Simple Core Strengthening Exercises - Part 2: Front and Side Planks.

Last post we talked about the deadbug exercise and how important it is to be able to resist lumbar extension when needed to create a stable and healthy core structure.

Today we follow up on that same concept, but this time using a two very important core exercises: the Front Plank and the Side Plank.

1. Anti Extension Core Exercises

A. Standard Front Plank

Setup

Begin lying on your front, propped up on your elbows.

Movement.

Engage your abdominal muscles and lift your hips and legs up into a plank position, keeping your elbows directly under your shoulders. Hold this position.

Tip

Make sure to keep your back straight and maintain a gentle chin tuck during the exercise.

B. Plank with Hip Extension

In this variation we ask the spine to resist extension and rotation at the same time and it’s a great exercise to start challenging even more the core stability.

Setup

Begin on all fours.

Movement.

Move your body forward into a plank position, with your elbows on the ground. Maintaining this position, lift one foot straight backward off the floor ( just a bit !!!, you don’t need to lift high) , then lower it back down and repeat with your other foot.

Tip

Make sure to keep your back straight and core engaged. Do not let your hips rotate to either side as you lift your legs.

2. Anti Lateral Flexion Core Exercises

A. Side Plank on Knees

Now we place emphasis on the side pillars of the core musculature. Again, it is very important to feel stable in all planes and the side plank series will help you get stronger resisting Lateral flexion.

Setup

Begin lying on your side with your knees bent, propped up on your forearm. Your elbow should be directly under your shoulder.

Movement.

Engage your abdominal muscles and raise your hips up into a side plank position, keeping your knees on the ground. Hold this position, then return to the starting position and repeat.

Tip

Make sure to keep your core engaged during the exercise. Do not hold your breath or let your hips roll forward, backward, or drop towards the floor.

B. Modified Side Plank with Hip Abduction

Today we show you another good entry level exercise for this Side Plank Series.

In this variation there is more challenge to the side chain of muscles because of the added length in the movement.

Setup

Begin lying on your side, resting on your forearm with your bottom leg bent at a 90 degree angle and your top leg straight.

Movement

Tighten your abdominals and lift your hips up off of the floor. Then raise your heel so it is at the same level as your hip. Hold briefly, then relax and repeat.

Tip

Make sure that your head, hips, and leg are in a straight line and your shoulder is directly over your elbow. Do not let your hips roll backward or forward during the exercise.

C. Standard Side Plank

Setup

Begin lying on your side with your feet stacked, resting on your elbow.

Movement.

Lift your hips off the floor so your body is in a straight line and your hips and shoulders are facing forward. Hold this position.

Tip

Make sure to keep your head in line with your trunk, do not let your hips drop toward the floor, and do not roll forward or backward during the exercise.

D. Side Plank with hip Abduction

Side Plank with Hip Abduction one by one.

Side Plank with Hip Abduction continuous.

One of the most challenging exercises is the Side Plank on Elbow with Hip Abduction.

It looks easy but most of my clients with back or lower extremities issues cannot do this variation of the side plank. In my experience, I noticed that people that cannot do 10 repetitions in a row of this exercise without losing form will experience some type of pain or dysfunction while practicing sports.

Setup

Begin lying on your side with your feet stacked, resting on your elbow. Lift your hips off the floor into a side plank position.

Movement.

Hold this position and lift your upper leg, then lower it back down and repeat.

Tip

Make sure not to let your hips drop toward the floor, or roll forward or backward during the exercise.

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries.

With more than 20 years of experience helping athletes return to their sports after an injury.

He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#westonlowbackpain #backpain  #core #coremuscles #PulledMuscle #Soccerinjuries #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy

Simple Core Strengthening Exercises - Part 1

Many people still don't understand or know what the core is and the importance of the core for Sports like soccer.

Anatomy of the Core Muscles ?

The major muscles of the core reside in the area of the belly and the mid and lower back.

Major muscles included are the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae  and the diaphragm.

The lumbar muscles, quadratus Lumborum, Spinal erectors.

Minor core muscles include the latissimus dorsi, gluteus maximus, adductors and trapezius.

Anatomically it can be divided in two big groups:

The Deep Core Muscles :

Diaphragm, Transverse Abdominis, Pelvic Floor Muscles and Multifidus. These deep muscles wrap around the spine and act as a brace of belt around it.

The Superficial Core Muscles:

Rectus abdominis, internal and external obliques, erector spinae  and the minor core muscles like glutes, Lats, Trapezius. The superficial group assist with spine stability ( avoid excessive motion ) and initiate any movement in the arms or legs.

