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Low Back Pain? Make PT Your First Stop… The Sooner the Better

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Low back pain?  You’re not alone. Low Back Pain (LBP) is common, costly, and debilitating.  “Epidemic” is a word commonly used by experts. Lifetime prevalence of low back pain (LBP) is about 70%.  LBP alone accounts for 2.5% to 3% of all physician visits annually in the United States. It is the most common reason to see a primary care provider in the US second only to the common cold.  Healthcare costs for LBP in the US were ~ $86 BILLION in 2005, a 65% increase from 1997 estimates, and they continue to rise. Yet despite increasing resources, recurrence is common (24% – 33% likelihood), and back pain numbers continue to grow, with chronic low back pain the fastest growing segment, estimated to be ~ 10% of cases.  Costs from lost work productivity due to LBP in the United States exceed a staggering $7 billion dollars annually. Money spent on lumbar fusions for low back pain in the US annually is roughly equal to what the US government spends on foreign aid annually — ~ $20 billion (compared to cancer research for prostate, breast and lung cancer combined, $1.9 billion).  The United States had dramatic increasing trends in MRIs, opioid prescriptions, epidural steroids and fusions from 1994 – 2004, and yet, we do not see improved outcomes in chronic low back pain. 44 million medication prescriptions were written for LBP in 2000, of which hundreds of thousands of people experienced life-threatening adverse events and deaths.  In one large study of over 2,000 patients with LBP, the most common initial treatments were opioids (~ 40%) and muscle relaxants (~40%). Despite the noted increasing medical expenditures dedicated to its management with these interventions, the prevalence of chronic, disabling LBP continues to increase. The majority of patients with LBP initially access healthcare through a primary care provider.  Given the volume of patients with LBP managed in primary care, decisions in this setting have substantial implications for process of care and overall healthcare cost.  Research shows that there are wide variations in primary care practice for decisions such as prescribing medication, ordering imaging, and referral to specialists. Physical Therapy Clinical Practice Guidelines that synthesize the latest clinical research for LBP recommend an active approach to physical therapy care with the focus on exercise interventions and other strategies to help patients maintain and improve their overall activity levels.  Despite this recommended approach and the fact that various interventions within the scope of practice of physical therapists (eg, exercise, spinal manipulation / manual therapy, education) are recommended as effective, unfortunately, many physicians mostly recommend delaying referral to physical therapists for at least 4 weeks following initial primary care consultation.  This “wait and see” approach is based on the belief that most patients with LBP will recover rapidly, and intervening quickly would not be cost-effective. However, more and more, the evidence is indicating that this belief and approach to managing LBP is failing patients and burdening the healthcare system.  Despite current medical management guidelines to the contrary, the current approach has yielded high rates of initial use of imaging, nonsteroidal anti-inflammatory drugs, and opioid medications in the initial management of patients with LBP.  There is not evidence that clinical outcomes are improving with these interventions; in fact, rates of chronicity related to an episode of LBP are increasing.  A majority of “wait and see” patients go on to experience persistent and/or recurrent symptoms, and up to one-third report moderate to severe pain 1 year following the initial primary care encounter.  Contrary to current medical practice guidelines, early use of imaging and opioids are common, as referenced above, and are associated with higher rates of prolonged disability, invasive procedures (injections and surgery), greater cost and poor quality of life. What’s the missing link to successful recovery from LBP?  Evidence points more and more to Physical Therapy-guided active recovery.  We see improved outcomes, lower costs and reduced risk of invasive procedures like injections and surgery when compared to delaying care, opioids, and early imaging.  Yet primary care referral rates were as low as 7% in a very large study of 32,000 people with low back pain. In a study across more than 400,000 low back pain patients, the evidence showed: Significant DECREASE in likelihood of surgery when people receive PT in the acute (1 – 30 days) and sub acute phase (31 – 90 days) Significant DECREASE in risk for injections in those who received PT in acute or subacute phase vs. chronic (91 – 365 days) Significant DECREASE in frequent (11 or more) office visits for LBP who received PT in acute or subacute phase Overall, patients who received PT within the first 30 days had fewer episodes of doctor visits, epidural injections, and surgeries in the year compared to those who received PT after 90 days (chronic phase). And yet… Mean time to initiate PT in this very large study was 86 days. Physical therapy evidence-based interventions, and clinical reasoning to match the right patient to the right treatment at the right time by a physical therapist earlier in the course of care, can prove more cost-effective by promoting recovery and reducing the need for more invasive and costly interventions. The good news is, this trend is improving as the research becomes clearer and is broadly shared across the medical system, and evidence-based guidelines are more and more integrated into medical practices.  So we’re headed in the right direction for best practices. At Elevate, we treat people experiencing low back pain A LOT, and in our model of 1:1 care with our highly experienced Doctor of Physical Therapy and our Evidence-Based Approach, we have great success.  If you’re having back pain, don’t delay any longer.  The sooner you receive proper care, the better.  And don’t despair if your pain is longer standing.  We also treat many people coping with chronic low back pain very successfully as well. No physician referral or prescription is necessary. California is a Direct Access state allowing you to go directly to Physical

