review Service for fitness professionals – personal trainers, conditioning specialists and coaches.   

RESEARCH REVIEW SERVICE FITNESS is here! 

This is the web address: http://www.fitness.researchreviewservice.com   

How does RRS-Fitness work? 

Every week, RRS-Fitness posts 1-2 new reviews which analyze, contextualize, and put into practice the findings of a recently published scientific article from industry-leading peer-reviewed journals.  Each review takes 5-10 minutes to read and focuses on the practical application of results and functional knowledge of research methodology.  The reviews are all contained in a database that subscribers have full access to. Topical content is varied and comprehensive, ranging from exercise sciences to sports injuries and rehabilitation.  The overall goal of RRS-Fitness is to increase knowledge translation from the scientific literature to those in contact with clients in all types of exercise and training environments.  Further, RRS-Fitness will help subscribers collaborate more effectively with Chiropractors, Physiotherapists, and others who deal with common sports injuries – this can help GROW YOUR CLIENT BASE and INCREASE YOUR REVENUE!   

FREE Sample Reviews: 

We have posted 5 sample reviews on the site to give you an idea of the format and length of the weekly postings.  They can be viewed here: http://fitness.researchreviewservice.com/content/view/396/71/  

Existing Database: 

There are currently over 120 reviews ALREADY in the RRS-Fitness Database – a significant amount of useful information for new subscribers! Weekly posting will begin in the next couple of weeks. 

Subscription Plans: 

All prices listed below are in Canadian Dollars.  You can subscribe online using a credit card via PayPal, or offline with a check by downloading our Offline Subscription Form (Click HERE to download). 

• 1-year professional: $99
• 2-year professional: $179
• 3-year professional: $249
• 1-year student: $59**

** Note: students must register using their student email address 
 

Writing Opportunities with RRS-Fitness: 

RRS-Fitness is looking for skilled writers, preferably those in the fitness industry with graduate level degrees and a working knowledge of research methodology and implementation.  This is a paid position.  If you are interested please send a resume/CV to me (shawn@researchreviewservice.com).  

If you have any questions about the service, please do not hesitate to contact me. 

Best Regards,

Shawn 
 

SPECIAL BONUS!  

Here is the first review that will be posted this May! 

Study Title:  

Exercises for spine stabilization: Motion/motor patterns, stability progressions, and clinical technique 

Authors:

McGill SM, Karpowicz A 

Publication Information:

Archives of Physical Medicine & Rehabilitation 2009; 90: 118-126. 

Summary:

Spinal stabilization exercises have become very popular, and for good reason.  They are commonly prescribed for a wide range of lower back and other musculoskeletal conditions.  These exercises are aimed at improving motor control, endurance and coordination of key trunk muscles that contribute to spine stiffness, stability, and coordinated motion.  Recent research has indicated that results of these exercises are improved when “neutral spine position” is maintained (1), so the reader should keep this in mind throughout this review.  To this end, prudent conditioning specialists are very adept at making “on the fly” adjustments and modifications to patient performance of spinal stability exercises.  Encouraging postures to spare painful joints, knowing when to engage in corrective exercise, and knowing when to adjust co-activation patterns to make an exercise more tolerable for a client are all crucial skills, yet little literature exists to guide us. 

Sufficient spinal stability requires adequate activation of numerous trunk muscles.  It has been well established that when these muscles contract, they create both stiffness and force.  Muscle force may not be stabilizing, but muscle stiffness is ALWAYS stabilizing (2).  Many clinical populations of LBP patients have compromised load bearing capacity, therefore exercises are preferred that impose minimal spinal load.  In this study small basic science study (including only 8 healthy male subjects of university age), three such exercises that are well known by most evidence-based conditioning specialists – the curl-up, side bridge, and bird-dog (the “Big 3”) – were investigated for muscle activation, 3D spinal mechanics, and the influence of clinician correction.  Challenging progressions for these exercises were also outlined and evaluated.  

Pertinent results of this study include:

The results of this study will be discussed for each exercise individually, and will include technique recommendations for implementation and progression. 

Spinal Bracing: 

This technique was applied in the same manner with all exercises. Patients were instructed to contract and stiffen the abdominal wall as if they were about to be “hit in the belly” while not pushing out or sucking in.  Facilitation was achieved with fascial raking, where the clinician rakes the obliques while not encroaching on the rectus abdominus with the ends of the fingers – firm but not painful pressure should be used. 

