dynamic slings and optimal 3d function...filex 2012 workshop notes trish wisbey-roth ©trish...

FILEX 2012 Workshop Notes Trish Wisbey-Roth

©Trish Wisbey-Roth 2012 1

Dynamic slings and optimal 3D function

Trish Wisbey-Roth

Olympic/Specialist Sports Physiotherapist (FACP),

Masters of Sport Physiotherapy (AIS/UC)

Active Rehabilitation Consultant

Abstract

Layered over the deep stabilising muscles are dynamic slings which both counter the

effects of gravity and carry the large external loads associated with dynamic function.

Discover how to efficiently recruit the posterior, anterior and lateral dynamic

muscular/fascial slings of the body to optimise three-dimensional function for work,

daily activity or sporting function. A must-attend session if you work in rehab and

performance optimisation.

Table of Contents

Abstract 1 Posterior Oblique Sling 2

Grade 1 Isolating glut’s from hamstrings - prone ....................................................................................................... 2 Alternative Grade 1 Supine pushing ball into wall, pushing through the heel using gluts and keeping hamstring relaxed2 Grade 2 Hip flexion/extension using partner .............................................................................................................. 3 Grade 3 Prone over ball (toes on ground) and dropping one shoulder ....................................................................... 3 Alternative Grade 3 Moving toward shin into flexion and rotation ................................................................................... 3 Grade 4 Small squat and moving dynamically ............................................................................................................ 4 Grade 5 Travelling straight lunge with spinal rotation ............................................................................................... 4

Posterior longitudinal Sling 5 Grade 1 Sitting on ball ................................................................................................................................................ 5 Grade 2 Squats with ball against wall ........................................................................................................................ 6 Grade 3 Eccentric hamstrings ..................................................................................................................................... 6 Grade 4 Hamstrings - all 4’s hip extension + exercise band (hip 90 degrees to hip extension) ................................... 6 Grade 5 Step/stair jump with small bound ................................................................................................................. 7 Grade 5 Posterior oblique long and lateral sling. Eccentric hamstring control in standing with spinal rotation ...... 7

Lateral sling 8 Grade 1/2 External rotators activation .......................................................................................................................... 8 Grade 1/2 Glut med in sitting ......................................................................................................................................... 8 Grade 2 ¼ squat with the ball and transferring weight .............................................................................................. 9 Grade 3 Adding thoracic spine rotation slowly ........................................................................................................... 9 Grade 4 Eccentric oblique abdominal control with hip movement ........................................................................... 10 Alternative Grade 4 Glut Med for running/jumping ........................................................................................................ 10 Grade 5 Glut med against the wall ¼ squat, hip extension with thoracic spine rotation +. ...................................... 10

Anterior sling 11 Grade 1 Standing with weight transference ............................................................................................................. 11 Grade 2 Taking knee to side in supine – movement through the hips with pelvic control ........................................ 11 Grade 3 Bridge on ball with side to side weight transference .................................................................................. 12 Grade 3 Eccentric abdominals and hip flexors .......................................................................................................... 12 Grade 4 Thoracic spine rotation/extension in kneeling ............................................................................................ 12 Grade 5 Speed specific eccentric/concentric cuing for running jumping movements ............................................... 13

Post and anterior oblique post long and lateral slings 13 Grade 5 Eccentric abdominals and hip flexors with hip extension and arm reaching ............................................... 13



Posterior Oblique Sling

Grade 1 Isolating glut’s from hamstrings - prone

These big muscles are important in supporting the pelvis and hips. If they do not work

well your hamstrings (back of legs) will have to do twice the work and will probably be

quite tight.

Lie on your stomach with your knees bent and lower legs resting against the ball.

Gently tense your bottom muscles without moving and keeping the back of your legs

(hamstrings) relaxed. Hold for 10 seconds. It may take a

while to be able to relax the back of your legs but it will

come with practice.