ANKLE INJURY REHAB

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Don’t Dismiss Ankle Sprains: Manual Therapy, Balance, and Beginner to Advanced Exercises The ankle is one of the most common sites of injury in exercise and sports.  In a recent study, ankle sprain accounted for 76.7% of injuries in sports (1). While more common in sports, ankle sprains also occur in every-day activities like walking on uneven ground or stepping off a curb. Up to 70% of people who sprain their ankles will continue to have difficulty with them. In fact, once an ankle is sprained, up to 80% of people will suffer recurrent sprains (2), and up to 72% will develop symptoms of chronic ankle instability (CAI) (3). Between 5% and 19% of athletes experience psychological distress following an injury to levels comparable with patients receiving treatment for mental health illness (4). Stress increases the risk of an athletic injury (5). Rehabilitation following injury can be adversely affected by loss of confidence, fear, and anxiety. To safely return to exercise activities, it is crucial to train physical and cognitive demand, as well as sport-specific technical skills (6) in order to establish optimal neuromuscular control, injury reduction, and overall performance capabilities (7). Ankle sprains can be very disabling, as the research shows.  These data suggest that it’s important to better care for ankle sprains.  The good news is, research also shows that individuals who have sprained their ankles can benefit from a physical therapy program that includes manual therapy and a supervised exercise program. Potential benefits are less pain and improved ability to perform daily activities and return to sport (2). What follows is an evidence-based rehabilitation approach for various ankle injuries including the management of ankle sprains.  What we do as Doctors of Physical Therapy at Elevate PT & Fitness always depends on our thorough evaluation of each individual patient.  What interventions we choose and when depends on the specifics of the injury, the tissues involved, a patient’s pain  and function level, and patient-specific goals.  In this article you’ll see a manual therapy intervention; early-stage non weight-bearing exercises for important ankle muscles often weakened in an injured ankle; balance and proprioception exercises; and high level plyometric training. Manual Therapy Joint Mobilization: Manual therapy joint mobilization techniques are used to modulate pain and treat joint dysfunctions that limit range of motion (ROM) by specifically addressing the stiffness and altered mechanics of the joint. The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or malalignment or subluxation of the bony surfaces. Non Weight-bearing Band Resistance: Non weight-bearing exercises allow activation of muscle tissue, low-intensity stress through connective tissue (ie. tendons/ligaments), loading without over stressing tissue or compromising healing process.  The following are Theraband exercises for Tibialis Posterior and Peroneus Longus, two muscles often impaired in injured ankles. Population: For individual unable to tolerate full weight-bearing.   Weight-bearing: Re-introduction to weight-bearing exercise will increase tolerance to standing and walking, in an attempt to normalize gait pattern and reduce stress on neighboring joints and tissues. Population: For individual several days/weeks after injury, tolerant to full weightbearing on affected limb.   Balance/Stability/Proprioception: Challenge balance to restore proprioceptive feedback to neuromuscular system, increase awareness of body position in space and in relation to ground surface. Loss of proprioception is a risk factor for re-injury.  What follows are several single leg exercises to challenge balance, proprioception, and nueromuscular control in all planes of ankle movement.  Population: For individuals able to weight-bear with minimal pain, ambulate short distances, and who display poor control, strength and stabilization. Power/Plyometric: Plyometric movements are similar to game-time speed and intensity, stress joints and tissue to maximal extent. Agility and control of momentum is often impaired by ankle injuries, and can lead to further injury if not appropriately addressed. Final stage before return to sport-specific activities.  The following exercises demonstrate a few ways to introduce higher level, sport-like challenges in the sagittal and frontal planes. Population: For individuals able to run/jump without pain, returning to sport-specific skills training.   (A licensed physical therapist can perform a thorough evaluation to help determine if you are a good candidate for this treatment as part of a program designed to help get you back to full activity after an ankle sprain. For more information on the treatment of ankle sprains, contact us  at Elevate PT & Fitness, or your physical therapist specializing in musculoskeletal disorders.) _________________________________________ References:  (1)Predictors of lower extremity injuries at the community level of Australian football. Gabbe BJ, Finch CF, Wajswelner H, Bennell KL. Clin J Sport Med. 2004 Mar; 14(2):56-63. (2)Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:43 Issue:7 Pages:456–456 DOI: 10.2519/jospt.2013.0504 (3)The Relationship between Muscle Function and Ankle Stability. Lentell G, Katzman LL, Walters MR. J Orthop Sports Phys Ther. 1990; 11(12):605-11. (4)Considerations for Normalizing Measures of the Star Excursion Balance TestPhillip Gribble-Jay Hertel – Measurement in Physical Education and Exercise Science – 2003 (5)A systematic review on ankle injury and ankle sprain in sports. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. Sports Med. 2007; 37(1):73-94. (6)The team physician and return-to-play issues consensus statement http://www.amssm.org/MemberFiles/RTP_Cons_State.pdf Published 2002. Accessed September 2011  (7)Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain.Vicenzino B, Branjerdporn M, Teys P, Jordan K. J Orthop Sports Phys Ther. 2006 Jul; 36(7):464-71.