The core is where your Power, your Strength, your Endurance and your balance originates.

The core allows you to Throw, Kick, jump, walk and all these activities while breathing.

It is very important to understand how the Core and the spine work to be able to deal with pain and back problems choosing better motions , postures and properly loading the spine to avoid damage of the joints ligaments or the discs of the spine.

Function of the Core Muscles

The core  muscles act to stabilize your spine providing a firm support to the spine for all the activities we do.

The core muscles are arranged around the spine and the main function is to STOP spinal movement ( movement in between the vertebraes).

The core muscles are set up in layers forming a “brace “ for the protection  of the spine and to create enough force and stiffness to bear loads , control movements , facilitate breathing and functional movements like squat lift pull push carry .

Your core muscles have to work together in symmetry in order to avoid abnormal movement. Muscle imbalance means that there is not a good equilibrium between muscles that are too tight or loose versus muscles that are weak or strong.  A typical example of this imbalance is when  in the pelvic area hip flexors and lumbar paraspinals are very tight and the gluteal/core muscles are very weak. This combination could result in an anterior pelvic tilt which can cause lower back pain as well as knee and hip problems.

The core is traditionally assumed to originate most full-body functional movement, including most sports.

Core Weakness and Injury

Functional movements are highly dependent on this part of the body, and lack of core muscular development can result in a predisposition to injury.

We must look at core strength as the ability to control the force we produce.

It is important to first achieve core stability to protect the spine and surrounding musculature from injury in static and dynamic movements. Second, we want to effectively and efficiently transfer and produce force during dynamic movements while maintaining core stability.

When the core muscles are inefficient they allow “excessive “ movement in the spine which will cause some type of damage in the lumbar area or down in the kinetic chain: hips, thighs, knees, lower leg, ankle or foot

Core weakness has been associated with every single injury in the back and lower extremity:

ACL tears, Low Back Pain, Groin Pain, ITB syndrome, Patello-Femoral Pain, Ankle sprains, Pulled Hamstrings.

To recover from this condition a good starting point is to train the core properly to set up a good stable base for safe limb movement.

Essential Core Exercises ❗️❗️❗️❗️

There are 3 primary categories of core training ( see picture above) :

1. Anti extension.

Exercises that challenge the core to resist extension of the spine. Example: Deadbugs.

2. Anti Lateral Flexion.

Exercises that challenge the core to resist the spine side bending. Example: Side Plank.

3. Anti rotation.

Exercises that challenge the core to resist rotation of the spine. Example: Palloff Press.

Training your core in a functional way will protect your spine and maximize your strength and performance

1. Anti Extension Core Exercises

A. Deadbugs Level 1 and 2

The dead bug exercise is a popular way to build core strength and stabilization.

It helps build a solid, stable foundation that protects the spine and allows for greater ease in everyday and athletic movements, such as moving heavy objects, walking up hills, and throwing.

In this exercise we challenge the body to resist extension of the spine.

The main goal is to keep the spine stable on the ground while you move your legs and arms.

Setup.

Begin lying on your back with your knees bent and feet flat on the floor.

Movement

Tighten your abdominals, lift both legs to a 90 degree angle. Keep your arms up and Slowly straighten one leg at down.

Return to the starting position and repeat with your other leg.

Tip

Make sure to keep your abdominals tight and back flat on the floor during the exercise.

B. Deadbugs Level 3 and 4.

Level 1 and 2 were just preparations to be able to perform this exercises properly therefore Level 3 is the real deadbug exercise.

Setup

Begin lying on your back with your knees bent and feet flat on the floor.

Movement.

Tighten your abdominals, lift both legs to a 90 degree angle and your arms up toward the ceiling. Slowly lower one arm overhead and you straighten your opposite leg at the same time. Return to the starting position and repeat with your other arm and leg.

Tip

Make sure to keep your abdominals tight and back flat on the floor during the exercise.

Level 4 is a simple version of a resisted deadbug to challenge even more your core exercises.

In the coming weeks I will continue showing you the other essential core exercises... stay tuned for Part 2.

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries.

With more than 20 years of experience helping athletes return to their sports after an injury.

He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#westonlowbackpain #backpain  #core #coremuscles #PulledMuscle #Soccerinjuries #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy

Illiotibial Band Syndrome (ITBS) in Soccer Players

Introduction

Iliotibial Band Syndrome is the common term used to describe any one of several conditions that cause pain around the kneecap, also known as the patella.