Glut/Hamstring differentiation in prone. Have ball against

wall and participant prone with both legs bent up and

resting against the ball.

Alternative Grade 1 Supine pushing ball into wall, pushing through the heel using gluts

and keeping hamstring relaxed

Hip extension using ball: Supine, one leg positioned with hip at 90 and knee at 60 with

ball against wall and foot resting midway on the ball. Other leg positioned with hip and

knee flexed, foot flat on the floor. Push through heel into the ball using gluts and keeping

hamstrings relaxed.

Activate your deep stabilising muscles. Gently contract

your bottom muscle and push the ball into the wall trying

to keep the back of your thigh as relaxed as possible. It

helps to think about trying to push the ball away by

straightening from your hip rather than your knee.

.



Grade 2 Hip flexion/extension using partner

Hip extension using ball and partners: Supine with one foot resting midway on the ball.

Partners “feet to feet” ball in between. Move through hip and knee flexion and extension

by pushing through foot into the ball using gluts and

Activate your deep stabilising muscles. Gently contract

your bottom muscle and push into the ball so that you

start to move your leg from bent knee to straight. Your

partner will be doing the opposite. Keep your hamstrings

relaxed.

Grade 3 Prone over ball (toes on ground) and dropping one shoulder

Thoracic spine rotation prone over the ball. Drop one shoulder by bending through the

elbow and rotating through the thoracic spine. Lumbar spine remains stable.

Position yourself over the ball, with the ball supporting

your pelvis.

Activate your deep stabilizing muscles and bend at one

elbow and drop through that shoulder. As you do this you

will allow your thoracic spine to rotate. Bring that

shoulder back to the starting point. Repeat on each side

Alternative Grade 3 Moving toward shin into flexion and rotation

Sitting on the ball with exercise band attached to point above shoulder height and

directly behind. Hold onto the exercise band with both hands above your head.

Bend forward at the hips and rotate so that you are taking the

band toward one shin. Your spine will now bend and rotate at the

same time as you move. Ensure your shoulder blades remain

fixed against your ribs and that your deep stabilisers are

activated.

Forward flexion with rotation sitting on the ball with exercise

band. Have exercise band behind and hands above head.

Movement occurs initially through the hip and then becomes

flexion and rotation of the thoracic spine toward one knee. Allow

lumbar spine movement toward the end of the movement.



Grade 4 Small squat and moving dynamically

Reaching in standing with exercise band and partners in a small squat position. Keep

exercise band at the same tension and reaching at waist level allowing thoracic spine

rotation but keeping lumbar spine stable. Watch for locking through the thoracic spine or

excessive lumbar spine motion. Increase speed of movement to increase challenge.

Take your arms forward and back allowing your thoracic

spine to rotate. Keep your lower back and pelvis still by

activating your deep stabilising muscles. Try to gradually

increase the speed of the movement to the speed where

you can control your lower back and pelvis.

Grade 5 Travelling straight lunge with spinal rotation

Stand holding your ball and take a large step forward and

come into a lunge by bending through both hips and

knees. As you lunge take the ball to the ground on the

outside of the front foot by twisting through the spine. As

you straighten up bring the back leg through past the

other so that you perform another lunge. Continue to

lunge swapping legs each time and travelling in a straight

line taking the ball from side to side as you. A medicine

ball can be used.



Posterior longitudinal Sling

Grade 1 Sitting on ball

Looking over cliff cue

These muscles are vital for supporting the lower levels of the spine, including the discs

and the sacrum. Research has shown that they stop working when there is/has been

pain in the area and they need to be trained to work again.

Sit on the ball with feet shoulder width apart.

To commence ensure you are sitting in the neutral spine position

and gently draw your shoulder blades toward each other. Try to

gently draw your pelvic floor up and your lower stomach in

towards your spine. They may well be a little contracted as they

help you to sit up. Hold this contraction for 10-20 seconds as you

continue to breathe.