SHOULDER FOUNDATION STABILIZATION SERIES

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ELEVATE Shoulder Stabilization Series Part I DO YOU HAVE SHOULDER PAIN?  One of the most common impairments we see among our patients with shoulder pain is weakness of the muscles that control the scapula (aka the shoulder blade). This is distinct from the rotator cuff muscles which control glenohumeral joint (aka the ball and socket joint). If the shoulder was a house, the scapula would be it’s FOUNDATION. If the foundation of the shoulder is compromised then the risk injury may be higher. Three key muscles that help strengthen and control this foundation are the middle/lower trapezius and the serratus anterior. Together, these muscles help keep the scapula secured onto the thoracic spine during overhead shoulder movement and allow the rotator cuff muscles to work more effectively, thus improving performance and reducing injury risk! If you want to learn how to make a strong shoulder foundation, read on for PART II of our Shoulder Stabilization Series 🏼   ELEVATE Shoulder Stabilization Series Part II HOW TO STRENGTHEN YOUR SHOULDER FOUNDATION PART II  – Progression Level 1️⃣ (Isometrics): Prone A’s, T’s, and Y’s. While laying on your stomach of on a Swiss ball, position your arms to form an ‘A’, ‘T’, or ‘Y’. Pinch your shoulder blades back as if you were trying to grab a pencil with your shoulder blades. At the same time drive the shoulder blades down towards your feet to prevent excessive shrugging. Hold each position for 30-60 seconds for 2-3 sets. This exercise appears simple but can be extremely challenging for those who are not used to recruiting these muscles. _ Progression Level 2️⃣ (Isotonics): In the same positions at level 1, add resistance via weight or resistance bands and allow your arms to slowly lower to the ground (eccentric phase) and then rise back to the starting position (concentric). Choose a weight where 3 sets of 15 can be performed successfully. _ Progression Level 3️⃣ (sitting or standing): the third progression helps train the individual to use the middle and lower trapezius in a more upright position, which is where people more commonly perform overhead movement throughout their day. Using a resistance band or cables, perform the A’s, T’s, and Y’s in sitting or standing (standing tends to be more challenging due to it being easier to compensate with the lumbar extensors). Choose a weight where 3 sets of 15 can be performed successfully. _ This progression is not the only way to improve scapular strength but it has been found to be effective for improving mid/low trapezius recruitment and shoulder functional outcomes among persons with shoulder impingement. _ De May et al. Scapular Muscle Rehabilitation Exercises in Overhead Athletes with Impingement Symptoms. The American Journal of Sports Medicine. 2012. _ Read on for Part III where we go over how to strengthen another crucial shoulder muscle: the serratus anterior!   ELEVATE Shoulder Stabilization Series Part III HOW TO STRENGTHEN YOUR SHOULDER FOUNDATION PART III  _ The serratus anterior is another underutilized muscle group among those with shoulder dysfunction. Here are a few exercises to improve activation and strength of this muscle. _   Exercise 1, Quadruped Rockbacks: Begin by going onto your hands and knees. In this position, push your hands  into the ground as if you were trying to push the earth  away from you while also trying to spread the floor apart with your hands. Maintain this force while bringing your butt towards your heels similar to a child’s pose, and then return to the start position. You should feel muscle activation occurring at the outside of your shoulders. Recommended dosage: 3 sets of 15 repetitions. _ Exercise 2, Quadruped Circles: Similar to exercise 1, begin on hands and knees and press into the floor with your hands while also spread the floor apart. Shift your body weight to either the right or left hand and begin moving your body in circles over that hand. You should feel muscle activation occurring at the outside of your shoulders. Recommend dosage: 3 sets of 15 circles clockwise and 15 circles counter clockwise and then switch hands. This can be progressed to a modified plank or full plank position. _ Exercise 3, Scapular Push-Ups: Begin on hands and knees similar to the first two exercises. Allow your shoulder blades to relax, bringing your chest closer to the ground without bending at the elbows. Then bring your chest away from the ground by bringing your shoulder blades forward (towards the ground). While in this position, lift the knees 1 inch from the ground to increase resistance against the shoulder girdle. Recommend dosage: 3 sets of 15 repetitions with 1 second hold. This can be progressed to a modified plank or full plank position.