The two most common conditions include

• anterior knee pain syndrome also known as Patellofemoral Pain Syndrome (PFPS), patellofemoral malalignment, chondromalcia Patella ( see our Blog post on this topic )

• Iliotibial Band Syndrome ( ITBS)

In this blog we will focus on explaining causes and treatments for ITBS

Incidence

Iliotibial band syndrome (ITBS) is one of the most common causes of lateral knee pain, particularly in individuals involved in sports like soccer. It accounts for up to 5-12% of soccer injuries. ITBS is typically managed conservatively through physical therapy and temporary activity modification.

What is Iliotibial Band Syndrome (ITBS)?

Iliotibial band syndrome (ITBS) occurs when excessive irritation causes pain at the outside (or lateral) part of the knee.

The iliotibial band (ITB), often referred to as the "IT band" is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee.

As it approaches the knee, its shape thickens as it crosses a prominent area of the thigh (femur) bone, called the lateral femoral condyle.

Near the pelvis, it attaches to 2 important hip muscles, the tensor fascia latae (TFL) and the gluteus maximus.

Irritation and inflammation arise from friction between the ITB and underlying structures when an individual moves through repetitive straightening (extension) and bending (flexion) of the knee.

Typically, ITBS pain occurs with overuse during activities such as running, sprinting and change of direction.

ITBS involves many lower extremity structures, including muscles, bones, and other soft tissues. Usually discomfort arises from:

• Abnormal contact between the ITB and thigh (femur) bone

• Poor alignment and/or muscular control of the lower body

• Prolonged pinching (compression) or rubbing (shearing) forces during repetitive activities.

The common structures involved in ITBS are:

• Iliotibial band

• Bursa (fluid-filled sack that sits between bones and soft tissues to limit friction)

• Hip muscles

ITBS can occur in:

• Athletes performing repetitive activities, such as squatting, and endurance sports such as running and cycling

• Individuals who spend long periods of time in prolonged positions, such as sitting or standing for a long workday, climbing or squatting, or kneeling

• Individuals who quickly start a new exercise regimen without proper warm-up or preparation

Signs and Symptoms

With ITBS, you may experience:

• Stabbing or stinging pain along the outside of the knee

• A feeling of the ITB “snapping” over the knee as it bends and straightens

• Swelling near the outside of your knee

• Occasionally, tightness and pain at the outside of the hip

• Continuous pain following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position

• Pain is usually most intense when the knee is in a slightly bent position, either right before or right after the foot strikes the ground. This is the point where the ITB rubs the most over the femur.

How Is It Diagnosed?

Your physical therapist will ask you questions about your medical history and activity regimen. A physical examination will be performed so that your physical therapist can collect movement (range of motion), strength, and flexibility measurements at the hip, knee, and ankle.

When dealing with ITBS, it is also common for a physical therapist to use special tests and complete a movement analysis, which will provide information on the way that you move and how it might contribute to your injury. This could include assessment of walking/running mechanics, foot structure, and balance. Your therapist may have you repeat the activity that causes your pain to see firsthand how your body moves when you feel pain. If you are an athlete, your therapist might also ask you about your chosen sport, shoes, training routes, and exercise routine.

Typically, medical imaging tests, such as x-ray and MRI, are not needed to diagnosis ITBS.

There are many potential factors. (see picture below)

Dynamic Valgus Alignment and Iliotibial Band Syndrome

Dynamic Valgus happens during normal single leg activities. With poor mechanical control of the Pelvis and Lower Extremity the knee will go into an Excessive Dynamic Valgus . In this case the Patella and the lateral aspect of the Knee Joint (condyle) will come under excessive stress. All these deviations are even more noticeable when striking on the foot during running.

Excessive Dynamic Valgus components:

• Pelvis Drop

• Femur rotates internally

• Tibia also rotates internally

• Foot collapses inwards (excessive pronation)

Physical Therapy Treatment

ITB pain rehabilitation is divided into two main phases

1. Pain Dominant Phase

2. Load Dominant phase

Overall, these phases aim to maximize loading the ITB while keeping lateral knee irritation capped at a minimum ( in a scale of 1 to 10 lets say below 5 ) either during the session or upon waking the next morning after the exercises.

1 - Pain Dominant Phase

The goal of this phase is to reduce abusive loads and irritation of the ITB while maintaining loading as tolerated. So avoiding the ITB impingement zone (~30 deg knee flexion) .

Exercises for this stage are

• ITB mobility drill

• Single Leg Bridge

• Hip Abduction with Band

• Side Plank on Knee

• Side Plank on foot

ITB mobility dril

In this exercises the Thomas test position is used as a low-load ITB excursion exercise.