Sitting posture +PF/TA

Need to find individual cue ant/post tilt and palpation (may have

it with correct posture) flaring ischial tuberosities tilting of the top

of the sacrum forwards bulging muscles into fingers with PF/TA activation, lean forward

at hips to switch mm on and work at keeping it on.Need to watch for excessive mult/ES

activity (check neutral spine). **Participants really need individual feedback and to find

the cue that works best for them.



Grade 2 Squats with ball against wall

Squats with ball against wall : have ball behind back and teach movement at the hips

not lumbar spine/pelvis. Aim to use gluts on extension and try to minimise hamstring

activity.

Stand with your ball between a wall and your mid back. Your feet

should be placed in front of you a comfortable distance.

Find neutral spine, activate your deep stabilising muscles and

gently squat ¼-½ range by predominantly bending through your

hips so that your knees do not pass your toes.

Gently tense your bottom muscles at the bottom of the squat and

keep them tense as you straighten back to the start position.

Your spine should stay straight and your weight should be on

your heels, not your toes

Grade 3 Eccentric hamstrings

Lie on your back with the ball against the wall and both

feet on the ball. Lift your bottom off the ground by using

your bottom muscles and come into a bridge position.

Lift one leg and keep it lifted as you slowly lower your

bottom back to the ground. You feel the back of your leg

working which is the aim of this exercise to have your

hamstrings working as they are stretching out. Once your

bottom is on the floor also lower the lifted leg back

Cue smooth movement and pelvis position. Watch for over gripping of upper body

through the floor.

Grade 4 Hamstrings - all 4’s hip extension + exercise band (hip 90 degrees

to hip extension)

Kneel on all fours with a piece of exercise band around

the heel of one foot and hold onto the other end with one

hand. Straighten the leg with the exercise band out

behind aiming to get your back, hip and leg in a straight

line parallel to the ground. Now that your bottom muscles

are so strong we are adding training of the hamstrings

(back of the legs) particularly on stretch. This is vital for

many sports and physical activities such as running.

Move more quickly remembering to keep control through

your low back and pelvis.

Increase the speed of movement to teach switching on and off through

eccentric/concentric movement.



Grade 5 Step/stair jump with small bound

Stand with both feet on a step/stair shoulder width apart.

Jump onto the ground and as you land move into a squat

and then bound forward (jump with both feet). Again as

you land move into a squat to help soften the impact. Try

to remember the important components of squatting

such as bending through the hips and knees, keeping

control of your spine and keeping your knees from

travelling in front of your toes. Do one jump forward after

jumping off the step and then return to the step.

Commence on step, jump off step, move into squat to shock absorb and then follow

immediately by a bound. Cue use of arms to assist propulsion. Cue landing position, soft

knees, moving into squat with knees not travelling in front of toes and bending through

hips.

Grade 5 Posterior oblique long and lateral sling.

Eccentric hamstring control in standing with spinal rotation

Stand holding onto exercise band with one end under one foot.

Lift one leg and have it behind you. Bend forwards at the hip so

that your body is moving towards the foot on the floor. The

exercise band will give you assistance on the way down and

resistance on the way back. Make sure you are moving through

the hip and keeping your spine in neutral. You may feel the back

of your legs

Your hamstring will be working particularly on the way down –

they should be working on stretch so the aim is to keep the

movement smooth.

Ensure that the rotation is spinal not just shoulders. Make sure your hands stay in line

with your breastbone and keep your eyes in line with your hands.



Lateral sling

Grade 1/2 External rotators activation

(Piriformis, Gemellus superior and inferior, Obturator internus and

Externus, Quadratus femoris and gluteus maximus)

Lying on your back, knees bent and a exercise band around your thighs above your knees

(blue/black). Rotate your knees out from your 2nd to your 3rd toe. You should feel the

side of your bottom switching on and not the front of your hip. (Grade 1) Alternatively this

exercise can be performed sidelying with pillow under knee. Scoop this knee in an arc to

be lifted to level with your hip. The weight of the leg replaces use of exercise band.