STICK MOBILITY

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    Here are 6 of our favorite mobility flow sequences with Stick Mobility • Ninja Flow From the shoulders and chest, down the thoracic spine and into the hips and lower limbs, the ninja flow is an excellent way to synergistically open up the entire movement system throughout the kinetic chain.  Slapshot Rotational range of motion and muscular coordination is critical for athletic and everyday activities alike – whether you are looking at improving your golf swing or reaching back behind the passenger seat to grab your bag, the slapshot will give you the edge you need to move smoothly and efficiently. • Split Stance Bow & Arrow The SS Bow and Arrow is an outstanding way to activate the muscles of the lower extremities for stability and balance while simultaneously encouraging mobility through the spine up the chain into the shoulder and upper extremities. • Single-Leg RDL Counterforce This movement flow adds a core activation and balance challenge to the traditional single-leg deadlift and is a must-have for the athlete or weekend warrior looking to take their RDL to the next level. • Half-Kneeling Bow & Arrow Tight hips and stiff shoulders? The HK Bow and Arrow is a perfect way to release this tension and open up the lateral chain for more fluid movement.   Half-Kneeling T/S Opener Not only does this seemingly simple mobility flow release tension in the hip flexors while activating the gluteal muscles, it also encourages rotational movement throughout the thoracic spine.  