CURL-UP (including the “DEAD BUG”): 

Patient Instructions:

• patient is supine with one leg flat on the ground and one foot flat on the floor (with knee at 90°)
• both hands are placed under the lumbar spine to support the neutral curve, and the elbows are on the ground
• patient is instructed to pivot about the sternum and lift the shoulder blades off the mat while maintaining neutral neck position for 5 seconds
• Progressions: can include elevating the elbows, pre-bracing (stiffening) the abdominal wall, and deep breathing during the exercise
• Dead Bug: patient is supine with one hand under the lumbar spine – starting with the hips, knees and shoulders at 90°, patients then extend the other arm/opposite leg to a horizontal position (but still elevated slightly from the ground) and held for 5 seconds
• Dead Bug Progression: a plyometric, short range movement where the patient pre-braces the midsection then contract ballistically to create motion only at the shoulder, and hip, but not torso

Results from the Study for the Curl-Up/Dead Bug:

• raising the elbows caused a trend of increasing rectus abdominus (RA) activity while reducing upper erector spinae (ES) activity – indicating more of a flexor torque challenge
• while using the abdominal brace – both internal obliques (IO) and external obliques (EO) increased their activation (IO reached roughly 30% of maximum voluntary contraction level)
• the addition of heavy breathing did not increase abdominal muscle activity (actually in some cases it reduced activity)
• although not likely significant, the authors noted that gluteus medius activity increased from 3 to 6% MVC with bracing
• during the Dead Bug, increased muscle activity was noted in all muscles

SIDE BRIDGE: 

Patient Instructions:

• the easiest variation has the patient resting on their elbow (directly under the glenohumeral joint) with their hips back in a squat position and knees on the floor (legs bent backward)
• support is then shifted from the hip to the knee as the pelvis is raised (up and forward) in alignment with the sternum and knees
• the opposite hand is placed over the supporting shoulder to stabilize the weight-bearing shoulder
• Progressions: patient removes their opposite hand from the weight-bearing shoulder and places the hand on the waist, extending to a full side bridge with support on the feet (top foot over lower foot), rotating slowly from a side bridge to a front plank position (attempting to lock the ribcage to the pelvis during the transition – see below)

Results from the Study for the Side Bridge:

• a clear progression emerged – the lowest muscle challenge was noted when the exercise was performed from the knees, increasing with foot support, and being the highest when rotating from a side bridge to a front plank (muscle activity approached 50% MVC in the RS and IO/EO, and 30% in the latissumus dorsi)

BIRD-DOG: 

Patient Instructions:

• the starting position is on all fours with hips and shoulders at 90°
• Progressions: just arm elevation, just leg elevation, both arm and opposite leg elevation (full Bird-Dog), then the addition of abdominal bracing and/or deliberate slight abduction of the shoulder with further elevation, finally drawing squares with the hand and foot while they are extended (with motion occurring only at the hip and shoulder)

Results from the Study for the Bird-Dog:

• the progression of muscle activation followed the progression mentioned above

The Effect of Expert/Clinician Correction:

• corrections were aimed at correcting asymmetries in spinal twist axis posture toward neutral spine posture
• fascial raking was employed as described above
• conditioning specialists are in a perfect position to make continuous hands-on feedback in this manner to improve exercise performance

Results from Study for Clinician Correction:

• clinician correction makes subtle but important changes
• fascial raking increased MVC in the obliques and reduced RA activity during the curl-up, while also reducing spinal flexion to maintain neutral spine position
• correcting the locking of ribcage to pelvis while rotating from a side bridge to front plank increased activity in IO/EO and reduced torso twisting

Conclusions and Practical Application:

The “Big 3” exercises used in this study have been well researched. The data presented in this study can be used to assist clinical decisions regarding where to begin exercise progressions, how to implement corrective techniques, and which exercises to select.  Most of the exercise progressions corresponded with predictable increases in difficulty and muscle activation.  One finding that may contradict common thought and practice is that the addition of heavy breathing did not affect muscle activation to a significant degree versus abdominal bracing.  Further, subjects showed varying muscle activity linked to inspiration and expiration, indicating that some patients can entrain their respiratory muscles to function independently of their spine stabilizing role.   

Prudent fitness professionals should take time with their clients and athletes to teach and correct form on spinal stability exercises to ensure proper motor skill attainment, and minimization of unnecessary spinal loads.  This study demonstrated that simple corrections using hands-on methods can have positive influences on exercise performance. 

Study Methods:

Eight university aged, healthy male volunteers participated in this study, which included measuring EMG and orthogonal 3D spine position measurements during the three exercises.  Five of the subjects repeated the exercises with the guidance of an experienced clinician.  This data was collected and analyzed according to the methods previously used in this laboratory (Dr. McGill’s at the University of Waterloo), the leading authority on this topic. 

Study Strengths/Weaknesses:

This study, despite having a small number of subjects, utilized well-described and previously published methods of data collection and exercise implementation.  It should be noted however, that these subjects were healthy males with no history of LBP.  Further research is necessary to clarify best practice for implementing these exercises effectively with LBP patients.   

Additional References:

1. Suni J et al. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: A 12-month randomized controlled study. Spine 2006; 31: E611-620.
2. Brown SH, McGill SM. Muscle force-stiffness characteristics influence joint stability. Clinical Biomechanics 2005; 20: 917-922.

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