Grade 1/2 Glut med in sitting

Sit on the ball, hands on outside of knees, flaring ischial tuberosities(or turning thighs

outward) and then gentle outward pressure against the hands. Add side to side

movement keeping shoulders and hips in line.

Think about flaring your sitting bones away from each other and

then gently push your legs into your hands not letting legs

actually move. Exercise band around thighs can replace hands.



Grade 2 ¼ squat with the ball and transferring weight

¼ squat with the ball and transferring weight. Holding the squat will begin to build

endurance of your stabilisers.

Stand with your ball between a wall and your lower back.

Your feet should be placed in front of you a comfortable distance

so that when you squat down, your knees stay in line with your

heels. Activate your deep stabilizing muscles and gently squat ¼

range. Gently tense your bottom muscles at the bottom of the

squat and keep them tense as you transfer weight from side to

side. Make sure you don’t let your hip drop to the side. Repeat 5-

10 times side to side and then straighten up. Repeat process 5-

10 times

Movement is through the hips and the spine remains neutral.

Sustained ¼ squat will build endurance and side to side

incorporating glut med control.

Grade 3 Adding thoracic spine rotation slowly

Starting to train slings for walking

Glut med in standing with ball against the wall. Side onto the wall and gentle outward

pressure with inside leg to hold ball against wall. Now adding rotation of thoracic spine

away from the wall. Pelvis, low back and hips remain stable

Have the ball off the ground and lift your inside leg off the ground

with the knee bent and gently push the ball into the wall with this

leg.

In this position cross your arms against your chest and rotate to

the side by using your thoracic spine. You will move away from

the ball. Keep your hips square, pelvis and low back stable.

Repeat 10 times and then swap legs.



Grade 4 Eccentric oblique abdominal control with hip movement

Lie sideways on the ball with the ball on your waist/hips.

Your feet at ground level, up against a wall with feet

together. Have your arms across your chest and you body

in a straight line (this will be diagonal to the floor). Bring

your upper body away from the ball by bending in a

sideways motion and hold this position. Now lift the top

leg away from the other leg and move it up and down.

Once you have completed 5-10 reps in this position

lower your body so it is sideways over the ball.

Eccentric IO/EO - side on to the ball, feet on the wall, feet together, trunk in 2 positions

a) lateral flexion b) eccentric lateral flexion, hip abd/add, knee bent, top arm across

chest. Have participants place feet together on the wall (can remain apart in needed)

with arms crossed against the chest (can have hands on ball if unstable). Have

participants move into lateral flexion and sustain this position as they lift the top leg into

hip abduction.

Alternative Grade 4 Glut Med for running/jumping

Stand on step and quick drop of one leg

and dip of pelvis with concentric

activation of Glut med on standing leg.

Fast repeated movements to build

eccentric/ concentric endurance.

Grade 5 Glut med against the wall ¼ squat, hip extension with thoracic

spine rotation +.

Stand side onto the wall with the ball in between. Have the ball

off the ground and lift your inside leg off the ground with your

knee bent and gently push the ball into the wall with this leg.

Bend the leg you are standing on into a small squat and keep

this position while you move the leg with the ball backwards by

moving through the hip. At the same time as your leg moves

backwards take the shoulder near the wall toward your opposite

knee by twisting through the upper back. This exercise is an

essential component of effective and efficient running.

This exercise contains essential components of an effective and

efficient running pattern. Start with ¼ squat on stance leg and

the hip extension with leg with ball and thoracic spine flexion and rotation away from

the wall. Keep range of rotation small to keep lumbar spine control.



Anterior sling

Grade 1 Standing with weight transference

Even weight through feet i.e. not too much on toes/heels

Pelvis on hips, ribs over pelvis, shoulders and head

position

Stand with both feet about hip width apart.