SURFING DYNAMIC WARMUP

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Hey surfers! Here’s a dynamic warm-up just for you designed by Elevate Co-founder Dr. Meredith Soelberg PT, DPT, MBA. Research is clear that a dynamic warm-up (vs. static stretching) is best to prepare for sport ️ and to prevent injuries. A sport-specific warm-up is specially designed to move the body through the necessary range of motion and activate the neuromuscular system in ways that simulate the sport. ‍Surfing is a high demand sport with significant injury risk. Up to ⅓ of surfers sustain an injury each year requiring medical attention, missed work, or time off from surfing,  and 91% of surfers have sustained an injury surfing in their lifetime. We see lots of injured surfers at Elevate. Most often we hear that they don’t warm-up at all,🤭 and don’t have an exercise regimen to get their bodies strong for the great demands of surfing. A surf-specific dynamic warm-up will go a long way to help mitigate the risks and prevent injury (especially when combined with our surf-specific strength exercises coming next week). We know the waves are like a Siron song calling you the minute you feel the sand in your toes, but put earplugs in for just 5 minutes and prepare your body for the awesome intensity of surfing!   What a surf-specific dynamic warm-up can do for YOU: Increase core temperature Increase blood flow to muscles Increase stimulation to mechanoreceptors in joints Increase stimulation to the central nervous system Increase musculoskeletal control Increase confidence for performance Increase movement through the range of motion demands for the upcoming activities ️Improve exercise / sport performance Reduce risk for injury If you don’t have 5 minutes to spare, here’s the 60sec express version!    

HEAD & NECK INJURIES

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Recently, the topic of head injuries, including concussions, has rapidly come to the forefront of sports medicine. The prevalence of head and neck injuries in all sports has led to an increased awareness and education on concussions; what they are, how they occur, and how they’re diagnosed. However, risk factors related to demographics and optimal treatment approach to a diagnosed concussion is still evolving. The “boom” of the concussion topic begs the question: why are there so many concussions? Are our bodies prone to head injury? Is there something we can do to decrease risk for a head injury? Recent studies have shown that women take longer to recover from a TBI (traumatic brain injury), report more symptoms and receive more concussions than men in similar sports, possibly due to neuroanatomical differences, weaker neck muscles and hormonal changes. Hormones and the physiology of women’s necks and upper bodies are two possible reasons why women experience concussions differently than men.1 Specifically in the sport of soccer, concussions are recorded to occur just as frequently as they occur in football and ice hockey, with the risk being higher in goalkeepers, females, and youth.2 Head-to-head contact is the most common mechanism for concussion diagnosis in soccer, while heading the ball is not a common cause. Many head-to-head contact injuries occur accidentally, or unintentionally, but there is less understanding of how intentional head impacts (i.e. heading in soccer) can also cause brain injury and affect cognitive function. Although concussions have been the “hot topic” in recent years, all head injuries are not diagnosed as concussions. In soccer, intentional head impacts (i.e. heading the ball) have been shown to worsen cognitive function, specifically associated with frequent ball heading, rather than unintentional head impacts due to collisions.3 Furthermore, another study revealed that kids between the ages of 9 and 11 who experienced at least one “subconcussive” impact associated with heading the soccer ball showed decreased cognitive test scores. These changes in cognition showed variation in gender, suggesting girls had memory changes, whereas boys had processing changes.4 Another study has shown that heading soccer balls is more damaging to the female brain than the male brain. These findings suggest that gender-specific guidelines for soccer heading may be required. Researchers suggest that females are more at risk for brain injury associated with heading a soccer ball due to differences in neck strength, sex hormones or genetics.5 Not only does heading in soccer cause head injury, but it can also lead to neck injuries associated with the cervical spine. These potential injuries include muscle strains, ligamentous sprains, compressive disc injuries and joint injuries. With all this risk for injury associated with heading the soccer ball, what should be done about it? Some researchers, after analyzing the data of their respective studies, have considered the question of whether or not heading should be allowed, but realized that that would be unrealistic. They have also posed rules and heading restrictions that are gender-based and age-based. Research is providing evidence that neck muscle development and protective headgear may play a role in the prevention of head injuries, specifically concussions.2 Additional research has found that cervical spine biomechanics is a modifiable risk factor in reducing sports-related concussions. This being said, preventative treatment of head injuries can be geared towards improving cervical spine biomechanics and postural education.6 Furthermore, a combination of cervical and vestibular physiotherapy has decreased the medical clearance time to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.7 Therefore, the employment of both cervical and vestibular exercises to accelerate recovery and return to sport is important. Historically, treating a concussion has been quite passive, physicians and sports medicine staff relying heavily on pure rest to allow for the brain to heal and recover from the traumatic and potentially damaging event. Progressive research and evidence are now suggesting that an active approach to all types of head injury recovery is the most appropriate for returning an athlete to normal activities of daily living and his/her sport. This includes a multi-modal approach of collaboration among health care professionals who are able to apply their respective areas of expertise to a patient-centered recovery.8 Please contact us at Elevate to set up an appointment for an active approach to your PT treatment plan following a head or neck injury.   References:   Covassin, T., Swanik, C.B., & Sachs, M.L. (2003). Sex differences and the incidence of concussions among collegiate athletes. J Athl Training, 38(3), 238-244. Al-Kashmiri, A., & Delaney, J. S. (2006). Head and neck injuries in football (soccer). Trauma, 8(3), 189–195. https://doi.org/10.1177/1460408606071144. Stewart, W.F., Kim, N, Ifrah, C, Sliwinski, M, Zimmerman, M.E., Kim, M, Lipton, R.B., Lipton, M.L. Heading frequency is more strongly related to cognitive performance than unintentional head impacts in amateur soccer players. Frontiers in Neurology, 2018; 9 DOI: 10.3389/fneur.2018.00240 Lopez-Roman, LR, Diaz-Rodriguez, YI. Are subconcussive impacts harmless in youth soccer players?: 1965 Board #226 May 31 3. Medicine & Science in Sports & Exercise. 50. 475. 10.1249/01.mss.0000536644.03929.cd. Rubin, TG, Catenaccio, E, Fleysher, R, Hunter, LE, Lubin, N, Stewart, WF, Kim, M, Lipton, RB, Lipton, ML. MRI-defined white matter microstructural alteration associated with soccer heading is more extensive in women than men. Radiology 2018 289:2, 478-486. Streifer, M, Brown, AM, Porfido, T, Anderson, EZ, Buckman, J, Esopenko, C. The potential role of the cervical spine in sports-related concussion: clinical perspectives and considerations for risk reduction. J Orthop Sports Phys Ther. 2019 Jan 15:1-22. doi: 10.2519/jospt.2019.8582. Schneider, KJ, Meeuwisse, WH, Nettel-Aguirre, A, Barlow, K, Boyd, L, Kang, J, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. (2014) 48:1294–8. 10.1136/bjsports-2013-093267. Ries E. (2017 March). Beyond rest: physical therapists and concussion management. PT in Motion, 18-27.