This is a mobility drill with the intention of starting loading the Band and at the same time increasing the extensibility of the quadriceps , hip flexor and IT band .

Recommended doing 2-3 sets of 10 repetitions .

Be sure you keep the other leg against your chest all the time to lock the lumbar spine and be able to create tension without rocking your back or pelvis.

Single Leg Bridge

In this exercise the goal is to target the hip extensor musculature: glutes and hamstrings .

Recommended doing 2-3 sets of 5-8-10 repetitions .

Push on the ground and be sure you reach full hip extension during the bridge for necessary glute activation .

Hip Abduction with Band

The hip abductors play a crucial role in improving ITB pain, the more strength and endurance you develop in this exercise the less you’ll load the band .

I like doing this variation where the top leg is slightly and internally rotated behind the down leg to target the glute mid and decrease the activation of the hip flexors and ITB by avoiding going into hip flexion which is a common compensation during this exercise.

Recommended doing 2-3 sets of 5-8-10 repetitions . Burning at the side is a common feeling and it’s encouraged .

Side Plank on Knee / Side Plank on foot

As a follow up from our previous exercise, The Side Plank is my favorite exercise and one that needs to be mastered if you want to get rid of ITB pain .

Two variations : on knee , simplest one and on foot to increase the lever of the movement and load to the lateral chain .

Recommended doing 2-3 sets of 5-8-10 repetitions . Burning at the side is a common feeling and it’s encouraged .

Phase 2 - Load Dominant phase

Split Squat Progression

The split squat progression is a great exercise to progressively load the ITB at different angles from the easiest one in the lower position to top position and full tension in the ITB.

This exercise loads the relevant musculature and ITB with heavy, slow resistance training.

Be aware that the injured leg is the right one aka as trailing leg . Shift as much body weight as possible through the right foot and leg .

Level 1 - 2 - 3 are identical in how you perform it with the only difference being the Hip Extension and Knee Flexion angle which starts low and progresses to full hip extension and knee flexion combined in level 3 .

Do 6-second repetitions. 3 seconds way down and then 3 seconds up .

Level 1 and 2

Level 3

Overuse: Too much load , too Fast as the cause of ITBS

Overuse, in this case means an overload to the ITB.

Think about building friction or pressure over time: more training ( rapid increase in practices and games), more intensity of the training (hill workouts , repetitive jumps) ...

Returning to playe after a long period of inactivity ...

Too much Load, applied too fast...

In these situations, the Iliotibial band will became irritated first and more painful over time.

Athletes will continue training at the beginning because pain usually goes away with warm up.

As the condition progresses and the root of the problem is not solved , pain will continue increasing in intensity and it will not disappear with warm up, continuing getting worse till one day the athlete can not compete anymore .

So we as therapist will look for recent alterations in sporting activities. Any changes in the frequency, duration and intensity of training should be investigated in detail.

The training program also should be appraised for errors, including increasing exercise intensity too rapidly, inadequate recovery time and extreme hill workouts.

Treatment

Educate the soccer player in the importance of loading the joint progressively. For example, return to play in small amounts and with proper rest time in between practices or games. Increase load very slowly and paying a lot of attention to the Pain during these practices and the pain afterwards to decide when to load the joint again.

Increased tightness and pain in ITB

The ITB is a very thick tissue with almost no ability to stretch so trying to stretch the Iliotbial band is a waste of time.

Treatment

With this in mind, We at White Bay Physical Therapy , use a combination of techniques ( cupping and Instrument Assisted Soft Tissue Mobilization) to modulate and decrease pain in this area, not with the purpose of stretching anything but with the idea of modulating the pain and increasing the tolerance to the activity. By moving the area properly the pain will get better soon.

Foam Rolling: it may help a little bit as well in terms of modulating the pain but be sure your roll it on the side of the thigh from the middle up, Do not foam roll the painful area by the knee, this will only increase the irritation on the band.

Conclusion:

• Iliotibial Band syndrome is a complex condition.

• Solving this condition requires a comprehensive approach to correct all deficits that can be causing the lateral knee pain .

• Research shows that a combination of Hip and Knee Strengthening exercises is the best approach to ITBS

• Taping and Orthotics are secondary tools that can be using in the treatment of ITBS

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receiving information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#whitebayphysicaltherapy #kneepain #ITBS #Iliotibialbandsyndrome #patellofemoralpain #PulledMuscle #Soccerinjuries #Soccercalfinjury #westonsoccer #westonkneepain #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston