The Hip Hinge

The hip hinge is a biomechanically efficient way of lifting or picking things up from the floor, particularly when those items are heavy. The movement pattern involves bending forward at the trunk while pivoting at the hips, all while keeping the spine neutral. Practicing the hip hinge reduces the load at the neck, back and shoulders, primarily employing the posterior chain, which is composed of the gluteus maximus, back (erector spinae muscles) and hamstrings to bring about the movement. Therefore, performing a hip hinge on a regular basis will strengthen these muscles, allowing one to lift heavier weights over time. The hip hinge is a foundational movement pattern for many functional exercises, such as deadlift, kettlebell swing, power clean.

Technique - With your feet approximately shoulder width apart, bend/hinge forward at the trunk (from the hip joints) while pushing your hips backward. The knees can remain soft during the movement, letting the length of the hamstrings take control of their position. While reversing the movement, contract your gluteals to bring yourself back to an upright position. Here are some additional helpful tips to keep in mind:

1. Keep the weight/load being lifted as close to the body as possible.

2. Avoid rounding or excessively extending the back. 

3. If needed, bend your knees a bit more to lift the weight from the lowest position. However, one must remember that this is not a squat so avoid excessively lowering the hips during the movement.

4. Engage the core and keep the pelvis in a neutral position. 

As demonstrated in the video above, using a dowel / stick can be a helpful tool when practicing the hip hinge. Align it over the back so that it is touching the back of the head, upper back and the sacrum (tailbone). Hold it with either one or two hands (one at each end if using both), while making sure the contact between the stick and the three points is maintained throughout the movement. Once you are able to perform the movement with the dowel, try lifting a kettlebell or any weighted object accessible to you, using the same technique. 

Performing the perfect hip hinge is a skill and may take several attempts to learn the correct technique so stick with it. If you need any help, please contact us through our “Ask A PT” feature on our website.

Good luck!

-Ishi Upasani, PT, MS

Five Basic Principles of STOTT Pilates

The five basic principles developed by STOTT Pilates are breathing, pelvic placement, rib cage placement, scapular (shoulder blade) movement and stabilization and head and cervical (neck) placement.  They work together to create Intelligent Exercise that is both safe and effective for injury prevention and recovery from injury.

1.  Breathing:

The STOTT Pilates breath pattern expands the ribcage out to the sides, without allowing the shoulders to lift.  It allows for breath into the lower part of your lunges, resulting in more efficient gas exchange.  Inhale is achieved through the nose filling the belly, and exhale through pursed lips as if blowing out a candle.  Breathing can also facilitate movement, where an inhale can facilitate an extended or straightened position and an exhale can facilitate a flexed or curled position.

2. Pelvic Placement:

STOTT Pilates emphasizes stabilization of the pelvis and lumbar spine in either a neutral or imprinted position.  Neutral maintains the normal curve of the lower back and the surface you are laying on.  This position provides relaxation for the muscles.  In the imprinted position the lower back is moving towards the mat and the natural space between your back and the surface is slightly flattened.  This position is often used for “safety” for people with special conditions such as excessive lordosis or spinal stenosis.  

3. Rib Cage Placement:

The rib cage position affects the alignment of the upper spine.  It is the rotational center of your spine.  When lying on your back in a neutral position the rib cage should have a sense of weight gently resting on the mat.  You do not want to push your rib cage up towards the ceiling or down into the mat.  It should rest centered and balanced over your neutral pelvis.  Pay particular attention to the placement of your rib cage when inhaling or while performing arm movements as it will often flare out of position.  

4. Scapular Movement and Stabilization:

Stabilization of your scapulae (shoulder blades) on the back of the rib cage is as important as contracting your abdominals during initiation of exercise.  This will help you avoid straining through your neck and upper upper shoulders.  You want to make sure you do not round your shoulders forward or squeeze them together towards the spine.  Shoulders should not be lifted too far up towards the ears, or over-depressed down away from the ears.  They should feel relaxed and tension-free in optimal placement  

5. Head and Cervical Placement:

The cervical spine (neck) should hold its natural curve with your head balanced directly above your shoulders when lying, sitting and standing.  In some cases a small pillow may be needed under the head or neck to find the neutral position.  If any other part of your spine is off, your head will respond to correct your gaze forward, throwing the rest of the body out of alignment.  

These five principles of alignment can help you in a lying, sitting or standing position.  Re-center yourself whenever possible to bring the forces of gravity acting on your body to a minimum to allow pain and pressure relief for your spine and extremities.  A STOTT Pilates trained therapist or instructor can help you find and master these five principles to get you on the road to recovery.

-Katie Chen, DPT, OCS, COMT

What Is Pilates?

Pilates is a low impact form of exercise that focuses on engaging your core to improve postural alignment, strength, flexibility and mind-body movement awareness.  

Pilates was created by a man named Joseph Pilates who was born in Germany in 1883.  Joseph studied yoga, meditation, circus arts, boxing and gymnastics and enjoyed a healthy active lifestyle.  He moved to England before the start of World War 1, but was interned with other German citizens when war broke out.  During his internment he worked with soldiers and detainees in the hospitals.  He began to notice a trend that soldiers who exercised, even if in bed, did not get influenza as often.  This bias began to set up the idea for Pilates, and he began attaching springs to patients beds to provide resistance training to exercise them.    

After the war he returned to Germany, and eventually emigrated to the United States and set up Joe’s Place, a gym, in New York.  He continued to refine his idea of Pilates and began teaching others his new concept.  Thus the Reformer (picture 1) and Cadillac (picture 2)  were born, based off a concept of a bed you could exercise on.

Reformer

Cadillac

Classical Pilates follows a rigid flow based on the growth and development of babies.  Movements begin with flexion based posture, then move to extension based posture and then add combinations of the two postures.  Joseph Pilates trainees began to refine that rigid structure and branch out to provide movements that better fit the clientele they were working with.  Pilates continues to evolve to this day.     

Who is Pilates good for?

Pilates is good for anyone looking to improve their breathing, trunk control, core activation, posture, body awareness and the knowledge of how to move within their own body.  It can be good for healthy persons, persons looking for injury prevention, persons looking to recover from injury and persons looking for continued strength to reduce the instance of re-injury.

-Katie Chen, DPT, OCS, COMT

The Role of "Clustering" in Running-Related Injuries

If you are like most people, you do the majority of your long runs on the weekend. The typical 9:00-5:00 work day leaves little time to squeeze in anything over a 5 mile run during the week, especially this time of year, when the days are getting shorter. The result is often a behavioral phenomenon called clustering, which refers to performing a large portion of our physical activity (in this case, running) in a short period of time. Think of the runner training for a marathon, getting out for 5 mile runs 3 days per week due to time constraints, before performing a 20 mile training run on the weekend. The long run for this individual would be over 50% of the weekly training mileage, which puts them at an increased risk of injury. When considering how to organize or arrange our training mileage for a given week, we want to consider the 70/30 rule, which states that our long run each week should not exceed more than 30% of our total weekly training mileage, while the mileage from the rest of our training runs should add up to at least 70% of our total weekly training mileage. Following the 70/30 rule helps to promote consistency, creating a better environment for your tissues to adapt gradually over time. Following this rule also helps to promote specificity in training, as we need to consistently run long distances in order to run long distances well. In other words, running 5 miles is not the best way to help you run 26.2 miles well. Rather, running distances as close to 26.2 miles consistently will preferentially help you run 26.2 miles well. While training speed does not apply to the 70/30 rule, specificity applies to speed as well: training fast is the best way to help you run fast (i.e. training slow does not help you run fast).

Now there are a lot of other rules out there we are instructed to follow when training: the 10% rule (do not increase your weekly training mileage by more than 10% per week), the 40 mile rule (training beyond 40 miles per week increases your risk of injury), the 6 days per week rule (running 6 or more days per week increases your risk of injury, the 13 mile rule (running 13 miles or more for your long run more than once over a 2 week period of time increases your risk of injury). Finding a training program that adheres to all of these rules can be rather difficult so it is important to note that these are simply rules designed to help reduce our risk of injury and breaking them does not guarantee that we will get injured. The key is to follow the rules that seem to have the greatest impact on how we run. For example, if you consistently notice running over 40 miles per week tends to result in your knee hurting, but you can run every single day of the week without issue, the 40 mile rule may be important to adhere to, while the 6 days per week rule might be one you can ignore. Consistency seems to be one of the more important aspects of training though, which is why the 70/30 rule and the concept of clustering are so relevant. Big outliers in our training tend to result in tissue irritation or injury. A consistent training program, with slow and methodical increases built in will help you progress at the safest and fastest rate possible because this allows you to minimize your risk of injury. Getting injured is a sure way to slow down your training program, which will ultimately slow down your progress. In other words, you need to progress slowly in order to progress as quickly as possible.

Train smart!

-Grant Hennington, DPT

Foam Rolling Vs. Stretching

Foam rolling and stretching both have their loyal set of followers and there often is a question about which technique is better. We will be answering that question in this blog post, as well as going through the effects and indications of both.

Foam rolling and stretching somewhat overlap each other with respect to their benefits. Both techniques facilitate relaxation and increases in the ROM of the muscles.

Foam rolling improves blood flow (to the region being foam rolled), increases range of motion and decreases muscle soreness without affecting the performance of that muscle group [2]. Interestingly enough, foam rolling can be performed before and/or after a workout or really at any time of the day to be beneficial. More recently, it has become increasingly popular, with more people opting for it over stretching. It is, however, important to learn the correct foam rolling technique from the experts in the field. Here is a sample foam rolling routine for the lower body:

As you will see, it is recommended to roll each segment for 30-60 seconds, with a full routine typically taking between 5-10 minutes.

Stretching is indicated for improving soft tissue flexibility/extensibility, thereby increasing range of motion. This increased flexibility may reduce the risk of exercise-related injuries. 

There are primarily two types of stretching: dynamic and static. Dynamic stretching increases the heart rate and seeks to “warm up” stiff or tight muscles, making it ideal for a pre-workout routine. Here is a sample dynamic stretching routine recommend for runners:

Static stretching involves passively holding a position or stretch, typically for 30-60 seconds, which has shown to impede muscle performance (reduced power output) during the exercise when performed prior to a workout [1]. Therefore, static stretching is best suited for the post-workout period, as it may help gently “cool down” the muscles while still increasing overall range of motion in the long term. Static stretching can also aid in physical and mental relaxation. Here is a sample static stretching routine for the lower body:

Typically, both dynamic and static stretching routines should take no more than 5-10 minutes. It is important to note that all stretching should be gentle and relatively pain-free. Also, no breath holding while performing any of the routines shown above. Remember to breathe!

-Ishi Upasani, PT, MS

References -

1. Kay, A. D., & Blazevich, A. J. (2012). Effect of Acute Static Stretch on Maximal Muscle Performance. Medicine & Science in Sports & Exercise, 44(1), 154–164. doi: 10.1249/mss.0b013e318225cb27

2. Macdonald, G. Z., Penney, M. D., Mullaley, M. E., Cuconato, A. L., Drake, C. D., Behm, D. G., & Button, D. C. (2013). An Acute Bout of Self-Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force. Journal of Strength and Conditioning Research, 27(3), 812–821. doi: 10.1519/jsc.0b013e31825c2bc1