Elevate’s *MINUTE FIT* Fall Challenge!

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How much can you handle in 60 seconds?! Our *MINUTE FIT* Challenge for Fall is all about pushing yourself to the limit in 12 different intervals💪🏻 With a little recovery time between each one, we’re sure you’ll be able to surprise yourself with what you’re capable of! Here’s a sneak peek of what to expect – which one would you try first?!

Pain: Part 1 – What is Pain?

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As physical therapists the main complaint we deal with daily is pain. It may be as straightforward as a patient reporting isolated ankle pain due to an ankle sprain 3 days ago sustained playing soccer or as complicated as a patient reporting widespread pain throughout their body for over 10 years that has progressively worsened over time. Interestingly, even though almost everyone will deal with some sort of pain condition in their lifetime, our collective understanding of pain seems to be hugely lacking…For instance, if I were to ask you “what is pain?” do you think you would be able to answer? My guess is probably not, and the reason why is that pain is surprisingly and wonderfully complex! As a result, it can be very difficult to understand and manage. So…the question is, what exactly is pain? Well, pain is an amazing gift that helps us protect ourselves by alerting us to real or potential dangers. The intention is that by alerting us to these real or potential dangers we will make a change to address the danger, and the best way that our body can alert us to these dangers is through the unpleasant experience known as pain! Just think about it, if you were walking and had a nail go through your shoe and stick into your foot it would be important to feel pain to get the nail out of your foot. The unpleasant sensation of pain that occurs is a fantastic signal to get us to do something about the nail! On the other hand, if you were unaware of the nail in your foot, or if the sensation was not an unpleasant one, you would be far less likely to address the problem and it could cause more tissue injury if left unattended to. This example perfectly highlights the purpose of pain! Pain is your body’s attempt to tell you “protect yourself” or “change something”. Unfortunately, we often misunderstand the intention of pain! We view it as the villain because of the unpleasant experience that is associated with it. However, if we can instead view pain is a helpful warning sign or signal for change, it can help us better understand that we should not necessarily fear pain. Instead, when we feel pain, it means we should investigate why it is occurring. We must ask, “why does my body feel it needs protecting?” and address the real or potential dangers to make the body feel protected! However, the complex part is that there are so many factors that feed into your body’s decision that you need protecting that the driver behind the resulting pain experience can be a very difficult thing to understand. These factors can include actual tissue injury and include life stressors, previous experiences with pain and injury, other underlying health conditions, and more. It is our hope that through this series on pain we can better inform you about pain so that you can understand what it means and what you can do about it.

Elevate’s Side Plank Progression: Beginner to Advanced

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  Now that you have a good understanding of the Forward or Prone Plank from our post on Monday, next try this Side Plank Series Beginner to Advanced! Side Plank will strengthen numerous important muscles of the core including the back muscles called the multifidus and quadratus lumborum, the obliques, as well as the side hip muscles including the gluteus medius (and let’s not forget the shoulder stabilizers and neck muscles as an added bonus too!). With Forward and Side Plank you’re well on your way to developing a strong healthy core! If you can do the last one in this series, you’re a STAR. 🌟 . A ripped core is cool, but how well you can use that musculature for movement and stability of the spine, pelvis and hips during life when applying or absorbing external forces is key! Having a strong core is extremely important for EVERYONE from the average person to the professional athlete. To safely and easily manage the loads in your life, whether they be lifting/carrying kids, groceries or trash; tolerating a hit or cutting and changing direction on the soccer pitch; or jumping and landing in volleyball or basketball, a strong core is a good place to start. Try this Side Plank Series to help you expand your toolbox and get stronger! 1️⃣Side Plank on Hands & Knees 2️⃣Side Plank on Elbow & Knees 3️⃣Side Plank on Elbow with Knee Down & Starfish 4️⃣Side Plank on Elbow & Feet Staggered 5️⃣Side Plank on Elbow & Feet Stacked 6️⃣Side Plank on Elbow Starfish. IMPORTANT FORM TIPS: ▶️Maintain a neutral spine all the way from your neck to the hips ▶️ Brace abdominals and avoid sagging at waist ▶️Push down through the floor with your hand/elbow to avoid sagging in shoulder blade ▶️Use a mirror to check yourself! Give these variations a try during your warmup, inside of a circuit, or as an accessory during your next abdominal training day. Need help? Email us! Concierge@elevateptfit.com

Elevate’s Prone Plank Progression: Beginner to Advanced

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Continuing with our core strength development series, this week we’ll focus on a great trunk stabilization exercise, The Plank. Here’s a prone plank progression, beginner to advanced. Try them all! Our ability to create stability around the pelvis and lower back is an important factor when trying to limit our potential for injury. For example, have you ever picked up a heavy box, package, or toddler and had to carry it from one place to another? Your ability to stabilize the spine and hips often determines how easy or hard that is for you because that external load is either pulling your torso forward or laterally. Pushing a couch from one place to another, or pulling a refrigerator away from its space requires a good amount of core stability to be done safely and easily. When it comes to playing sports, battling an opposing player for position to grab a rebound in basketball will require the athlete to both take a hit and give it back, and control the trunk when landing, cutting and changing direction in order to avoid injury. Planks can help improve core stability and control while absorbing and applying force to make those daily activities easier, reduce risk for injury during those activities as well as during sports, AND improve performance. So let’s do it! Here is a nice progression of prone plank from beginner to advanced. 1️⃣Plank on hands & knees 2️⃣Full plank on hands 3️⃣Forearm plank 4️⃣Plank walk-ups 5️⃣Plank reaches 6️⃣Plank with hip extensions 7️⃣Plank reaches with hip extensions. . IMPORTANT FORM TIPS: Maintain a neutral spine all the way from your neck to the hips. Brace your abdominals and avoid sagging in your low back. Push down into the floor through your hands/elbows to avoid sagging at the mid back/shoulder blades. Avoid lifting hips in the air. Use a mirror to check yourself! Give these variations a try during your warmup, inside of a circuit, or as an accessory during your next abdominal training day. Need help? Email us! Concierge@elevateptfit.com