Activate your stabilising muscles and gently tighten your bottom

muscles. Tilt your pelvis one way and then the other to find your

“neutral spine“ in standing. To progress transfer weight from one

side to the other like you were going to lift one leg but don’t

actually lift it. Maintain the position of your spine and stabiliser

muscles on throughout the exercise.

Grade 2 Taking knee to side in supine – movement through the hips with

pelvic control

Abdominals activated in supine with one knee to side. Supine, hips and knees flexed with

feet flat on the floor. Taking one knee at a time out to the side. The movement should

just occur through the hip and pelvis with lumbar spine stable.

Lie on your back with your knees bent and feet flat on

the floor.

Gently pull in your pelvic floor and lower stomach

muscles up and back toward your spine. Try to maintain

the tension as you take one knee out to the side by

moving through the hip. Return to the start position and

alternate sides continuing to breathe normally. Ensure

you keep your low back and pelvis still and that the

movement is occurring just at the hip.



Grade 3 Bridge on ball with side to side weight transference

This strengthens the stabilisers and gluteals by having to lift some of your body weight.

By adding the ball your stabilisers have to work harder which is important to train your

body to deal with unstable surfaces

Lie with your back and hips resting on the ball with feet

flat on the floor.

Cross your arms on your chest. Activate your deep

stabilizing muscles. Start with participants sitting on the

ball and have them walk their feet out and roll down to

have their upper back on the ball. Activate stabilisers

and gluts keeping hamstrings relaxed.Dropping the

bottom and moving into more of a sitting position will

make it easier for many participants. Proprioceptive

feedback on the hamstrings will also assist to turn off overactive hamstrings.

Grade 3 Eccentric abdominals and hip flexors

Sitting on the ball holding onto exercise band attached to

point in front of you. Starting in the upright sitting position

move backwards by opening out through the front of your

hips. Your spine should stay in the neutral position throughout

the movement. You may begin to shake/wobble as you go

back and if so just go back a little way to where you start to

shake/wobble. As you gain more control you can work on

increasing how far back you go. Allow the ball to gently roll up your back as you move

more.

Sitting on the ball, moving from neutral to hip extension, neutral lumbar spine,

black/blue exercise band. Cue opening out through the hips maintaining neutral spine.

Partner work challenges proprioception

Grade 4 Thoracic spine rotation/extension in kneeling

Kneel with one leg up holding onto exercise band at shoulder height attached to a point

on the side of the back leg.

Moving through the upper back and shoulders take arms toward

the bent leg and up to the ceiling. You will be moving in a

diagonal pattern. Make sure your lower back, hips and pelvis

remain stable. Kneeling, TSp rotation/extension with stable

partner, rotation toward the bent leg. Have participants hold for

each other and try to have back leg in hip extension (or at least

neutral).



Grade 5 Speed specific eccentric/concentric cuing for running jumping

movements

Start in a side plank

position than drop hips

towards the floor, then

arch waist area away

from floor. Increase

speed as strength and

endurance increases.

Post and anterior oblique post long and lateral slings

Grade 5 Eccentric abdominals and hip flexors with hip extension and arm

reaching

Kneel with the ball in front of you with your elbows resting on the ball. Roll the ball

forward by taking your body forwards so that your hip knees and shoulders remain in a

straight line. Your arms should not move higher than

shoulder height and shoulder blades fixed against your

ribs. This exercise will work your abdominals and hip

flexors on stretch and you may get the shakes/wobbles.

If so, move until you start to shake a little and then

return aiming to increase the range of movement as

you get stronger.

Add taking one leg backwards and the opposite arm

forwards as you roll out. Make sure you can keep your

spine in a neutral position and that the movement is occurring through your hip, knee

and shoulder, elbow. Watch for lumbar spine extension.

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dynamic slings and optimal 3d function...filex 2012 workshop notes trish wisbey-roth ©trish...

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